Respiratory

Introduction Serum procalcitonin levels increase in response to bacterial infections and decrease with successful treatment. Procalcitonin can, therefore, inform decisions around antibiotic use. For adults with suspected infection, using procalcitonin to start antimicrobials is not advocated but serial testing is suggested to aid with the decision to discontinue therapy. Methods A retrospective study was performed of adults over the age of 80 years admitted on a medical ward whom had a serum procalcitonin completed between November 2022 and April 2023. Their electronic patient records were reviewed, with data collated and analysed using Microsoft Excel. Results Of 160 patients studied, median age was 85 with a median clinical frailty score of 6. The suspected sources of infection for the patients were chest (65%), unknown source (22.5%), urine (5%), cellulitis (3%), biliary (1.3%), osteomyelitis (1.25%), abdomen (0.63%) and infected haematoma (0.63%). Confirmed viral respiratory infection was present in 76 (47.5%) patients. Of all patients, only 62% were taking antibiotics at the time the procalcitonin was taken. Only 4 patients (2.5%) had serial procalcitonin testing (24-48 hours apart). Conclusion Procalcitonin was more likely to be used for suspected respiratory tract infection than other suspected infections. The majority of patient were taking antibiotics at the time the test was performed, which would indicate the tests being used to support a diagnosis of bacterial infection. Only a minority of patients (2.5%) had more than one procalcitonin result indicating that the clinical utility of this blood test to aid decision making in altering antimicrobial therapy was not occurring. Therefore, procalcitonin testing within an older adult population is being used in an inappropriate manner in the context of infection. Given a cost of £39.50 per test we anticipate that in its current use procalcitonin testing is not being used in a cost effective or clinically effective manner.

Introduction:

It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. 

Material and Methods:

A pilot study was conducted from January 2020 - December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution and qualitative variables as percentages. Student's t-test was performed to evaluate differences between two variables. All statistical analyses were performed with (SPSS for Windows, v.22.1; Chicago, IL).

Results:

The present study showed that metabolic syndrome variables in these patients were elevated. Male sex was 77% and female 23%, smoking 61%. The GLOBORISK equation found mostly patients with low to moderate cardiovascular risk. It was found that there was a higher cardiovascular risk in those patients with FEV1 less than 30%, showing a statistical correlation of this alteration for the GLOBORISK scale.

Conclusions:

This is the first pilot study that estimates cardiovascular risk using GLOBORISK in the COPD population. We consider integrating national and international networks to compare the results found here.
 

Introduction Frailty is a clinical state that predisposes to patients to clinical deterioration in response to minor stressor events. Frailty tends to be more prevalent in patients with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD). Therefore, we aim to investigate the influence of clinical frailty on mortality in COPD patients. Methods Data collection from electronic records for patients seen in Ysbyty Ystrad Fawr, Neville Hall Hospital, Grange University Hospital or Royal Gwent Hospital between 5-17th June 2024 was completed as part of patient input to the National Respiratory Audit Programme, focussing on patients who were admitted with an acute COPD exacerbation. The data collected were clinical frailty as measured by the Clinical Frailty Scale (CFS), smoking status, and the life status of patients at the time of data collection. This data was then exported to an excel spreadsheet, anonymised and simplified for statistical analysis using chi squared tests. Results Of the total 209 patients, 84 were male and 125 were female; the mean age was 72. 113 patients were ex-smokers, 71 were current smokers, 7 had never smoked and 18 were not recorded. 97 patients had a CFS of 5 or above, 112 had a CFS of 4 or below. 48% of ex-smokers were frail whereas 40% of current smokers were frail (p=0.478). 161 patients were alive at the time of data collection. 29% of those classed as frail had died since their admission whereas 17.6% of those classed as not frail had died following their admission (p=0.030). Of those alive, 41.2% were still smokers on admission. Of those dead, only 25.6% were still smokers on admission (p=0.055). Conclusion COPD patients who are frail tend to have higher rates of mortality compared to those who are not. Future studies exploring the relationship between smoking and frailty are needed.

Introduction

Respiratory viral illnesses (RVI) pose a serious threat to LTC residents. Those with frailty often experience non-specific presentations causing delayed diagnosis and treatment of infection. To facilitate early RVI detection, a screening protocol was developed to evaluate changes in cognitive and functional status of LTC residents using

the Single Question in Delirium (SQiD) with new Single Question in Functioning (SQiF) and Single Question in Reduced Mobility (SQiRM). This study aims to address: (i) If  novel (SQiD/SQiF/SQiRM) screening was superior to public health in detecting COVID-19 in LTC, and; (ii) Did combining the novel and public health screening improve detection of COVID-19?

Methods

The novel screening protocol was integrated into daily screening for RVI at three LTC homes in Nova Scotia, Canada. Daily assessments were recorded in consenting residents. If any of the novel protocol was positive, the 4As Test (4AT) and Hierarchal Assessment of Balance and Mobility (HABAM) were evaluated and a positive 4AT and/or HABAM triggered an RVI swab for COVID-19. Area under the curve (AUC,) sensitivity and specificity analysis using PCR tests as the reference criterion was utilized.

Results

Between October 2021 to February 2024, 378 LTC residents consented to participate, resulting in 142 positive COVID-19 PCR tests. Preliminary results show public health screening had a sensitivity of 68.3%, specificity of 52.1% and AUC of 0.60. Novel protocol exhibited sensitivity of 12.0%, specificity of 85.2% and AUC of 0.49. Combining public health and novel screening yielded a sensitivity of 80.3%, specificity of 32.3% with a AUC of 0.59.

Conclusions

Preliminary results suggest that incorporating public health and novel protocol screening for daily RVI assessments in LTC is advantageous. Predictive accuracy is slightly less with combined  screening, but sensitivity of the combined screening protocols remains high.

Other information

Ethical approval obtained from Nova Scotia Health Research Ethics Board #1026558.

BACKGROUND

• RSV is one of the most common causes of seasonal respiratory infections worldwide, with a marked global burden in older adults and those with significant underlying medical conditions.1-5 It is increasingly clear that RSV infections in older adults in the United Kingdom significantly impact the already strained public health system, especially during the winter months.
• However, the true burden remains underestimated,6,7 as estimates in the UK are likely to be conservative due to the limitations in testing and diagnostic coding practices.

OBJECTIVES

• We conducted a TLR of existing literature to investigate the disease burden of RSV infection in older adults, aged 60 years and older in the UK, and to highlight potential evidence gaps. METHODS • We searched OVID MEDLINE, Embase, and EconLit to identify existing literature from January 2011 to August 2023, including an additional search for grey literature. Eligibility criteria were defined based on population (intervention/comparator [no limit]), outcomes (clinical, epidemiological, economic, and quality of life) and limited to UK-only results. See PRISMA flowchart for details.

RESULTS

• In the OVID search, we identified 1,001 records, and in the supplementary search, 12 records of possible interest were identified. All records were screened against the predefined eligibility criteria. Despite the relatively broad screening criteria, only 14 studies could be included.
• There were four model studies, five cohort studies, and five time series analyses included. Of these, nine studies reported on epidemiology, one study informed both on epidemiology and costs, and four studies reported on model outcomes. Nine studies reported unique data on the UK and five studies included data from several countries, including the UK.
  • All identified studies emphasised the challenges in estimating the true RSV burden in the UK due to limitations in testing and a lack of standardised disease definition in older adults. There is a lack of evidence for adult risk groups, particularly clinical and economic consequences in patients at a higher risk of RSV infection and severe sequelae.
  • Due to the overall small number of studies and the heterogeneity of study design and outcomes reported, it was not possible to establish reliable data on incidence, prevalence, and mortality in the UK.

• The results of the TLR suggest that RSV infection in older adults may place a high economic burden on the UK’s healthcare system.

CONCLUSIONS

• A limited number of studies meeting the criteria on RSV infection in older adults in the UK were found, with nearly no data on adult risk groups and related cost. The scarcity of data, lack of standardised disease definitions and surveillance methodologies likely lead to an underestimation of RSV disease burden in older adults in the UK.
• It is imperative that surveillance systems are improved to understand the true burden. Therefore, a deeper comprehension of the impact of RSV infection within this population would enhance the ability to demonstrate the cost-effectiveness of a national immunisation programme more reliably.
• This paucity of data creates great challenges for the Joint Committee on Vaccination and Immunisation, and UK policymakers to make informed decisions on the population benefit of RSV vaccination programmes for older adults.

ADDITIONAL INFORMATION

Copies of this presentation obtained through the QR code are for personal use only and may not be reproduced without permission of the authors.

REFERENCES

1. Nguyen-Van-Tam, J.S., et al., Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries. European Respiratory Review, 2022. 31(166): p. 220105.

2. Falsey, A.R., et al., Respiratory syncytial virus infection in elderly and high-risk adults. New England Journal of Medicine, 2005. 352(17): p. 1749-1759.

3. Falsey, A.R., et al., Respiratory syncytial virus–associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure. Journal of Medical Virology, 2019. 91(1): p. 65-71.

4. Global Burden of Disease 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infectious Diseases, 2018. 18(11): p. 1191-1210.

5. Savic, M., et al., Respiratory syncytial virus disease burden in adults aged 60 years and older in high‐income countries: a systematic literature review and meta‐analysis. Influenza and Other Respiratory Viruses, 2023. 17(1): p. e13031.

6. Korsten, K., et al., Burden of respiratory syncytial virus infection in community-dwelling older adults in Europe (RESCEU): an international prospective cohort study. European Respiratory Journal, 2021. 57(4): p. 2002688.

7. Sharp, A., et al., Estimating the burden of adult hospital admissions due to RSV and other respiratory pathogens in England. Influenza and Other Respiratory Viruses, 2022. 16(1): p. 125-131.

ACKNOWLEDGEMENTS

Writing and/or editorial assistance was provided by MEDiSTRAVA and was funded by Moderna, Inc. This study was funded by Moderna, Inc.

DISCLOSURES

ICON (MM, BB) was commissioned by Moderna, Inc., to conduct the TLR. SC, MD, OB and TA are employees of Moderna, Inc., and hold stock/stock options in the company.

Introduction:

The use of pneumonia scores to stratify the prognosis is very useful in general terms, since it allows objectively evaluating the risks in these patients. The main objective was to determine the usefulness of pulse oximetry as a substitute for urea of the CURB 65 score in the evaluation of the severity of comunity acquired pneumonia (CAP) in patients.

Methods:

open-label, mixed-type study, first cross-sectional phase Test vs. Test, second phase follow-up at 8 and 30 days. Carried out between November 2017 and April 2018.

Results:

5 patients, gender distribution was comparable, the main age group was made up of over 65 years. The frequency of comorbidities was greater than 90%, among which hypertension, diabetes and smoking stand out. The mean hospitalization time was 10 days. The variable that most defined the need for hospital admission was hypoxemia with a percentage of 72%, regardless of the score on the CURB 65 scale, it was shown that oxygen saturation <92% is associated with a high 30-day mortality rate ( 43.07%) n=28, (p 0), with a relative risk of at least 4 times more to die. When correlating the CURB 65 and CORB 65 scales with Spearman's Rho test, a correlation coefficient (0.898) was obtained.

Conclusions:

pulse oximetry proved to be a good substitute for urea in the CURB 65 score, useful for defining hospitalization, severity, and mortality in patients with CAP.