Identifying Prognostic Factors for Adverse Outcomes in Adults with Bacteremic Pneumococcal Pneumonia
Bibliographic record
Abstract
Bacteremic pneumococcal pneumonia (BPP) is a severe form of invasive pneumonia that continues to cause significant morbidity and mortality worldwide, yet large-scale studies identifying prognostic factors for adverse outcomes in patients with BPP is significantly lacking. Furthermore, considerable knowledge gaps and conflicting results exist for even widely known prognostic factors for mortality such as smoking. Therefore, the first objective of this program of research was to identify prognostic factors associated with mortality and in-hospital complications in adult patients with BPP. This objective was achieved using a population-based cohort study composed of 1636 adults (≥18 years) with BPP hospitalized between 2000-2010 in Northern Alberta, Canada. The results indicated that both acid-suppressing drugs and guideline discordant antibiotic treatments are potentially modifiable prognostic factors. Furthermore, frailty (i.e. elderly, nursing home residents, or dementia patients), pneumonia severity, and high case fatality rate (CFR) serotypes were associated with an increased risk of morbidity and mortality, while prior pneumococcal vaccination was associated with a reduced risk. Paradoxically, current smoking was associated with reduce mortality in patients with BPP. Building on this result, the second objective of this research program was to examine whether differential acquisition of pneumococcal serotypes in smokers could potentially explain the influence on mortality. The results indicated that current smokers were more likely to be infected with low CFR pneumococcal serotypes compared to non-smokers, which may fully, or partially, explain the reduced mortality previously reported in studies involving patients with CAP. Collectively this research suggests that several modifiable prognostic factors exist in patients with BPP. Moreover, additional follow-up in patients who are frail following BPP may also be warranted. As this research is the first to suggest that differential acquisition of low CFR serotypes may explain the reduced mortality in smokers with pneumonia, further research is needed to confirm these findings and determine the usefulness of providing CFR data rapidly at the point of care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".