title: Host Factors and Biomarkers Associated with Poor Outcomes in Adults with Invasive Pneumococcal Disease.
abstract: BACKGROUND
  Invasive pneumococcal disease (IPD) causes considerable morbidity and mortality. We aimed to identify host factors and biomarkers associated with poor outcomes in adult patients with IPD in Japan, which has a rapidly-aging population.
  
  
  METHODS
  In a large-scale surveillance study of 506 Japanese adults with IPD, we investigated the role of host factors, disease severity, biomarkers based on clinical laboratory data, treatment regimens, and bacterial factors on 28-day mortality.
  
  
  RESULTS
  Overall mortality was 24.1%, and the mortality rate increased from 10.0% in patients aged ˂50 years to 33.1% in patients aged ≥80 years. Disease severity also increased 28-day mortality, from 12.5% among patients with bacteraemia without sepsis to 35.0% in patients with severe sepsis and 56.9% with septic shock. The death rate within 48 hours after admission was high at 54.9%. Risk factors for mortality identified by multivariate analysis were as follows: white blood cell (WBC) count <4000 cells/μL (odds ratio [OR], 6.9; 95% confidence interval [CI], 3.7-12.8, p < .001); age ≥80 years (OR, 6.5; 95% CI, 2.0-21.6, p = .002); serum creatinine ≥2.0 mg/dL (OR, 4.5; 95% CI, 2.5-8.1, p < .001); underlying liver disease (OR, 3.5; 95% CI, 1.6-7.8, p = .002); mechanical ventilation (OR, 3.0; 95% CI, 1.7-5.6, p < .001); and lactate dehydrogenase ≥300 IU/L (OR, 2.4; 95% CI, 1.4-4.0, p = .001). Pneumococcal serotype and drug resistance were not associated with poor outcomes.
  
  
  CONCLUSIONS
  Host factors, disease severity, and biomarkers, especially WBC counts and serum creatinine, were more important determinants of mortality than bacterial factors.
authors.affiliation: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan.|Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hanada
authors.affiliation: Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Morozumi
authors.affiliation: Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Chiba
authors.affiliation: Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Wajima
authors.affiliation: Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Misako
authors.initials: M
authors.lastname: Takata
authors.affiliation: Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kimiko
authors.initials: K
authors.lastname: Ubukata
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003401:Creatine / Q000097:blood; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D011379:Prognosis; D012121:Respiration, Artificial; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003401:Creatine
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