{"id":6342,"date":"2026-10-19T09:48:47","date_gmt":"2026-10-19T09:48:47","guid":{"rendered":"https:\/\/phd.hi.is\/doktorsvorn\/doktorsvorn-i-laeknavisindum-kristjan-godsk-rognvaldsson\/"},"modified":"2026-10-19T09:48:47","modified_gmt":"2026-10-19T09:48:47","slug":"doktorsvorn-i-laeknavisindum-kristjan-godsk-rognvaldsson","status":"publish","type":"phd_defence","link":"https:\/\/phd.hi.is\/en\/doktorsvorn\/doktorsvorn-i-laeknavisindum-kristjan-godsk-rognvaldsson\/","title":{"rendered":"Doktorsv\u00f6rn \u00ed l\u00e6knav\u00edsindum – Kristj\u00e1n Godsk R\u00f6gnvaldsson"},"content":{"rendered":"
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F\u00f6studaginn 17. n\u00f3vember 2023 ver Kristj\u00e1n Godsk R\u00f6gnvaldsson doktorsritger\u00f0 s\u00edna \u00ed l\u00e6knav\u00edsindum vi\u00f0 L\u00e6knadeild H\u00e1sk\u00f3la \u00cdslands. Ritger\u00f0in ber heiti\u00f0 Samf\u00e9lagslungnab\u00f3lga me\u00f0al fullor\u00f0inna: Ranns\u00f3knir \u00e1 v\u00f6ldum \u00fe\u00e1ttum sem tengjast horfum og lifun. Community-Acquired Pneumonia among Adults: Studies on selected factors which associate with severe disease and risk of death.<\/p>\n

Andm\u00e6lendur eru dr. Jan Kristian Dam\u00e5s, pr\u00f3fessor vi\u00f0 NTNU \u00ed \u00der\u00e1ndheimi og St. Olavs h\u00e1sk\u00f3lasj\u00fakrah\u00fasi\u00f0, og dr. Pernille Ravn, yfirl\u00e6knir og kl\u00edn\u00edskur d\u00f3sent vi\u00f0 Herlev og Gentofte sj\u00fakrah\u00fasi\u00f0 og Kaupmannahafnarh\u00e1sk\u00f3la.<\/p>\n

Umsj\u00f3narkennari og lei\u00f0beinandi var Magn\u00fas Gottfre\u00f0sson, s\u00e9rfr\u00e6\u00f0il\u00e6knir og pr\u00f3fessor og me\u00f0lei\u00f0beinandi var Agnar Bjarnason, s\u00e9rfr\u00e6\u00f0il\u00e6knir og lektor. Auk \u00feeirra s\u00e1tu \u00ed doktorsnefnd A\u00f0alsteinn Gu\u00f0mundsson, s\u00e9rfr\u00e6\u00f0il\u00e6knir, Inga Sif \u00d3lafsd\u00f3ttir, s\u00e9rfr\u00e6\u00f0il\u00e6knir og lektor, og Kristj\u00e1n Orri Helgason, s\u00e9rfr\u00e6\u00f0il\u00e6knir.<\/p>\n

S\u00e6d\u00eds S\u00e6varsd\u00f3ttir, pr\u00f3fessor og varadeildarforseti L\u00e6knadeildar, stj\u00f3rnar ath\u00f6fninni sem fer fram \u00ed H\u00e1t\u00ed\u00f0arsal H\u00e1sk\u00f3la \u00cdslands og hefst kl. 09.00.<\/p>\n

\u00c1grip<\/strong><\/p>\n

Samf\u00e9lagslungnab\u00f3lga er alvarlegur og algengur sj\u00fakd\u00f3mur sem getur \u00fe\u00f3 veri\u00f0 erfitt a\u00f0 greina, s\u00e9rstaklega me\u00f0al aldra\u00f0ra. Skortur er \u00e1 ranns\u00f3knum sem bera saman \u00fe\u00e1 sem eru me\u00f0 einkenni lungnab\u00f3lgu en \u00e1n greinilegra \u00edfer\u00f0a \u00e1 lungnamynd vi\u00f0 hina, sem eru me\u00f0 sta\u00f0festa lungnab\u00f3lgu \u00e1 lungnamynd. Sumar fyrri ranns\u00f3knir hafa bent til \u00feess a\u00f0 gj\u00f6f aset\u00fdlsalic\u00fdls\u00fdru (ASA) tengist l\u00e6gri t\u00ed\u00f0ni dau\u00f0sfalla \u00ed kj\u00f6lfar lungnab\u00f3lgu en a\u00f0rar ekki. N\u00fdir meinvaldar lungnab\u00f3lgu geta skyndilega sprotti\u00f0 fram, eins og ger\u00f0ist \u00ed heimsfaraldri SARS-CoV-2, sem mikilv\u00e6gt er a\u00f0 rannsaka. Uppl\u00fdsingar skortir um tengsl k\u00e6fisvefns vi\u00f0 tilur\u00f0 alvarlegrar COVID-19 lungnab\u00f3lgu.<\/p>\n

\u00derj\u00fa a\u00f0skilin gagnas\u00f6fn voru notu\u00f0 \u00ed doktorsverkefninu. \u00cd fyrsta lagi var g\u00f6gnum safna\u00f0 framskyggnt um tilfelli sem l\u00f6g\u00f0ust inn me\u00f0 grun um lungnab\u00f3lgu \u00e1 t\u00edmabilinu 2018-2019 (grein 1). \u00cd \u00f6\u00f0ru lagi var notast vi\u00f0 afturskyggnt gagnasafn allra sta\u00f0festra \u00edfarandi pneum\u00f3kokkas\u00fdkinga 1975-2019 \u00e1 \u00cdslandi. \u00cd \u00feri\u00f0ja lagi var gagnasafn um \u00f6ll tilfelli me\u00f0 COVID-19 \u00e1 \u00cdslandi \u00e1ri\u00f0 2020 nota\u00f0. Gagnl\u00edkindahlutf\u00f6ll (GH) og h\u00e6ttuhlutf\u00f6ll (HH) voru reiknu\u00f0 me\u00f0 l\u00edkindaskorsvigtun og l\u00f3gist\u00edskri a\u00f0hvarfsgreiningu.<\/p>\n

Tilfelli me\u00f0 lungnab\u00f3lgu \u00e1samt \u00edfer\u00f0 \u00e1 lungnamynd voru l\u00edklegri til a\u00f0 m\u00e6last me\u00f0 h\u00e6kka\u00f0an l\u00edkamshita, h\u00e6rra CRP og a\u00f0 greinast me\u00f0 meinvaldinn S. pneumoniae. Lei\u00f0r\u00e9tt gagnl\u00edkindahlutfall dau\u00f0a \u00feeirra sem voru me\u00f0 einkenni lungnab\u00f3lgu \u00e1n greinanlegrar \u00edfer\u00f0ar mi\u00f0a\u00f0 vi\u00f0 \u00fe\u00e1 sem voru me\u00f0 \u00edfer\u00f0 innan 30 daga var 0,86 (95% \u00f6ryggisbil (\u00d6B) 0,40-1,85) en 1,25 (95% \u00d6B 0,81-1,95) vi\u00f0 1 \u00e1r. Eftir lei\u00f0r\u00e9ttingu h\u00f6f\u00f0u \u00feeir sj\u00faklingar sem fengu ASA betri lifun \u00e1 t\u00edmabilinu 0-7 d\u00f6gum eftir s\u00fdkingu (HH, 0,42, 95% \u00d6B 0,19-0,92), en ekki milli 7-30 daga eftir greiningu (HH 1,08, 95% \u00d6B 0,46-2,55). Me\u00f0al HH yfir eitt \u00e1r s\u00fdndi betri lifun \u00feeirra sem fengu ASA en \u00feeirra sem ekki voru \u00e1 lyfinu (0,48, 9% \u00d6B 0,31-0,75). COVID-19 tilfelli sem h\u00f6f\u00f0u k\u00e6fisvefn voru l\u00edklegri til a\u00f0 \u00feurfa innl\u00f6gn e\u00f0a deyja en tilfelli sem voru me\u00f0 COVID-19 en ekki k\u00e6fisvefn \u00ed fulllei\u00f0r\u00e9ttu m\u00f3deli (GH 2,0 95% \u00d6B 1,2-3,2).<\/p>\n

Kl\u00edn\u00edsk einkenni lungnab\u00f3lgu \u00e1n \u00edfer\u00f0a er algeng \u00e1st\u00e6\u00f0a innlagna \u00e1 sj\u00fakrah\u00fas og \u00fer\u00e1tt fyrir a\u00f0 \u00edfer\u00f0 sj\u00e1ist ekki vi\u00f0 myndranns\u00f3kn var d\u00e1nart\u00ed\u00f0ni ekki markt\u00e6kt l\u00e6gri en hj\u00e1 \u00feeim sem voru me\u00f0 sta\u00f0festa \u00edfer\u00f0. Notkun \u00e1 ASA tengist l\u00e6gri d\u00e1nart\u00ed\u00f0ni \u00feeirra sem greinast me\u00f0 \u00edfarandi pneum\u00f3kokkalungnab\u00f3lgu en \u00fe\u00f6rf er \u00e1 ranns\u00f3knum sem lei\u00f0r\u00e9tta fyrir m\u00f6gulegri skekkju heilbrig\u00f0ari notenda. K\u00e6fisvefn er \u00e1h\u00e6ttu\u00fe\u00e1ttur fyrir sj\u00fakrah\u00fasinnl\u00f6gn e\u00f0a dau\u00f0a me\u00f0al \u00feeirra sem greinast me\u00f0 COVID-19 a\u00f0 teknu tilliti til bj\u00f6gunar\u00fe\u00e1tta.<\/p>\n

Abstract<\/strong><\/p>\n

Community-acquired pneumonia (CAP) is a common and serious disease, which can be difficult to diagnose, especially among older adults. However, studies are lacking comparing cases that have symptoms of pneumonia without radiographic confirmation of an infiltrate (SPWI) with those that have symptoms of pneumonia with radiographic confirmation. Some earlier studies indicated that acetylsalicylic acid (ASA) decreased mortality following pneumonia, but others did not. Pneumonia etiology can suddenly change, as observed recently in the SARS-CoV-2 pandemic. Information is lacking on the association of obstructive sleep apnea (OSA) with severe COVID-19.\u00a0<\/p>\n

Three different datasets were used for the work presented in this thesis. In the first paper we performed a prospective study on cases hospitalized with suspected pneumonia over a one-year period (2018-2019). In the second paper we used a retrospective dataset on all invasive pneumocccal infections 1975-2019 in Iceland. In the third paper we used a dataset on all COVID-19 infections in Iceland in the year 2020. Odds ratio (OR) and hazard ratio (HR) was calculated using inverse probability weighting and logistic regression.<\/p>\n

When compared to SPWI, CAP cases more frequently had fever (\u226538\u00b0C), higher CRP value and S. pneumoniae as microbial etiology. The adjusted OR of mortality for SPWI cases compared with CAP within 30 days was 0.86 (95% confidence interval (CI) 0.40-1.85) but 1.25 (95% CI 0.81-1.95) at 1 year. After adjustment ASA cases had a better survival 0-7 days after diagnosis (HR 0.42, 95% CI 0.19-0.92), but not between 7-30 days (HR 1.08 95% CI 0.46-2.55). Average HR over 1-year showed a better survival for the ASA cases compared to those not on ASA (0.48, 9%CI 0.31-0.75). COVID-19 cases with OSA were more likely to need hospitalization or die than cases that had COVID-19 but without a prior OSA diagnosis in a fully adjusted model (OR 2.0 95% CI 1.2-3.2).<\/p>\n

SPWI is a common reason for hospitalization and despite lacking radiographic infiltrates, mortality was not significantly lower than in CAP. The use of ASA is associated with lower mortality among those diagnosed with invasive pneumococcal pneumonia, but studies adjusting for healthy user bias are needed. OSA is a risk factor for hospitalization or death among those diagnosed with COVID-19.<\/p>\n

Um doktorsefni\u00f0<\/strong><\/p>\n

Kristj\u00e1n Godsk R\u00f6gnvaldsson er f\u00e6ddur \u00e1ri\u00f0 1990 \u00e1 Sau\u00f0\u00e1rkr\u00f3ki. Hann \u00fatskrifa\u00f0ist af n\u00e1tt\u00farufr\u00e6\u00f0ibraut Menntask\u00f3lans \u00e1 Akureyri \u00e1ri\u00f0 2009. Kristj\u00e1n lauk BS-pr\u00f3fi og kand\u00eddatspr\u00f3fi \u00ed l\u00e6knisfr\u00e6\u00f0i fr\u00e1 H\u00e1sk\u00f3la \u00cdslands \u00e1rin 2012 og 2015. Doktorsn\u00e1m hans vi\u00f0 H\u00e1sk\u00f3la \u00cdslands h\u00f3fst formlega sumari\u00f0 2018. Me\u00f0fram n\u00e1minu sinnti Kristj\u00e1n einnig stundakennslu vi\u00f0 H\u00e1sk\u00f3la \u00cdslands og h\u00f3f vinnu \u00e1 s\u00fdkla- og veirufr\u00e6\u00f0ideild Landsp\u00edtala \u00ed \u00e1g\u00fast 2022. Kristj\u00e1n hefur n\u00fa hafi\u00f0 s\u00e9rn\u00e1m \u00ed s\u00fdkla- og veirufr\u00e6\u00f0i vi\u00f0 R\u00edkissj\u00fakrah\u00fasi\u00f0 \u00ed Kaupmannah\u00f6fn. Foreldrar Kristj\u00e1ns eru R\u00f6gnvaldur Ragnar S\u00edmonarson og Kirsten Godsk. Kristj\u00e1n er kv\u00e6ntur Salv\u00f6ru Rafnsd\u00f3ttur l\u00e6kni og doktorsnema og saman eiga \u00feau einn dreng, St\u00edg.\u00a0<\/p>\n<\/div><\/div>","protected":false},"featured_media":5645,"template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_phd_date_start":"2023-11-17T09:00:00+00:00","_phd_date_end":"2023-11-17T12:00:00+00:00","_phd_location":"A\u00f0albygging H\u00e1t\u00ed\u00f0asalur","_phd_admission":"A\u00f0gangur \u00f3keypis","_phd_thesis_title":"Samf\u00e9lagslungnab\u00f3lga me\u00f0al fullor\u00f0inna: Ranns\u00f3knir \u00e1 v\u00f6ldum \u00fe\u00e1ttum sem tengjast horfum og lifun. 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