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Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, Fermín-Martínez CA, Naveja JJ, Aguilar-Salinas CA. Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. J Clin Endocrinol Metab 2020; 105:5849337. [PMID: 32474598 PMCID: PMC7313944 DOI: 10.1210/clinem/dgaa346] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age ≥ 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). CONCLUSIONS Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Division of Research, Instituto Nacional de Geriatría
- Corresponding author: Omar Yaxmehen Bello-Chavolla. Division of Research. Instituto Nacional Geriatría. Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, 10200, Mexico City, Mexico. Phone: +52 (55) 5548486885. E-mail:
| | | | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | | | - Alejandro Márquez-Salinas
- Division of Research, Instituto Nacional de Geriatría
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - Carlos A Fermín-Martínez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - J Jesús Naveja
- Instituto de Química, Universidad Nacional Autónoma de México
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Department of Endocrinolgy and Metabolism. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud
- Corresponding author: Carlos A. Aguilar-Salinas. Unidad de Investigación de Enfermedades Metabólicas. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14080; Tlalpan, Distrito Federal, México. Phone: +52(55)54870900, 5703. E-mail:
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Kiddle SJ, Whittaker HR, Seaman SR, Quint JK. Prediction of five-year mortality after COPD diagnosis using primary care records. PLoS One 2020; 15:e0236011. [PMID: 32692772 PMCID: PMC7373295 DOI: 10.1371/journal.pone.0236011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022] Open
Abstract
Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004-2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783-0.809 and the calibration slopes between 0.911-1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator (https://skiddle.shinyapps.io/incidentcopdsurvival/).
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Affiliation(s)
- Steven J. Kiddle
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- * E-mail: (SJK); (JKQ)
| | - Hannah R. Whittaker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Shaun R. Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- * E-mail: (SJK); (JKQ)
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Rabe KF, Martinez FJ, Ferguson GT, Wang C, Singh D, Wedzicha JA, Trivedi R, St Rose E, Ballal S, McLaren J, Darken P, Aurivillius M, Reisner C, Dorinsky P. Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. N Engl J Med 2020; 383:35-48. [PMID: 32579807 DOI: 10.1056/nejmoa1916046] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Triple fixed-dose regimens of an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA) for chronic obstructive pulmonary disease (COPD) have been studied at single dose levels of inhaled glucocorticoid, but studies at two dose levels are lacking. METHODS In a 52-week, phase 3, randomized trial to evaluate the efficacy and safety of triple therapy at two dose levels of inhaled glucocorticoid in patients with moderate-to-very-severe COPD and at least one exacerbation in the past year, we assigned patients in a 1:1:1:1 ratio to receive twice-daily inhaled doses of triple therapy (inhaled glucocorticoid [320 μg or 160 μg of budesonide], a LAMA [18 μg of glycopyrrolate], and a LABA [9.6 μg of formoterol]) or one of two dual therapies (18 μg of glycopyrrolate plus 9.6 μg of formoterol or 320 μg of budesonide plus 9.6 μg of formoterol). The primary end point was the annual rate (the estimated mean number per patient per year) of moderate or severe COPD exacerbations, as analyzed in the modified intention-to-treat population with the use of on-treatment data only. RESULTS The modified intention-to-treat population comprised 8509 patients. The annual rates of moderate or severe exacerbations were 1.08 in the 320-μg-budesonide triple-therapy group (2137 patients), 1.07 in the 160-μg-budesonide triple-therapy group (2121 patients), 1.42 in the glycopyrrolate-formoterol group (2120 patients), and 1.24 in the budesonide-formoterol group (2131 patients). The rate was significantly lower with 320-μg-budesonide triple therapy than with glycopyrrolate-formoterol (24% lower: rate ratio, 0.76; 95% confidence interval [CI], 0.69 to 0.83; P<0.001) or budesonide-formoterol (13% lower: rate ratio, 0.87; 95% CI, 0.79 to 0.95; P = 0.003). Similarly, the rate was significantly lower with 160-μg-budesonide triple therapy than with glycopyrrolate-formoterol (25% lower: rate ratio, 0.75; 95% CI, 0.69 to 0.83; P<0.001) or budesonide-formoterol (14% lower: rate ratio, 0.86; 95% CI, 0.79 to 0.95; P = 0.002). The incidence of any adverse event was similar across the treatment groups (range, 61.7 to 64.5%); the incidence of confirmed pneumonia ranged from 3.5 to 4.5% in the groups that included inhaled glucocorticoid use and was 2.3% in the glycopyrrolate-formoterol group. CONCLUSIONS Triple therapy with twice-daily budesonide (at either the 160-μg or 320-μg dose), glycopyrrolate, and formoterol resulted in a lower rate of moderate or severe COPD exacerbations than glycopyrrolate-formoterol or budesonide-formoterol. (Funded by AstraZeneca, ETHOS ClinicalTrials.gov number, NCT02465567.).
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Affiliation(s)
- Klaus F Rabe
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Fernando J Martinez
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Gary T Ferguson
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Chen Wang
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Dave Singh
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Jadwiga A Wedzicha
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Roopa Trivedi
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Earl St Rose
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Shaila Ballal
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Julie McLaren
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Patrick Darken
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Magnus Aurivillius
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Colin Reisner
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
| | - Paul Dorinsky
- From LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany (K.F.R.); the Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York (F.J.M.); the Pulmonary Research Institute of Southeast Michigan, Farmington Hills (G.T.F.); the National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing (C.W.); the Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester (D.S.), and the National Heart and Lung Institute, Imperial College London, London (J.A.W.) - both in the United Kingdom; AstraZeneca, Durham, NC (R.T., P. Dorinsky); AstraZeneca, Morristown, NJ (E.S.R., S.B., P. Darken, C.R.); AstraZeneca, Gaithersburg, MD (J.M.); and AstraZeneca, Gothenburg, Sweden (M.A.)
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Lonergan M, Dicker AJ, Crichton ML, Keir HR, Van Dyke MK, Mullerova H, Miller BE, Tal-Singer R, Chalmers JD. Blood neutrophil counts are associated with exacerbation frequency and mortality in COPD. Respir Res 2020; 21:166. [PMID: 32611352 PMCID: PMC7329438 DOI: 10.1186/s12931-020-01436-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Identifying patients with COPD at increased risk of poor outcomes is challenging due to disease heterogeneity. Potential biomarkers need to be readily available in real-life clinical practice. Blood eosinophil counts are widely studied but few studies have examined the prognostic value of blood neutrophil counts (BNC). METHODS In a large population-based COPD registry in the East of Scotland (TARDIS: Tayside Allergic and Respiratory Disease Information System), BNC were compared to measures of disease severity and mortality for up to 15 years follow-up. Potential mechanisms of disease modification by BNC were explored in a nested microbiome substudy. RESULTS 178,120 neutrophil counts were obtained from 7220 people (mean follow up 9 years) during stable disease periods. Median BNC was 5200cells/μL (IQR 4000-7000cells/μL). Mortality rates among the 34% of patients with elevated BNCs (defined as 6000-15000cells/μL) at the study start were 80% higher (14.0/100 person years v 7.8/100py, P < 0.001) than those with BNC in the normal range (2000-6000cells/μL). People with elevated BNC were more likely to be classified as GOLD D (46% v 33% P < 0.001), have more exacerbations (mean 2.3 v 1.3/year, P < 0.001), and were more likely to have severe exacerbations (13% vs. 5%, P < 0.001) in the following year. Eosinophil counts were much less predictive of these outcomes. In a sub-cohort (N = 276), patients with elevated BNC had increased relative abundance of Proteobacteria and reduced microbiome diversity. CONCLUSION High BNC may provide a useful indicator of risk of exacerbations and mortality in COPD patients.
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Affiliation(s)
- Mike Lonergan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Alison J Dicker
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Megan L Crichton
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Holly R Keir
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Melissa K Van Dyke
- Epidemiology, Value Evidence and Outcomes, GSK R&D, Collegeville, PA, USA
| | - Hana Mullerova
- Epidemiology, Value Evidence and Outcomes, GSK R&D, Uxbridge, UK
| | - Bruce E Miller
- Medical Innovation, Value Evidence and Outcomes, GSK R&D, Collegeville, PA, USA
| | - Ruth Tal-Singer
- Medical Innovation, Value Evidence and Outcomes, GSK R&D, Collegeville, PA, USA
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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Vestergaard AHS, Neergaard MA, Christiansen CF, Nielsen H, Lyngaa T, Laut KG, Johnsen SP. Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study. BMJ Open 2020; 10:e033493. [PMID: 32595146 PMCID: PMC7322325 DOI: 10.1136/bmjopen-2019-033493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). DESIGN A nationwide register-based cohort study. SETTING Data on all in-hospital admissions obtained from nationwide Danish medical registries. PARTICIPANTS All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. OUTCOME MEASURES Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. RESULTS Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). CONCLUSION Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.
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Affiliation(s)
| | | | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Lyngaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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Lindenauer PK, Stefan MS, Pekow PS, Mazor KM, Priya A, Spitzer KA, Lagu TC, Pack QR, Pinto-Plata VM, ZuWallack R. Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries. JAMA 2020; 323:1813-1823. [PMID: 32396181 PMCID: PMC7218499 DOI: 10.1001/jama.2020.4437] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge. OBJECTIVE To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival. DESIGN, SETTING, AND PATIENTS This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. EXPOSURES Initiation of pulmonary rehabilitation within 90 days of hospital discharge. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality. RESULTS Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], -6.7% [95% CI, -7.9% to -5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, -4.6% [95% CI, -5.9% to -3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, -11.1% [95% CI, -13.2% to -8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01). CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.
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Affiliation(s)
- Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- University of Massachusetts School of Public Health and Health Sciences, Amherst
| | - Kathleen M. Mazor
- The Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- University of Massachusetts School of Public Health and Health Sciences, Amherst
| | - Kerry A. Spitzer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
| | - Tara C. Lagu
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Quinn R. Pack
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Division of Cardiovascular Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Victor M. Pinto-Plata
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Divsion of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Richard ZuWallack
- Pulmonary and Critical Care Division, Saint Francis Hospital and Medical Center, Hartford, Connecticut
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Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with cough, sputum production or dyspnoea, and a reduction in lung function, quality of life, and life expectancy. Apart from smoking cessation, no other treatments that slow lung function decline are available. Roflumilast and cilomilast are oral phosphodiesterase-4 (PDE₄) inhibitors proposed to reduce the airway inflammation and bronchoconstriction seen in COPD. This Cochrane Review was first published in 2011, and was updated in 2017 and 2020. OBJECTIVES To evaluate the efficacy and safety of oral PDE₄ inhibitors for management of stable COPD. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 9 March 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs if they compared oral PDE₄ inhibitors with placebo in people with COPD. We allowed co-administration of standard COPD therapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Two independent review authors selected trials for inclusion, extracted data, and assessed risk of bias. We resolved discrepancies by involving a third review author. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were change in lung function (minimally important difference (MID) = 100 mL) and quality of life (scale 0 to 100; higher score indicates more limitations). MAIN RESULTS We found 42 RCTs that met the inclusion criteria and were included in the analyses for roflumilast (28 trials with 18,046 participants) or cilomilast (14 trials with 6457 participants) or tetomilast (1 trial with 84 participants), with a duration between six weeks and one year or longer. These trials included people across international study centres with moderate to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades II to IV), with mean age of 64 years. We judged risks of selection bias, performance bias, and attrition bias as low overall amongst the 39 published and unpublished trials. Lung function Treatment with a PDE₄ inhibitor was associated with a small, clinically insignificant improvement in forced expiratory volume in one second (FEV₁) over a mean of 40 weeks compared with placebo (mean difference (MD) 49.33 mL, 95% confidence interval (CI) 44.17 to 54.49; participants = 20,815; studies = 29; moderate-certainty evidence). Forced vital capacity (FVC) and peak expiratory flow (PEF) were also improved over 40 weeks (FVC: MD 86.98 mL, 95% CI 74.65 to 99.31; participants = 22,108; studies = 17; high-certainty evidence; PEF: MD 6.54 L/min, 95% CI 3.95 to 9.13; participants = 4245; studies = 6; low-certainty evidence). Quality of life Trials reported improvements in quality of life over a mean of 33 weeks (St George's Respiratory Questionnaire (SGRQ) MD -1.06 units, 95% CI -1.68 to -0.43; participants = 7645 ; moderate-certainty evidence). Incidence of exacerbations Treatment with a PDE₄ inhibitor was associated with a reduced likelihood of COPD exacerbation over a mean of 40 weeks (odds ratio (OR) 0.78, 95% CI 0.73 to 0.84; participants = 20,382; studies = 27; high-certainty evidence), that is, for every 100 people treated with PDE₄ inhibitors, five more remained exacerbation-free during the study period compared with those given placebo (number needed to treat for an additional beneficial outcome (NNTB) 20, 95% CI 16 to 27). No change in COPD-related symptoms nor in exercise tolerance was found. Adverse events More participants in the treatment groups experienced an adverse effect compared with control participants over a mean of 39 weeks (OR 1.30, 95% CI 1.22 to 1.38; participants = 21,310; studies = 30; low-certainty evidence). Participants experienced a range of gastrointestinal symptoms such as diarrhoea, nausea, vomiting, or dyspepsia. Diarrhoea was more commonly reported with PDE₄ inhibitor treatment (OR 3.20, 95% CI 2.74 to 3.50; participants = 20,623; studies = 29; high-certainty evidence), that is, for every 100 people treated with PDE₄ inhibitors, seven more suffered from diarrhoea during the study period compared with those given placebo (number needed to treat for an additional harmful outcome (NNTH) 15, 95% CI 13 to 17). The likelihood of psychiatric adverse events was higher with roflumilast 500 µg than with placebo (OR 2.13, 95% CI 1.79 to 2.54; participants = 11,168; studies = 15 (COPD pool data); moderate-certainty evidence). Roflumilast in particular was associated with weight loss during the trial period and with an increase in insomnia and depressive mood symptoms. Participants treated with PDE₄ inhibitors were more likely to withdraw from trial participation; on average, 14% in the treatment groups withdrew compared with 8% in the control groups. Mortality No effect on mortality was found (OR 0.98, 95% CI 0.77 to 1.24; participants = 19,786; studies = 27; moderate-certainty evidence), although mortality was a rare event during these trials. AUTHORS' CONCLUSIONS For this current update, five new studies from the 2020 search contributed to existing findings but made little impact on outcomes described in earlier versions of this review. PDE₄ inhibitors offered a small benefit over placebo in improving lung function and reducing the likelihood of exacerbations in people with COPD; however, they had little impact on quality of life or on symptoms. Gastrointestinal adverse effects and weight loss were common, and the likelihood of psychiatric symptoms was higher, with roflumilast 500 µg. The findings of this review provide cautious support for the use of PDE₄ inhibitors in COPD. In accordance with GOLD 2020 guidelines, they may have a place as add-on therapy for a subgroup of people with persistent symptoms or exacerbations despite optimal COPD management (e.g. people whose condition is not controlled by fixed-dose long-acting beta₂-agonist (LABA) and inhaled corticosteroid (ICS) combinations). More longer-term trials are needed to determine whether or not PDE₄ inhibitors modify FEV₁ decline, hospitalisation, or mortality in COPD.
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Affiliation(s)
- Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Fortescue
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Phillippa Poole
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Xu M, Sbihi H, Pan X, Brauer M. Modifiers of the effect of short-term variation in PM 2.5 on mortality in Beijing, China. Environ Res 2020; 183:109066. [PMID: 32058147 DOI: 10.1016/j.envres.2019.109066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Epidemiologic studies have reported associations between short-term exposure to particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and mortality, but the role of modifiers remains unclear with studies reporting inconsistent results. We evaluated the impact of individual (age, gender and education) and township (geographic area, socioeconomic status, background air pollution and road density) level factors on the relationship between short-term variation in PM2.5 with cause-specific mortality in Beijing (population: 21.7 million in 2016), China. METHODS Daily PM2.5 concentrations in each township (n = 327; township population: 2000-359,400; township area: 1-392 km2) within Beijing were estimated by kriging with external drift using measurements from 35 air quality monitoring stations and geographic variables. Time-stratified case-crossover analysis with township-level mortality data from Oct. 1st, 2012 to Dec. 31st, 2013 was then used to examine associations between PM2.5 exposure estimates and cause-specific mortality, stratified by the potential effect modifiers. RESULTS A 10-μg/m3 increase in PM2.5 concentration was associated with a 0.17% [95% confidence interval (CI): 0.05%-0.29%] and 0.27% (95%CI:0.01%-0.52%) increase in non-accidental and stroke mortality with no lag, a 0.81% (95%CI:0.39%-1.23%) and 0.96% (95%CI:0.35%-1.57%) increase in respiratory disease (RD) and chronic obstructive pulmonary disease (COPD) mortality at a lag of two-day moving average. For individual-level effect modifiers, the elderly showed higher effects for all the specific causes of mortality; those with lower education level showed higher effects for non-accidental, cardiovascular disease and stroke mortality; females showed higher effects for non-accidental and cause-specific cardiovascular diseases. For township-level effect modifiers, effect estimates tended to be larger for suburban areas, areas of lower road density, lower PM2.5 and lower socioeconomic status. CONCLUSIONS Short-term exposure to township-level ambient PM2.5 was associated with increased mortality in Beijing, with indications of effect modification by both individual and township-level factors.
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Affiliation(s)
- Meimei Xu
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Hind Sbihi
- BC Children's Hospital Research Institute, Vancouver, BC, V6H 3N1, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, 100191, China.
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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Seow H, Tanuseputro P, Barbera L, Earle C, Guthrie D, Isenberg S, Juergens R, Myers J, Brouwers M, Sutradhar R. Development and Validation of a Prognostic Survival Model With Patient-Reported Outcomes for Patients With Cancer. JAMA Netw Open 2020; 3:e201768. [PMID: 32236529 PMCID: PMC7113728 DOI: 10.1001/jamanetworkopen.2020.1768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Existing prognostic cancer tools include biological and laboratory variables. However, patients often do not know this information, preventing them from using the tools and understanding their prognosis. OBJECTIVE To develop and validate a prognostic survival model for all cancer types that incorporates information on symptoms and performance status over time. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective, population-based, prognostic study of data from patients diagnosed with cancer from January 1, 2008, to December 31, 2015, in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable Cox proportional hazards regression model with baseline characteristics under a backward stepwise variable selection process to predict the risk of mortality as a function of time. Covariates included demographic characteristics, clinical information, symptoms and performance status, and health care use. Model performance was assessed on the validation cohort by C statistics and calibration plots. Data analysis was performed from February 6, 2018, to November 6, 2019. MAIN OUTCOMES AND MEASURES Time to death from diagnosis (year 0) recalculated at each of 4 annual survivor marks after diagnosis (up to year 4). RESULTS A total of 255 494 patients diagnosed with cancer were identified (135 699 [53.1%] female; median age, 65 years [interquartile range, 55-73 years]). The cohort decreased to 217 055, 184 822, 143 649, and 109 569 patients for each of the 4 years after diagnosis. In the derivation cohort year 0, and the most common cancers were breast (30 855 [20.1%]), lung (19 111 [12.5%]), and prostate (18 404 [12.0%]). A total of 47 614 (31.1%) had stage III or IV disease. The mean (SD) time to death in year 0 was 567 (715) days. After backward stepwise selection in year 0, the following factors were associated with increased risk of death by more than 10%: being hospitalized; having congestive heart failure, chronic obstructive pulmonary disease, or dementia; having moderate to high pain; having worse well-being; having functional status in the transitional or end-of-life phase; having any problems with appetite; receiving end-of-life home care; and living in a nursing home. Model discrimination was high for all models (C statistic: 0.902 [year 0], 0.912 [year 1], 0.912 [year 2], 0.909 [year 3], and 0.908 [year 4]). CONCLUSIONS AND RELEVANCE The model accurately predicted changing cancer survival risk over time using clinical, symptom, and performance status data and appears to have the potential to be a useful prognostic tool that can be completed by patients. This knowledge may support earlier integration of palliative care.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Craig Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Dawn Guthrie
- Department of Kinesiology and Physical Education, Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalyn Juergens
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Myers
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Brouwers
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wang M, Lin EPY, Huang LC, Li CY, Shyr Y, Lai CH. Mortality of Cardiovascular Events in Patients With COPD and Preceding Hospitalization for Acute Exacerbation. Chest 2020; 158:973-985. [PMID: 32184108 DOI: 10.1016/j.chest.2020.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/25/2020] [Accepted: 02/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Acute exacerbation (AE) of COPD may be accompanied by the deterioration of cardiovascular comorbidities, as evidenced by the increased incidence of acute cardiovascular events. RESEARCH QUESTION The goal of this study was to determine whether preceding AE might be associated with mortality of cardiovascular events. STUDY DESIGN AND METHODS Using a health insurance research database in Taiwan, patients with COPD were identified who experienced first-time acute myocardial infarction (AMI; n = 26,442), ischemic stroke (n = 54,959), and intracranial hemorrhage (ICH; n = 14,893) over a 13-year period. In each cohort, 4,356, 6,655, and 1,727 patients, respectively, had been hospitalized for AE within the previous year prior to the index cardiovascular events, and patients with COPD but without hospitalization for AEs constituted the control subjects. ORs of 90-day mortality and hazard ratios (HRs) of overall mortality during follow-up in relation to hospitalization for an AE and the frequency of hospitalization for AEs (ie, 1 and ≥ 2 hospitalizations for AEs) were estimated with adjustment for potential confounders. RESULTS Hospitalization for an AE was independently associated with 90-day mortality of AMI (OR, 1.33; 95% CI, 1.24-1.43), ischemic stroke (OR, 1.46; 95% CI, 1.36-1.56), and ICH (OR, 1.19; 95% CI, 1.06-1.32). Hospitalization for an AE was associated with overall mortality of AMI (HR, 1.23; 95% CI, 1.19-1.27), ischemic stroke (HR, 1.29; 95% CI, 1.26-1.33), and ICH (HR, 1.19; 95% CI, 1.13-1.26). In addition, compared with control subjects, patients with more frequent hospitalizations for AEs exhibited significant trends at higher risk of 90-day and overall mortality of AMI, ischemic stroke, and ICH. Finally, these results were consistent with propensity score matching-based estimates. INTERPRETATION Preceding hospitalization for AEs is associated with 90-day and overall mortality of cardiovascular events in COPD.
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Affiliation(s)
- Mai Wang
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Emily Pei-Ying Lin
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; Department of Medical Research, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Big Data Research Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Ching Huang
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yu Shyr
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Chao-Han Lai
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hwang JJ, Oh YM, Rhee CK, Yoo KH, Park YB, Yoon HI, Lim SY, Lee JH, Kim EK, Kim TH, Lee SW, Lee SD, Lee JS. Hyperuricemia Is Not Predictive of Long-Term Outcome in Patients with Stable Chronic Obstructive Pulmonary Disease. J Korean Med Sci 2020; 35:e58. [PMID: 32103646 PMCID: PMC7049621 DOI: 10.3346/jkms.2020.35.e58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although the association of hyperuricemia with an increased risk of mortality has been demonstrated in the context of acute exacerbation of chronic obstructive pulmonary disease (COPD), the long-term outcomes of hyperuricemia have not been studied in the case of stable COPD. METHODS We retrospectively analyzed baseline data of 240 men with stable COPD enrolled in the Korea Obstructive Lung Disease cohort. We evaluated associations between serum uric acid levels and clinical parameters, risk factors for all-cause mortality, and acute exacerbation of COPD. RESULTS The mean age of subjects was 66.4 ± 7.7 years, and the median follow-up time was 5.9 years. We identified no significant difference in terms of lung function or laboratory findings between patients with hyperuricemia and those without. Serum uric acid level was negatively associated with systemic inflammation indicated by neutrophil-lymphocyte ratio (r = -0.211, P = 0.001). Univariate Cox regression analysis revealed hyperuricemia to not be associated with an increased risk of all-cause mortality in men with stable COPD (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.250-1.370; P = 0.213). In the multivariate Cox regression model, hyperuricemia was not an independent predictor of acute exacerbation (HR, 1.383; 95% CI, 0.977-1.959; P = 0.068). CONCLUSION Among men with stable COPD, hyperuricemia is not an independent predictor of all-cause mortality or future acute exacerbation of COPD. These results differ from those of previous studies on patients with acute exacerbation of COPD.
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Affiliation(s)
- Jae Joon Hwang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gang-Dong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonology, Department of Internal Medicine, Hallym University Gangdong Sacred Heart Hospital, Seoul, Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Eun Kyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Tae Hyung Kim
- Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Rehman AU, Hassali MAA, Muhammad SA, Harun SN, Shah S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ 2020; 21:181-194. [PMID: 31564007 DOI: 10.1007/s10198-019-01119-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 09/13/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To find the economic burden of COPD and to identify the key cost drivers in the management of COPD patients across different European countries. BACKGROUND COPD is a major cause of mortality and morbidity and is associated with considerable economic burden on the individual and society. It limits the daily activities and working ability of the patients. METHODOLOGY We conducted a systematic search of PUBMED, SCIENCE DIRECT, Cochrane CENTRAL, SCOPUS, Google Scholar and SAGE Premier Databases to find scientific research articles evaluating the cost of COPD management from patient and societal perspective. RESULTS Estimated per patient per year direct cost in Norway, Denmark, Germany, Italy, Sweden, Greece, Belgium, and Serbia was €10,701, €9580, €7847, €7448, €7045, €2896, €1963, and €2047, respectively. Annual per patient cost of work productivity loss was highest in Germany as €5735 and lowest in Greece as €998. It was estimated as €4824, €2033 and €1298 in Bulgaria, Denmark and Sweden, respectively. Several factors found associated with increasing cost of COPD management that include but not limited to late diagnosis, severity of disease, frequency of exacerbation, hospital readmissions, non-adherence to the therapy and exposure to COPD risk factors. CONCLUSION Minimizing the COPD exacerbations and controlling the worsening of symptoms may potentially reduce the cost of COPD management at any stage.
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Affiliation(s)
- Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
- Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, Pakistan.
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | | | - Sabariah Noor Harun
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University Islamabad, Islamabad, Pakistan
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Le TT, Park S, Choi M, Wijesinha M, Khokhar B, Simoni-Wastila L. Respiratory events associated with concomitant opioid and sedative use among Medicare beneficiaries with chronic obstructive pulmonary disease. BMJ Open Respir Res 2020; 7:e000483. [PMID: 32213535 PMCID: PMC7173985 DOI: 10.1136/bmjresp-2019-000483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Opioids and sedatives are commonly prescribed in chronic obstructive pulmonary disease (COPD) patients for symptoms of dyspnoea, pain, insomnia, depression and anxiety. Older adults are advised to avoid these medications due to increased adverse events, including respiratory events. This study examines respiratory event risks associated with concomitant opioid and sedative use compared with opioid use alone in older adults with COPD. METHODS A 5% nationally representative sample of Medicare beneficiaries with COPD and opioid use between 2009 and 2013 was used for this retrospective cohort study. Current and past concomitant use were identified using drug dispensed within 7 days from the censored date: at respiratory event, at death, or at 12 months post index. Concomitant opioid and sedative use were categorised into no overlap (opioid only), 1 to 10, 11 to 30, 31 to 60 and >60 days of total overlap. The primary outcome was hospitalisation or emergency department (ED) visits for respiratory events (COPD exacerbations or respiratory depression). Propensity score matching was implemented and semi-competing risk models were used to address competing risk by death. RESULTS Among 48 120 eligible beneficiaries, 1810 (16.7%) concomitant users were matched with 9050 (83.3%) opioid only users. Current concomitant use of 1 to 10, 11 to 30 and 31 to 60 days was associated with increased respiratory events (HRs (95% CI): 2.8 (1.2 to 7.3), 9.3 (4.9 to 18.2) and 5.7 (2.5 to 12.5), respectively), compared with opioid only use. Current concomitant use of >60 days or past concomitant use of ≤60 days was not significantly associated with respiratory events. Consistent findings were found in sensitivity analyses, including in subgroup analysis of non-benzodiazepine sedatives. Additionally, current concomitant use significantly increased risk of death. CONCLUSION Short-term and medium-term current concomitant opioid and sedative use significantly increased risk of respiratory events and death in older COPD Medicare beneficiaries. Long-term past concomitant users, however, demonstrated lower risks of these outcomes, possibly reflecting a healthy user effect or developed tolerance to the effects of these agents.
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Affiliation(s)
- Tham Thi Le
- Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland, USA
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Siyeon Park
- Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Michelle Choi
- Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois, USA
| | - Marniker Wijesinha
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Bilal Khokhar
- General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Linda Simoni-Wastila
- Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland, USA
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, Maryland, USA
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Li X, Cao X, Guo M, Xie M, Liu X. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017. BMJ 2020; 368:m234. [PMID: 32075787 PMCID: PMC7190065 DOI: 10.1136/bmj.m234] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using data from the Global Burden of Disease Study 2017. DESIGN Systematic analysis. DATA SOURCE The Global Burden of Diseases, Injuries, and Risk Factors Study 2017. METHODS Mortality and DALYs from chronic respiratory diseases were estimated from the Global Burden of Disease Study 2017 using DisMod-MR 2.1, a Bayesian meta-regression tool. The estimated annual percentage change of the age standardised mortality rate was calculated using a generalised linear model with a Gaussian distribution. Mortality and DALYs were stratified according to the Socio-demographic index. The strength and direction of the association between the Socio-demographic index and mortality rate were measured using the Spearman rank order correlation. Risk factors for chronic respiratory diseases were analysed from exposure data. RESULTS Between 1990 and 2017, the total number of deaths due to chronic respiratorydiseases increased by 18.0%, from 3.32 (95% uncertainty interval 3.01 to 3.43) million in 1990 to 3.91 (3.79 to 4.04) million in 2017. The age standardised mortality rate of chronic respiratory diseases decreased by an average of 2.41% (2.28% to 2.55%) annually. During the 27 years, the annual decline in mortality rates of chronic obstructive pulmonary disease (COPD; 2.36%, uncertainty interval 2.21% to 2.50%) and pneumoconiosis (2.56%, 2.44% to 2.68%) has been slow, whereas the mortality rate for interstitial lung disease and pulmonary sarcoidosis (0.97%, 0.92% to 1.03%) has increased. Reductions in DALYs for asthma and pneumoconiosis have been seen, but DALYs due to COPD, and interstitial lung disease and pulmonary sarcoidosis have increased. Mortality and the annual change in mortality rate due to chronic respiratory diseases varied considerably across 195 countries. Assessment of the factors responsible for regional variations in mortality and DALYs and the unequal distribution of improvements during the 27 years showed negative correlations between the Socio-demographic index and the mortality rates of COPD, pneumoconiosis, and asthma. Regions with a low Socio-demographic index had the highest mortality and DALYs. Smoking remained the major risk factor for mortality due to COPD and asthma. Pollution from particulate matter was the major contributor to deaths from COPD in regions with a low Socio-demographic index. Since 2013, a high body mass index has become the principal risk factor for asthma. CONCLUSIONS Regions with a low Socio-demographic index had the greatest burden of disease. The estimated contribution of risk factors (such as smoking, environmental pollution, and a high body mass index) to mortality and DALYs supports the need for urgent efforts to reduce exposure to them.
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Affiliation(s)
- Xiaochen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Xiaopei Cao
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Mingzhou Guo
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Min Xie
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Xiansheng Liu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
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Axson EL, Ragutheeswaran K, Sundaram V, Bloom CI, Bottle A, Cowie MR, Quint JK. Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis. Respir Res 2020; 21:54. [PMID: 32059680 PMCID: PMC7023777 DOI: 10.1186/s12931-020-1312-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients. METHODS MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR). RESULTS Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF. CONCLUSIONS In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
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Affiliation(s)
- Eleanor L Axson
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
| | - Kishan Ragutheeswaran
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Varun Sundaram
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Alex Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
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ÖZDEMİR T, YILMAZ DEMİRCİ N, KILIÇ H, KOÇ O, KAYA A, ÖZTÜRK C. An epidemiologic study of physician-diagnosed chronic obstructive pulmonary disease in the Turkish population: COPDTURKEY-1. Turk J Med Sci 2020; 50:132-140. [PMID: 31759382 PMCID: PMC7080360 DOI: 10.3906/sag-1908-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background/aim Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016. Materials and methods This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/ or therapeutic purposes were evaluated retrospectively. Results In 2016, there were 3,434,262 cases of COPD (56.2% men) in Turkey, and the mean age of patients was 61.62 ± 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3% to 5.8%, which was a 35.0% relative increase (P < 0.05). In women, this rate rose from 3.7% to 5.1% (38% increase), and in men, it rose from 4.9% to 6.7% (37% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4% in women and 27.9% in men. The overall mortality was 4.3% in 2012, and 4.2% in 2016. The mortality rate in women was 3.5% in 2012 and 3.7% in 2016, and 5% in 2012 and 4.7% in 2016 in men. The mean prevalence by region was 5.26% (range 3.79%–7.65%). The Black Sea region had the highest COPD prevalence. Conclusion COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country.
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Affiliation(s)
- Tarkan ÖZDEMİR
- Department of Chest Diseases, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Research andTraining Hospital, AnkaraTurkey
| | | | - Hatice KILIÇ
- Department of Chest Diseases, School of Medicine, Yildirim Beyazit University, AnkaraTurkey
| | - Orhan KOÇ
- Department of Management, Social Security Institution, AnkaraTurkey
| | - Akın KAYA
- Department of Chest Diseases, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Can ÖZTÜRK
- Department of Chest Diseases, Faculty of Medicine, Gazi University, AnkaraTurkey
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Quaife M, Houben RMGJ, Allwood B, Cohen T, Coussens AK, Harries AD, van Kampen S, Marx FM, Sweeney S, Wallis RS, Menzies NA. Post-tuberculosis mortality and morbidity: valuing the hidden epidemic. Lancet Respir Med 2020; 8:332-333. [PMID: 32057300 DOI: 10.1016/s2213-2600(20)30039-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; TB Modelling Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; TB Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Rein M G J Houben
- TB Modelling Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; TB Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Anna K Coussens
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Anthony D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Sanne van Kampen
- National eHealth Living Lab, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Florian M Marx
- DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Faculty of Science, Stellenbosch University, Cape Town, South Africa; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sedona Sweeney
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Li X, Xiao J, Huang M, Liu T, Guo L, Zeng W, Chen Q, Zhang J, Ma W. Associations of county-level cumulative environmental quality with mortality of chronic obstructive pulmonary disease and mortality of tracheal, bronchus and lung cancers. Sci Total Environ 2020; 703:135523. [PMID: 31767293 DOI: 10.1016/j.scitotenv.2019.135523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.
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Affiliation(s)
- Xing Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Miaoling Huang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Junfeng Zhang
- Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China.
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Wilson ME, Dobler CC, Morrow AS, Beuschel B, Alsawas M, Benkhadra R, Seisa M, Mittal A, Sanchez M, Daraz L, Holets S, Murad MH, Wang Z. Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. JAMA 2020; 323:455-465. [PMID: 32016309 PMCID: PMC7042860 DOI: 10.1001/jama.2019.22343] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. OBJECTIVE To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia. DATA SOURCES Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019. STUDY SELECTION Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included. DATA EXTRACTION AND SYNTHESIS Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies. MAIN OUTCOMES AND MEASURES Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up. RESULTS A total of 21 RCTs and 12 observational studies evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], -5.53% [95% CI, -10.29% to -0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P = .003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, -35.26% [95% CI, -49.39% to -21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P < .001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, -8.02% [95% CI, -14.77% to -1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P = .02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P = .47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, -0.06 to 0.39]; P = .15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P < .001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, -11.99% [95% CI, -24.77% to 0.79%]; OR, 0.56 [95% CI, 0.29-1.08]; P = .49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P = .84; 6 studies; 414 patients). CONCLUSIONS AND RELEVANCE In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.
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Affiliation(s)
- Michael E. Wilson
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Claudia C. Dobler
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Allison S. Morrow
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Bradley Beuschel
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mouaz Alsawas
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Raed Benkhadra
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mohamed Seisa
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Aniket Mittal
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Manuel Sanchez
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lubna Daraz
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Steven Holets
- Division of Respiratory Care Education, Mayo Clinic, Rochester, Minnesota
| | - M. Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Blagev DP, Collingridge DS, Rea S, Carey KA, Mularski RA, Zeng S, Arjomandi M, Press VG. Laboratory-based Intermountain Validated Exacerbation (LIVE) Score stability in patients with chronic obstructive pulmonary disease. BMJ Open Respir Res 2020; 7:e000450. [PMID: 32060034 PMCID: PMC7047500 DOI: 10.1136/bmjresp-2019-000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Laboratory-based Intermountain Validated Exacerbation (LIVE) Score is associated with mortality and chronic obstructive pulmonary disease (COPD) exacerbation risk across multiple health systems. However, whether the LIVE Score and its associated risk is a stable patient characteristic is unknown. METHODS We validated the LIVE Score in a fourth health system. Then we determined the LIVE Score stability in a retrospective cohort of 98 766 patients with COPD in four health systems where it was previously validated. We assessed whether LIVE Scores changed or remained the same over time. Stability was defined as a majority of surviving patients having the same LIVE Score 4 years later. RESULTS The LIVE Score separated patients into three LIVE Score risk groups of low, medium, and high mortality and LIVE Score stability. Mortality ranged from 6.2% for low-risk LIVE to 45.8% for high-risk LIVE (p<0.001). We found that low-risk LIVE groups were stable and high-risk LIVE groups were unstable. Low-risk LIVE group patients remained low risk, but few high-risk LIVE group patients remained high risk (79.0% high vs 48.1% medium vs 8.8% low, p<0.001 for all pairwise comparisons). CONCLUSION The LIVE Score identifies three major clinically actionable cohorts: a stable low-risk LIVE group, an unstable high-risk LIVE group with high mortality rates, and a medium-risk LIVE group. These observations further our understanding of how existing data used to calculate the LIVE Score may target interventions across risk cohorts of patients with COPD in a health system.
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Affiliation(s)
- Denitza P Blagev
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Dave S Collingridge
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
| | - Susan Rea
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
| | - Kyle A Carey
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Richard A Mularski
- Department of Medicine, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Siyang Zeng
- Medicine, University of California San Francisco, San Francisco, California, USA
- Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mehrdad Arjomandi
- Medicine, University of California San Francisco, San Francisco, California, USA
- Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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71
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Peng L, Xiao S, Gao W, Zhou Y, Zhou J, Yang D, Ye X. Short-term associations between size-fractionated particulate air pollution and COPD mortality in Shanghai, China. Environ Pollut 2020; 257:113483. [PMID: 31677877 DOI: 10.1016/j.envpol.2019.113483] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
Particulate air pollution is a continuing challenge in China, and its adverse effects on chronic obstructive pulmonary disease (COPD) have been widely reported. However, epidemiological evidence on the associations between size-fractionated particle number concentrations (PNCs) and COPD mortality is limited. In this study, we utilized a time-series approach to investigate the associations between PNCs of particles at 0.25-10 μm in diameter and COPD mortality in Shanghai, China. Quasi-Poisson regression generalized additive models were applied to evaluate these associations, with adjustment of time trend, day of week, holidays, temperature and relative humidity. Stratification analyses were performed by season and gender. There were a total of 3238 deaths due to COPD during the study period. We found that daily COPD deaths were significantly associated with PNCs of particles <0.5 μm, and the magnitude of associations increased with decreasing particle size. An interquartile range (IQR) increase in PNC0.25-0.28, PNC0.28-0.3, PNC0.3-0.35, PNC0.35-0.4, PNC0.4-0.45 and PNC0.45--0.5 was associated with increments of 7.51% (95%CI: 2.45%, 12.81%), 7.22% (95%CI: 2.16%, 12.53%), 6.95% (95%CI: 1.81%, 12.35%), 6.26% (95%CI: 1.25%, 11.52%), 5.24% (95%CI: 0.56%, 10.13%) and 4.15% (95%CI: 0.14%, 8.32%), respectively. The associations remained robustness after controlling for the mass concentrations of gaseous air pollutants. In stratification analyses, significant associations between PNCs and COPD mortality were observed in the cold seasons, and in males. Our results suggested that particles <0.5 μm in diameter might be most responsible for the adverse effects of particulate air pollution on COPD mortality, and COPD patients are more susceptible to PM air pollution in the cold seasons, especially for males.
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Affiliation(s)
- Li Peng
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, 200030, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China.
| | - Shaotan Xiao
- Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
| | - Wei Gao
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China
| | - Yi Zhou
- Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China
| | - Dandan Yang
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China
| | - Xiaofang Ye
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200030, China
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Bhatta L, Leivseth L, Mai XM, Henriksen AH, Carslake D, Chen Y, Langhammer A, Brumpton BM. GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study. Int J Chron Obstruct Pulmon Dis 2020; 15:225-233. [PMID: 32099347 PMCID: PMC6999582 DOI: 10.2147/copd.s228958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995-1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (ptrend=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.
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Affiliation(s)
- Laxmi Bhatta
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - David Carslake
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yue Chen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Ben Michael Brumpton
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Ferguson JM, Costello S, Elser H, Neophytou AM, Picciotto S, Silverman DT, Eisen EA. Chronic obstructive pulmonary disease mortality: The Diesel Exhaust in Miners Study (DEMS). Environ Res 2020; 180:108876. [PMID: 31711661 DOI: 10.1016/j.envres.2019.108876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Miners are highly exposed to diesel exhaust emissions from powered equipment. Although biologically plausible, there is little evidence based on quantitative exposure assessment, that long-term diesel exposure increases risk of chronic obstructive pulmonary disease (COPD). To fill this gap, we examined COPD mortality and diesel exhaust exposure in the Diesel Exhaust in Miners Study (DEMS). METHODS We fit Cox models to estimate hazard ratios (HRs) for COPD mortality and cumulative exposure (μg/m3-years) to respirable elemental carbon (REC), a key metric for diesel exhaust exposure. Separate models were fit for ever-underground and surface-only miners to allow for effect modification. Exposure was lagged by 0, 10 and 15 years. In a secondary analysis, we addressed the healthy worker survivor effect by applying the parametric g-formula to handle time-varying confounding affected by prior exposure among ever-underground workers. RESULTS Based on 140 cases, the HRs for COPD mortality increased as categories of lagged REC exposure increased for all workers. Among surface-only workers, those in the middle exposure category (0 lag) had a significantly elevated hazard ratio of 2.34 (95% CI: 1.11-4.61) relative to those in the lowest category. Among the ever-underground, that ratio was 1.35, with wide confidence intervals. Using the g-formula, we estimated that the lifetime cumulative risk of COPD mortality would have been reduced from the observed 5.0%-3.1% under a hypothetical intervention where all ever-underground workers were always unexposed. CONCLUSIONS Our results suggest long term exposure to diesel exhaust may increase risk of COPD in miners, though power was limited.
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Affiliation(s)
- Jacqueline M Ferguson
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA.
| | - Sadie Costello
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Holly Elser
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Andreas M Neophytou
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sally Picciotto
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ellen A Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
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Park J, Hobbs BD, Crapo JD, Make BJ, Regan EA, Humphries S, Carey VJ, Lynch DA, Silverman EK. Subtyping COPD by Using Visual and Quantitative CT Imaging Features. Chest 2020; 157:47-60. [PMID: 31283919 PMCID: PMC6965698 DOI: 10.1016/j.chest.2019.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple studies have identified COPD subtypes by using visual or quantitative evaluation of CT images. However, there has been no systematic assessment of a combined visual and quantitative CT imaging classification. We integrated visually defined patterns of emphysema with quantitative imaging features and spirometry data to produce a set of 10 nonoverlapping CT imaging subtypes, and we assessed differences between subtypes in demographic features, physiological characteristics, longitudinal disease progression, and mortality. METHODS We evaluated 9,080 current and former smokers in the COPDGene study who had available volumetric inspiratory and expiratory CT images obtained using a standardized imaging protocol. We defined 10 discrete, nonoverlapping CT imaging subtypes: no CT imaging abnormality, paraseptal emphysema (PSE), bronchial disease, small airway disease, mild emphysema, upper lobe predominant centrilobular emphysema (CLE), lower lobe predominant CLE, diffuse CLE, visual without quantitative emphysema, and quantitative without visual emphysema. Baseline and 5-year longitudinal characteristics and mortality were compared across these CT imaging subtypes. RESULTS The overall mortality differed significantly between groups (P < .01) and was highest in the 3 moderate to severe CLE groups. Subjects having quantitative but not visual emphysema and subjects with visual but not quantitative emphysema were unique groups with mild COPD, at risk for progression, and with likely different underlying mechanisms. Subjects with PSE and/or moderate to severe CLE had substantial progression of emphysema over 5 years compared with findings in subjects with no CT imaging abnormality (P < .01). CONCLUSIONS The combination of visual and quantitative CT imaging features reflects different underlying pathological processes in the heterogeneous COPD syndrome and provides a useful approach to reclassify types of COPD. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jinkyeong Park
- Channing Division of Network Medicine, Boston, MA; Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-Si, Gyeonggi-do, South Korea
| | - Brian D Hobbs
- Channing Division of Network Medicine, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO
| | | | | | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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Shamsipour M, Hassanvand MS, Gohari K, Yunesian M, Fotouhi A, Naddafi K, Sheidaei A, Faridi S, Akhlaghi AA, Rabiei K, Mehdipour P, Mahdavi M, Amini H, Farzadfar F. National and sub-national exposure to ambient fine particulate matter (PM 2.5) and its attributable burden of disease in Iran from 1990 to 2016. Environ Pollut 2019; 255:113173. [PMID: 31521993 DOI: 10.1016/j.envpol.2019.113173] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 05/28/2023]
Abstract
Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 μm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 μm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 μg/m3 (UI: 19.03-24.9) and 35.4 μg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.
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Affiliation(s)
- Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Katayoun Rabiei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mokhtar Mahdavi
- Saveh University of Medical Sciences, Saveh, Iran; Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Heresh Amini
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Lortet-Tieulent J, Soerjomataram I, López-Campos JL, Ancochea J, Coebergh JW, Soriano JB. International trends in COPD mortality, 1995-2017. Eur Respir J 2019; 54:1901791. [PMID: 31744832 DOI: 10.1183/13993003.01791-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/25/2019] [Indexed: 11/05/2022]
Affiliation(s)
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Julio Ancochea
- Instituto de Investigación, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jan Willem Coebergh
- Dept of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joan B Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Omlor AJ, Trudzinski FC, Alqudrah M, Seiler F, Biertz F, Vogelmeier CF, Welte T, Watz H, Waschki B, Brinker TJ, Andreas S, Fähndrich S, Alter P, Jörres RA, Böhm M, Bals R. Time-updated resting heart rate predicts mortality in patients with COPD. Clin Res Cardiol 2019; 109:776-786. [PMID: 31734762 DOI: 10.1007/s00392-019-01572-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
High resting heart rate (RHR) is associated with higher mortality in the general population and in cardiovascular disease. Less is known about the association of RHR with outcome in chronic obstructive pulmonary disease (COPD). In particular, the time-updated RHR (most recent value before the event) appears informative. This is the first study to investigate the association of time-updated RHR with mortality in COPD. We compared the baseline and time-updated RHR related to survival in 2218 COPD patients of the German COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network). Patients with a baseline RHR > 72 beats per minute (bmp) had a significantly (p = 0.049) higher all-cause mortality risk (adjusted hazard ratio (HR) of 1.37 (1.00-1.87) compared to baseline RHR ≤ 72 bpm. The time-updated RHR > 72 bpm was markedly superior (HR 1.79, 1.30-2.46, p = 0.001). Both, increased baseline and time-updated RHR, were independently associated with low FEV1, low TLCO, a history of diabetes, and medication with short-acting beta agonists (SABAs). In conclusion, increased time-updated RHR is associated with higher mortality in COPD independent of other predictors and superior to baseline RHR. Increased RHR is linked to lung function, comorbidities and medication. Whether RHR is an effective treatment target in COPD, needs to be proven in controlled trials.
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Affiliation(s)
- Albert J Omlor
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany
| | - Franziska C Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany
| | - Mohamad Alqudrah
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany
| | - Frederik Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
| | - Henrik Watz
- Airway Research Center North, Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Benjamin Waschki
- Airway Research Center North, Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Titus J Brinker
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, Germany
- Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Sebastian Fähndrich
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Michael Böhm
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Saarland University, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Medicine, Saarland University Medical Centre, Saarland University Hospital, 66421, Homburg/Saar, Germany.
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Park SC, Kim DW, Park EC, Shin CS, Rhee CK, Kang YA, Kim YS. Mortality of patients with chronic obstructive pulmonary disease: a nationwide populationbased cohort study. Korean J Intern Med 2019; 34:1272-1278. [PMID: 31610634 PMCID: PMC6823577 DOI: 10.3904/kjim.2017.428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world. There are no population-based studies on longterm mortality in COPD patients in Korea. METHODS Using the large, population-based, National Health Insurance Service- National Sample Cohort (NHIS-NSC), we identified COPD patients using the International Classification of Disease-Tenth Revision (ICD-10) and prescription details in the NHIS-NSC during 2003 to 2013. We analyzed the survival curves of COPD patients by sex, age, and cause of death. RESULTS A total of 14,127 individuals older than 40 years were diagnosed with COPD. There were a total of 3,695 deaths (26.2%) in COPD patients during the study period. The 5-year mortality of COPD patients was 25.4% (29.9% in males and 19.1% in females). The mortality rate increased rapidly with age. The most common cause of death in COPD was chronic lower respiratory disease. CONCLUSION This study described long-term mortality in COPD patients in Korea. Higher mortality was observed in males, and it was closely related to age.
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Affiliation(s)
- Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Cheung Soo Shin
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Young Sam Kim, M.D. Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1971, Fax: +82-2-393-6884, E-mail:
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79
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Wu TD, Ejike CO, Wise RA, McCormack MC, Brigham EP. Investigation of the Obesity Paradox in Chronic Obstructive Pulmonary Disease, According to Smoking Status, in the United States. Am J Epidemiol 2019; 188:1977-1983. [PMID: 31504124 DOI: 10.1093/aje/kwz185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
An obesity paradox in chronic obstructive pulmonary disease (COPD), whereby overweight/obese individuals have improved survival, has been well-described. These studies have generally included smokers. It is unknown whether the paradox exists in individuals with COPD arising from factors other than smoking. Nonsmoking COPD is understudied yet represents some 25%-45% of the disease worldwide. To determine whether the obesity paradox differs between ever- and never-smokers with COPD, 1,723 adult participants with this condition were examined from 2 iterations of the National Health and Nutrition Examination Survey (1988-1994, 2007-2010), with mortality outcomes followed through December 2011. Using Cox proportional hazards models, adjusted for sociodemographic factors, lung function, and survey cycle, ever/never-smoking was found to modify the association between body mass index and hazard of death. Compared with normal-weight participants, overweight/obese participants had lower hazard of death among ever-smokers (for overweight, adjusted hazard ratio (aHR) = 0.56, 95% confidence interval (CI): 0.43, 0.74; for obesity, aHR = 0.66, 95% CI: 0.48, 0.92), but never-smokers did not (overweight, aHR = 1.41, 95% CI: 0.66, 3.03; obesity, aHR = 1.29, 95% CI: 0.48, 3.48). An obesity paradox appeared to be absent among never-smokers with COPD. This, to our knowledge, novel finding might be explained by pathophysiological differences between smoking-related and nonsmoking COPD or by smoking-associated methodological biases.
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Lee HW, Park J, Jo J, Jang EJ, Lee CH. Comparisons of exacerbations and mortality among regular inhaled therapies for patients with stable chronic obstructive pulmonary disease: Systematic review and Bayesian network meta-analysis. PLoS Med 2019; 16:e1002958. [PMID: 31730642 PMCID: PMC6857849 DOI: 10.1371/journal.pmed.1002958] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although exacerbation and mortality are the most important clinical outcomes of stable chronic obstructive pulmonary disease (COPD), the drug classes that are the most efficacious in reducing exacerbation and mortality among all possible inhaled drugs have not been determined. METHODS AND FINDINGS We performed a systematic review (SR) and Bayesian network meta-analysis (NMA). We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the European Union Clinical Trials Register, and the official websites of pharmaceutical companies (from inception to July 9, 2019). The eligibility criteria were as follows: (1) parallel-design randomized controlled trials (RCTs); (2) adults with stable COPD; (3) comparisons among long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICSs), combined treatment (ICS/LAMA/LABA, LAMA/LABA, or ICS/LABA), or a placebo; and (4) study duration ≥ 12 weeks. This study was prospectively registered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42017069087). In total, 219 trials involving 228,710 patients were included. Compared with placebo, all drug classes significantly reduced the total exacerbations and moderate to severe exacerbations. ICS/LAMA/LABA was the most efficacious treatment for reducing the exacerbation risk (odds ratio [OR] = 0.57; 95% credible interval [CrI] 0.50-0.64; posterior probability of OR > 1 [P(OR > 1)] < 0.001). In addition, in contrast to the other drug classes, ICS/LAMA/LABA and ICS/LABA were associated with a significantly higher probability of reducing mortality than placebo (OR = 0.74, 95% CrI 0.59-0.93, P[OR > 1] = 0.004; and OR = 0.86, 95% CrI 0.76-0.98, P[OR > 1] = 0.015, respectively). The results minimally changed, even in various sensitivity and covariate-adjusted meta-regression analyses. ICS/LAMA/LABA tended to lower the risk of cardiovascular mortality but did not show significant results. ICS/LAMA/LABA increased the probability of pneumonia (OR for triple therapy = 1.56; 95% CrI 1.19-2.03; P[OR > 1] = 1.000). The main limitation is that there were few RCTs including only less symptomatic patients or patients at a low risk. CONCLUSIONS These findings suggest that triple therapy can potentially be the best option for stable COPD patients in terms of reducing exacerbation and all-cause mortality.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, South Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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Abstract
OBJECTIVES Sex differences in respiratory physiology and predilection for developing chronic obstructive pulmonary disease (COPD) have been documented, suggesting that female sex hormones may influence pathogenesis. We investigated whether aspects of female reproductive health might play a role in risk of COPD among women. DESIGN Population-based prospective cohort study. SETTING UK Biobank recruited across 22 centres in the UK between 2006 to 2010. PRIMARY AND SECONDARY OUTCOMES MEASURES We examined a range of female reproductive health indicators in relation to risk of COPD-related hospitalisation/death (n=271 271) using Cox proportional hazards regression; and lung function (n=273 441) using linear regression. RESULTS Parity >3 was associated with greater risk of COPD-related hospitalisation/death (adjusted HR 1.45; 95% CI: 1.16 to 1.82) and lower forced expiratory volume at 1 second/forced vital capacity ratio (FEV1/FVC) (adjusted mean difference -0.06; 95% CI: -0.07 to 0.04). Any oral contraception use was associated with lower risk of COPD-related hospitalisation/death (adjusted HR 0.85; 95% CI: 0.74 to 0.97) and greater FEV1/FVC (adjusted mean difference 0.01; 95% CI: 0.003 to 0.03). Late menarche (age >15) and early menopause (age <47) were also associated with greater risk of COPD-related hospitalisation/death (but not lung function), while endometriosis was associated with greater FEV1/FVC (not COPD-related hospitalisation/death). Early menarche (age <12 years) was associated with lower FEV1/FVC (but not COPD hospitalisation/death). Associations with polycystic ovary syndrome (PCOS) or ovarian cysts, any hormone replacement therapy (HRT) use, hysterectomy-alone and both hysterectomy and bilateral oophorectomy were in opposing directions for COPD-related hospitalisation/death (greater risk) and FEV1/FVC (positive association). CONCLUSIONS Multiple female reproductive health indicators across the life course are associated with COPD-related hospitalisation/death and lung function. Further studies are necessary to understand the opposing associations of PCOS/ovarian cysts, HRT and hysterectomy with COPD and objective measures of airway obstruction.
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Affiliation(s)
- Rosalind Tang
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Christine Magnus
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Pinto-Plata V, Casanova C, Divo M, Tesfaigzi Y, Calhoun V, Sui J, Polverino F, Priolo C, Petersen H, de Torres JP, Marin JM, Owen CA, Baz R, Cordova E, Celli B. Plasma metabolomics and clinical predictors of survival differences in COPD patients. Respir Res 2019; 20:219. [PMID: 31615518 PMCID: PMC6794856 DOI: 10.1186/s12931-019-1167-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Plasma metabolomics profile (PMP) in COPD has been associated with clinical characteristics, but PMP's relationship to survival has not been reported. We determined PMP differences between patients with COPD who died an average of 2 years after enrollment (Non-survivors, NS) compared to those who survived (S) and also with age matched controls (C). METHODS We studied prospectively 90 patients with severe COPD and 30 controls. NS were divided in discovery and validation cohorts (30 patients each) and the results compared to the PMP of 30 S and C. All participants completed lung function tests, dyspnea scores, quality of life, exercise capacity, BODE index, and plasma metabolomics by liquid and gas chromatography / mass spectometry (LC/MS, LC/MS2, GC/MS). Statistically, we used Random Forest Analysis (RFA) and Support Vector Machine (SVM) to determine metabolites that differentiated the 3 groups and compared the ability of metabolites vs. clinical characteristics to classify patients into survivors and non-survivors. RESULTS There were 79 metabolites statistically different between S and NS [p < 0.05 and false discovery rate (q value) < 0.1]. RFA and SVM classification of COPD survivors and non-survivors had a predicted accuracy of 74 and 85% respectively. Elevation of tricyclic acid cycle intermediates branched amino acids depletion and increase in lactate, fructose and xylonate showed the most relevant differences between S vs. NS suggesting alteration in mitochondrial oxidative energy generation. PMP had similar predictive power for risk of death as information provided by clinical characteristics. CONCLUSIONS A plasma metabolomic profile characterized by an oxidative energy production difference between survivors and non-survivors was observed in COPD patients 2 years before death.
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Affiliation(s)
- Victor Pinto-Plata
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
- Pulmonary-Critical Care Medicine Division, Baystate Medical Center, University of Massachusetts-Baystate, 759 Chestnut St, Springfield, MA 01199 USA
| | - Ciro Casanova
- Servicio de Neumologia, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Miguel Divo
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | | | - Vince Calhoun
- The Mind Research Network, Lovelace Respiratory Research Institute, Albuquerque, USA
| | - Jing Sui
- The Mind Research Network, Lovelace Respiratory Research Institute, Albuquerque, USA
| | - Francesca Polverino
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Carmen Priolo
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Hans Petersen
- Servicio de Neumologia, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | - Jose Maria Marin
- Servicio de Neumologia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Caroline A. Owen
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Rebeca Baz
- Servicio de Neumologia, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Elizabeth Cordova
- Servicio de Neumologia, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Bartolome Celli
- Pulmonary-Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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83
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Censin JC, Peters SAE, Bovijn J, Ferreira T, Pulit SL, Mägi R, Mahajan A, Holmes MV, Lindgren CM. Causal relationships between obesity and the leading causes of death in women and men. PLoS Genet 2019; 15:e1008405. [PMID: 31647808 PMCID: PMC6812754 DOI: 10.1371/journal.pgen.1008405] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/09/2019] [Indexed: 12/25/2022] Open
Abstract
Obesity traits are causally implicated with risk of cardiometabolic diseases. It remains unclear whether there are similar causal effects of obesity traits on other non-communicable diseases. Also, it is largely unexplored whether there are any sex-specific differences in the causal effects of obesity traits on cardiometabolic diseases and other leading causes of death. We constructed sex-specific genetic risk scores (GRS) for three obesity traits; body mass index (BMI), waist-hip ratio (WHR), and WHR adjusted for BMI, including 565, 324, and 337 genetic variants, respectively. These GRSs were then used as instrumental variables to assess associations between the obesity traits and leading causes of mortality in the UK Biobank using Mendelian randomization. We also investigated associations with potential mediators, including smoking, glycemic and blood pressure traits. Sex-differences were subsequently assessed by Cochran's Q-test (Phet). A Mendelian randomization analysis of 228,466 women and 195,041 men showed that obesity causes coronary artery disease, stroke (particularly ischemic), chronic obstructive pulmonary disease, lung cancer, type 2 and 1 diabetes mellitus, non-alcoholic fatty liver disease, chronic liver disease, and acute and chronic renal failure. Higher BMI led to higher risk of type 2 diabetes in women than in men (Phet = 1.4×10-5). Waist-hip-ratio led to a higher risk of chronic obstructive pulmonary disease (Phet = 3.7×10-6) and higher risk of chronic renal failure (Phet = 1.0×10-4) in men than women. Obesity traits have an etiological role in the majority of the leading global causes of death. Sex differences exist in the effects of obesity traits on risk of type 2 diabetes, chronic obstructive pulmonary disease, and renal failure, which may have downstream implications for public health.
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Affiliation(s)
- Jenny C. Censin
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sanne A. E. Peters
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonas Bovijn
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Teresa Ferreira
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Sara L. Pulit
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Reedik Mägi
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael V. Holmes
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Big Data Institute Building, Roosevelt Drive, University of Oxford, Oxford, United Kingdom
| | - Cecilia M. Lindgren
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
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84
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Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, Li X, Wang L, Wang L, Liu Y, Liu J, Zhang M, Qi J, Yu S, Afshin A, Gakidou E, Glenn S, Krish VS, Miller-Petrie MK, Mountjoy-Venning WC, Mullany EC, Redford SB, Liu H, Naghavi M, Hay SI, Wang L, Murray CJL, Liang X. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 394:1145-1158. [PMID: 31248666 PMCID: PMC6891889 DOI: 10.1016/s0140-6736(19)30427-1] [Citation(s) in RCA: 1874] [Impact Index Per Article: 374.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. METHODS We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). FINDINGS Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). INTERPRETATION China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. FUNDING China National Key Research and Development Program and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xinying Zeng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Varsha Sarah Krish
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sofia Boston Redford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hongyan Liu
- China Population and Development Research Center, Beijing, China
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China.
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85
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Vazquez Guillamet R. Chronic Obstructive Pulmonary Disease and the Optimal Timing of Lung Transplantation. Medicina (Kaunas) 2019; 55:medicina55100646. [PMID: 31561607 PMCID: PMC6843760 DOI: 10.3390/medicina55100646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) accounts for the largest proportion of respiratory deaths worldwide and was historically the leading indication for lung transplantation. The success of lung transplantation procedures is measured as survival benefit, calculated as survival with transplantation minus predicted survival without transplantation. In chronic obstructive pulmonary disease, it is difficult to show a clear and consistent survival benefit. Increasing knowledge of the risk factors, phenotypical heterogeneity, systemic manifestations, and their management helps improve our ability to select candidates and list those that will benefit the most from the procedure.
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86
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Jayadev A, Stone R, Steiner MC, McMillan V, Roberts CM. Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits. BMJ Open Respir Res 2019; 6:e000444. [PMID: 31423314 PMCID: PMC6688668 DOI: 10.1136/bmjresp-2019-000444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Randomised control trial (RCT)-derived survival figures for acute exacerbation of chronic obstructive pulmonary disease admissions managed with non-invasive ventilation (NIV) have not been replicated in UK clinical audits. Subsequent guidelines have emphasised the need for timely NIV application. Methods Data from the 2008 and 2014 national chronic obstructive pulmonary disease audits was used to analyse the association between time to NIV and mortality. Results 1032 patients received NIV in 2008, and 1612 in 2014. Overall mortality rates reduced between the audits from 24.9% in 2008 to 16.8% in 2014 but time to NIV lengthened. In 2014, 20.9% of patients received NIV within 60 min versus 24.9% in 2008 (p=0.001). The proportion of patients receiving NIV between 3 and 24 hours increased from 31.3% in 2008 to 39% in 2014 (p=0.001). Patients admitted with hypercapnic acidotic respiratory failure who received NIV within 3 hours had lower in-patient mortality than those who received NIV between 3 and 24 hours, 15.9% versus 18.4%, but this did not reach statistical significance (p=0.425), but acidotic patients receiving NIV >24 hours after admission had significantly higher mortality (28.9%, p=0.002). A second cohort admitted with hypercapnia but normal range pH, who developed later acidosis, had higher mortality (24.6%), compared with those acidotic on admission (18% p≤0.001) and an extremely high mortality when NIV was given >24 hours after admission (42.6%). Conclusion Survival rates for those treated with NIV has improved between the two audits but remains lower than reported in RCTs. Patients who developed acidosis after admission and received NIV later in the hospital stay have even higher mortality and deserve further study and clinical attention.
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Affiliation(s)
- Anita Jayadev
- Respiratory Medicine, Wexham Park Hospital, Slough, UK
| | | | - Michael C Steiner
- Leicester Respiratory Biomedical Unit, Institute for Lung Health, Leicester, UK
| | - Viktoria McMillan
- National COPD audit Programme, Royal College of Physicians, London, UK
| | - C Michael Roberts
- Department of Respiratory Medicine, Princess Alexandra Hospital NHS Trust, Harlow, UK
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Nguyen HQ, Moy ML, Liu ILA, Fan VS, Gould MK, Desai SA, Towner WJ, Yuen G, Lee JS, Park SJ, Xiang AH. Effect of Physical Activity Coaching on Acute Care and Survival Among Patients With Chronic Obstructive Pulmonary Disease: A Pragmatic Randomized Clinical Trial. JAMA Netw Open 2019; 2:e199657. [PMID: 31418811 PMCID: PMC6704745 DOI: 10.1001/jamanetworkopen.2019.9657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE While observational studies show that physical inactivity is associated with worse outcomes in chronic obstructive pulmonary disease (COPD), there are no population-based trials to date testing the effectiveness of physical activity (PA) interventions to reduce acute care use or improve survival. OBJECTIVE To evaluate the long-term effectiveness of a community-based PA coaching intervention in patients with COPD. DESIGN, SETTING, AND PARTICIPANTS Pragmatic randomized clinical trial with preconsent randomization to the 12-month Walk On! (WO) intervention or standard care (SC). Enrollment occurred from July 1, 2015, to July 31, 2017; follow-up ended in July 2018. The setting was Kaiser Permanente Southern California sites. Participants were patients 40 years or older who had any COPD-related acute care use in the previous 12 months; only patients assigned to WO were approached for consent to participate in intervention activities. INTERVENTIONS The WO intervention included collaborative monitoring of PA step counts, semiautomated step goal recommendations, individualized reinforcement, and peer/family support. Standard COPD care could include referrals to pulmonary rehabilitation. MAIN OUTCOMES AND MEASURES The primary outcome was a composite binary measure of all-cause hospitalizations, observation stays, emergency department visits, and death using adjusted logistic regression in the 12 months after randomization. Secondary outcomes included self-reported PA, COPD-related acute care use, symptoms, quality of life, and cardiometabolic markers. RESULTS All 2707 eligible patients (baseline mean [SD] age, 72 [10] years; 53.7% female; 74.3% of white race/ethnicity; and baseline mean [SD] percent forced expiratory volume in the first second of expiration predicted, 61.0 [22.5]) were randomly assigned to WO (n = 1358) or SC (n = 1349). The intent-to-treat analysis showed no differences between WO and SC on the primary all-cause composite outcome (odds ratio [OR], 1.09; 95% CI, 0.92-1.28; P = .33) or in the individual outcomes. Prespecified, as-treated analyses compared outcomes between all SC and 321 WO patients who participated in any intervention activities (23.6% [321 of 1358] uptake). The as-treated, propensity score-weighted model showed nonsignificant positive estimates in favor of WO participants compared with SC on all-cause hospitalizations (OR, 0.84; 95% CI, 0.65-1.10; P = .21) and death (OR, 0.62; 95% CI, 0.35-1.11; P = .11). More WO participants reported engaging in PA compared with SC (47.4% [152 of 321] vs 30.7% [414 of 1349]; P < .001) and had improvements in the Patient-Reported Outcomes Measurement Information System 10 physical health domain at 6 months. There were no group differences in other secondary outcomes. CONCLUSIONS AND RELEVANCE Participation in a PA coaching program by patients with a history of COPD exacerbations was insufficient to effect improvements in acute care use or survival in the primary analysis. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02478359.
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Affiliation(s)
- Huong Q. Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Marilyn L. Moy
- Harvard Medical School, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vincent S. Fan
- University of Washington, Seattle
- VA Puget Sound Health Care System, Seattle, Washington
| | - Michael K. Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - William J. Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - George Yuen
- Kaiser Permanente Southern California, Orange County, Anaheim
| | - Janet S. Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Stacy J. Park
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Anny H. Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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Kwak MJ, Bhise V, Warner MT, Balan P, Nguyen TC, Estrera AL, Smalling RW, Dhoble A. National trend of utilization, clinical and economic outcomes of transcatheter aortic valve replacement among patients with chronic obstructive pulmonary disease. Curr Med Res Opin 2019; 35:1321-1329. [PMID: 30761914 DOI: 10.1080/03007995.2019.1583024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: We aimed to trend the utilization of transcatheter aortic valve replacement (TAVR) among COPD patients, compare its outcomes to surgical aortic valve replacement (SAVR) and assess any social disparities in its outcomes. Background: Patients with chronic obstructive pulmonary disease (COPD) have been increasingly undergoing TAVR, but studies to evaluate the national trend of TAVR utilization and outcomes are still lacking. Methods: We conducted a retrospective observational study using a nationally representative database, the National Inpatient Sample (NIS). Results: From 2010 to 2014, the proportion of TAVR among COPD patients has increased from <1% to >50%. Patients who underwent TAVR were older, more likely to be women or white, carried more public insurance and had more comorbidities. There was no overall difference in mortality between TAVR and SAVR (2.74% vs. 2.59%, p = .860), and it has been consistently similar over time. However, patients with TAVR had shorter length of stay in the hospital after the procedure and were more likely to be discharged home than the SAVR group. Among the TAVR group, there were no gender, race or insurance disparities for in-hospital mortality, but female gender was related to lower discharge home rate, higher cost and longer stay in hospital. Conclusions: The rate of TAVR among COPD patients has been increasing nationally since 2011. In spite of higher comorbidities, TAVR did not show a difference in hospital mortality compared to SAVR but demonstrated shorter length of stay and more home discharges. This suggests that TAVR is a viable and potentially better option for patients with COPD.
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Affiliation(s)
- Min Ji Kwak
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
| | - Viraj Bhise
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
- c Department of Internal Medicine, John A Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Mark T Warner
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Prakash Balan
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Tom C Nguyen
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Anthony L Estrera
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Richard W Smalling
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Abhijeet Dhoble
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
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Alvarenga Santos M, Esquinas AM. Survival after ward-based non-invasive ventilation for chronic obstructive pulmonary disease exacerbations: Ceiling treatment or causality? Clin Respir J 2019; 13:538-539. [PMID: 31063644 DOI: 10.1111/crj.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
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Abstract
BACKGROUND The benefit of a procalcitonin (PCT)-guided antibiotic strategy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain. OBJECTIVES This updated meta-analysis was performed to reevaluate the therapeutic potential of PCT-guided antibiotic therapy in AECOPD. DATA SOURCES We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to February 2019 to identify randomized controlled trials (RCTs) investigating the role of PCT-guided antibiotic strategies in treating adult patients with AECOPD. Relative risk (RR) or mean differences (MD) with accompanying 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS Eight RCTs with a total of 1376 participants were included. The results suggested that a PCT-guided antibiotic strategy reduced antibiotic prescriptions (RR: 0.55; 95% CI: 0.39-0.76; P = .0003). However, antibiotic exposure duration (MD: -1.34; 95% CI: -2.83-0.16; P = .08), antibiotic use after discharge (RR: 1.61; 95% CI: 0.61-4.23; P = .34), clinical success (RR: 1.02; 95% CI: 0.96-1.08; P = .47), all-cause mortality (RR: 1.05; 95% CI: 0.72-1.55; P = .79), exacerbation at follow-up (RR: 0.97; 95% CI: 0.80-1.18; P = .78), readmission at follow-up (RR: 1.12; 95% CI: 0.82-1.53; P = .49), length of hospital stay (MD: -0.36; 95% CI: -1.36-0.64; P = .48), and adverse events (RR: 1.33; 95% CI: 0.79-2.23; P = .28) were similar in both groups. IMPLICATIONS OF KEY FINDINGS A PCT-guided antibiotic strategy is associated with fewer antibiotic prescriptions, and has similar efficacy and safety compared with standard antibiotic therapy in AECOPD patients.
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Affiliation(s)
- Zhuying Li
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine
| | - Xingxing Yuan
- Department of Gastroenterology, Heilongjiang Academy of Traditional Chinese Medicine
- Department of Graduate School, Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang
| | - Ling Yu
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong
| | - Bingyu Wang
- Department of Gastroenterology, Heilongjiang Academy of Traditional Chinese Medicine
| | - Fengli Gao
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine
| | - Jian Ma
- Department of Endocrinology, First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang, China
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91
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Bhatt SP, Bodduluri S, Raghav V, Bhakta NR, Wilson CG, Kim YI, Eberlein M, Sciurba FC, Han MK, Dransfield MT. The Peak Index: Spirometry Metric for Airflow Obstruction Severity and Heterogeneity. Ann Am Thorac Soc 2019; 16:982-989. [PMID: 30865842 PMCID: PMC6774744 DOI: 10.1513/annalsats.201811-812oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation. Spirometry loops are not smooth curves and have undulations and peaks that likely reflect heterogeneity of airflow.Objectives: To assess whether the Peak Index, the number of peaks adjusted for lung size, is associated with clinical outcomes.Methods: We analyzed spirometry data of 9,584 participants enrolled in the COPDGene study and counted the number of peaks in the descending part of the expiratory flow-volume curve from the peak expiratory flow to end-expiration. We adjusted the peaks count for the volume of the lungs from peak expiratory flow to end-expiration to derive the Peak Index. Multivariable regression analyses were performed to test associations between the Peak Index and lung function, respiratory morbidity, structural lung disease on computed tomography (CT), forced expiratory volume in 1 second (FEV1) decline, and mortality.Results: The Peak Index progressively increased from Global Initiative for Chronic Obstructive Lung Disease stage 0 through 4 (P < 0.001). On multivariable analysis, the Peak Index was significantly associated with CT emphysema (adjusted β = 0.906; 95% confidence interval [CI], 0.789 to 1.023; P < 0.001) and small airways disease (adjusted β = 1.367; 95% CI, 1.188 to 1.545; P < 0.001), St. George's Respiratory Questionnaire score (adjusted β = 1.075; 95% CI, 0.807 to 1.342; P < 0.001), 6-minute-walk distance (adjusted β = -1.993; 95% CI, -3.481 to -0.506; P < 0.001), and FEV1 change over time (adjusted β = -1.604; 95% CI, -2.691 to -0.516; P = 0.004), after adjustment for age, sex, race, body mass index, current smoking status, pack-years of smoking, and FEV1. The Peak Index was also associated with the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index and mortality (P < 0.001).Conclusions: The Peak Index is a spirometry metric that is associated with CT measures of lung disease, respiratory morbidity, lung function decline, and mortality.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center
- University of Alabama at Birmingham Lung Imaging Core
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center
- University of Alabama at Birmingham Lung Imaging Core
| | - Vrishank Raghav
- Department of Aerospace Engineering, Auburn University, Auburn, Alabama
| | - Nirav R. Bhakta
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California
| | - Carla G. Wilson
- Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Young-il Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center
- Department of Preventive Medicine and
| | - Michael Eberlein
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Hospital, Iowa City, Iowa
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania and
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center
- University of Alabama at Birmingham Lung Imaging Core
| | - for the COPDGene Investigators
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center
- University of Alabama at Birmingham Lung Imaging Core
- Department of Preventive Medicine and
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Aerospace Engineering, Auburn University, Auburn, Alabama
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California
- Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Hospital, Iowa City, Iowa
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania and
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
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Chen PK, Hsiao YH, Pan SW, Su KC, Perng DW, Ko HK. Independent factors associate with hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease requiring intensive care unit admission: Focusing on the eosinophil-to-neutrophil ratio. PLoS One 2019; 14:e0218932. [PMID: 31291271 PMCID: PMC6619993 DOI: 10.1371/journal.pone.0218932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background Factors associated with hospital mortality are unclear in patients with acute exacerbation of COPD (AECOPD) requiring intensive care unit (ICU) admission. We aimed to characterize these patients and identify factors associated with hospital mortality. Patients and methods We used a retrospective observational case-control design and recruited patients between January 2015 and March 2017. Of 146 patients enrolled, 24 (16.4%) died during their hospital stay, while 122 survived. Results Multivariate logistic regression analyses revealed factors associated with hospital mortality: age (adjusted odds ratio [AOR] 1.12, 95% CI: 1.03–1.23), C-reactive protein (CRP) level >7.5 mg/dL at the emergency room (AOR 4.52, 95% CI: 1.27–16.04), peak eosinophil-to-neutrophil ratio (ENR)×102 on days 8–14 of treatment (AOR 0.22, 95% CI: 0.08–0.63), and in-hospital complications (AOR 4.23, 95% CI: 1.12–15.98) (all P<0.05). After receiver operating characteristic curve analyses, cutoff level for peak ENR×102 was 0.224. To examine the synergistic effects of CRP level and peak ENR, we divided patients into four groups: (G0, reference group) Peak ENR×102 >0.224 on days 8–14 and initial CRP <7.5 mg/dL; (G1) Peak ENR×102 >0.224 on days 8–14 and initial CRP >7.5 mg/dL; (G2) Peak ENR×102 <0.224 on days 8–14 and initial CRP <7.5 mg/dL; and (G3) Peak ENR×102 <0.224 on days 8–14 and initial CRP >7.5 mg/dL. For G2 and G3 patients, the AOR of mortality was significantly different from that of the reference group (G2: AOR 10.00, P = 0.020; G3: AOR 61.79, P<0.001). The relationship between 28-day mortality and the four groups was statistically significant (log-rank test, P<0.001). Conclusion Older age, initial CRP >7.5 mg/dL, peak ENR on days 8–14, and in-hospital complications were associated with hospital mortality in patients with AECOPD requiring ICU admission. Patients with both biomarkers, initial CRP >7.5 mg/dL, and peak ENR×102 <0.224 on days 8–14 of treatment, had an increased risk of hospital mortality.
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Affiliation(s)
- Pei-Ku Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Public Health, Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- * E-mail: (HKK); (DWP)
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- * E-mail: (HKK); (DWP)
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93
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Bhatt SP, Balte PP, Schwartz JE, Cassano PA, Couper D, Jacobs DR, Kalhan R, O’Connor GT, Yende S, Sanders JL, Umans JG, Dransfield MT, Chaves PH, White WB, Oelsner EC. Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality. JAMA 2019; 321:2438-2447. [PMID: 31237643 PMCID: PMC6593636 DOI: 10.1001/jama.2019.7233] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial. OBJECTIVE To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting COPD-related hospitalization and mortality. DESIGN, SETTING, AND PARTICIPANTS The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016. EXPOSURES Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach. RESULTS Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95% CI, -0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models. CONCLUSIONS AND RELEVANCE Defining airflow obstruction as FEV1:FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD.
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine and the UAB Lung Health Center, University of Alabama at Birmingham
| | - Pallavi P. Balte
- Division of General Medicine, Columbia University Medical Center, New York, New York
| | - Joseph E. Schwartz
- Division of General Medicine, Columbia University Medical Center, New York, New York
| | - Patricia A. Cassano
- Division of Nutritional Sciences, Weill Cornell Medical College, Ithaca, New York
| | - David Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - George T. O’Connor
- Division of Pulmonary, Allergy, Sleep, and Critical Care, Boston University, Boston, Massachusetts
| | - Sachin Yende
- Department of Critical Care Medicine, University of Pittsburgh and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jason L. Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine and the UAB Lung Health Center, University of Alabama at Birmingham
| | - Paulo H. Chaves
- Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami
| | - Wendy B. White
- Undergraduate Training and Education Center, Tougaloo College, Tougaloo, Mississippi
| | - Elizabeth C. Oelsner
- Division of General Medicine, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York
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GÜNAYDIN FE, KALKAN N, GÜNLÜOĞLU G, AKTEPE EN, DEMİRKOL B, ALTIN S. The relationship between serum levels of surfactant protein D in COPD exacerbation severity and mortality. Turk J Med Sci 2019; 49:888-893. [PMID: 31083857 PMCID: PMC7018249 DOI: 10.3906/sag-1809-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background/aim Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. In COPD patients, various inflammatory markers such as cytokines and acute phase proteins, which show systemic inflammation in the circulation, increase during exacerbations. In our study, we aimed to determine the relationship between serum SP-D levels and exacerbation severity, clinical course of the disease, and early mortality after discharge. Materials and methods Fifty hospitalized patients with COPD acute exacerbation (46 male and 4 female) were recruited in this study. Thirty-three of the subjects (31 male and 2 female) were reevaluated after discharge. Venous blood samples were taken from all patients and followed up for exacerbation frequency, hospital admission, and mortality for 12 months. Results Serum SP-D levels in the stable period of the patients were lower than exacerbation (P < 0.001). The median exacerbation period SP-D level of the patients admitted to emergency department in the first month was statistically significantly higher than that of the patients who were not admitted (P < 0.05) after discharge. There was a correlation between the rate of emergency admission and serum SP-D levels during the 12-month period after discharge (P = 0.04 (r = 0.29)). Conclusion Our study showed that serum SP-D was found to be a useful biomarker in predicting emergency admission and predictor of the health status of COPD patients but did not predict early mortality after the exacerbation.
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Affiliation(s)
- Fatma Esra GÜNAYDIN
- Department of Allergy and Immunology, Faculty of Medicine, Uludağ University, BursaTurkey
| | - Nurdan KALKAN
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Gülşah GÜNLÜOĞLU
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Esma Nur AKTEPE
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Barış DEMİRKOL
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Sedat ALTIN
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
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Zang E, Zheng H, Yang YC, Land KC. Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns. Int J Epidemiol 2019; 48:934-944. [PMID: 30508118 PMCID: PMC6934031 DOI: 10.1093/ije/dyy255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear. METHODS Using official mortality data, we study US annual mortality rates for ages 25-54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities. RESULTS We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns. CONCLUSIONS We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.
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Affiliation(s)
- Emma Zang
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Hui Zheng
- Department of Sociology, Ohio State University, Columbus, OH, USA
| | - Yang Claire Yang
- Department of Sociology, Lineberger Cancer Center, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth C Land
- Department of Sociology and Social Science Research Institute, Duke University, Durham, NC, USA
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96
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Riise G, Svanberg T, Samuelsson O. [Severe COPD can benefit from endobronchial valves]. Lakartidningen 2019; 116:FLM3. [PMID: 31192398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lung volume reduction using endobronchial one-way valves (EBV) have been introduced as a new treatment for end-stage COPD and emphysema. They cause the lung parenchyma distal to the valve to collapse by causing an atelectasis. Nine randomized controlled trials (RCTs) studying the effects of insertion of EBVs in patients with severe emphysema were identified. In two of the RCTs both lungs were treated whereas in seven a unilateral approach was used. In comparison with optimal medical therapy, unilateral placement of EBVs resulted in clinically and statistically significant improvements in lung function, quality of life, and physical capacity in patients with heterogeneous or homogeneous emphysema. There were no significant differences in mortality. The frequency of serious complications and adverse events, especially pneumothorax, was higher. Bilateral EBV treatment did not show corresponding improvements in the outcome variables.
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Affiliation(s)
- Gerdt Riise
- Sahlgrenska universitetssjukhuset - Lungmedicin Goteborg, Sweden - Respiratory Medicine Gothenburg, Sweden
| | - Therese Svanberg
- Sahlgrenska universitetssjukhuset - HTA-centrum Goteborg, Sweden Sahlgrenska universitetssjukhuset - HTA-centrum Goteborg, Sweden
| | - Ola Samuelsson
- Njurmedicinska kliniken - Göteborg, Sweden Njurmedicinska kliniken - Göteborg, Sweden
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97
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Gershon AS, Thiruchelvam D, Aaron S, Stanbrook M, Vozoris N, Tan WC, Cho E, To T. Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study. PLoS One 2019; 14:e0216741. [PMID: 31112573 PMCID: PMC6528994 DOI: 10.1371/journal.pone.0216741] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities. METHODS A population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death. RESULTS There were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01-1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk. INTERPRETATION Socioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death.
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Affiliation(s)
- Andrea S. Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | - Deva Thiruchelvam
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shawn Aaron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew Stanbrook
- Asthma & Airway Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicholas Vozoris
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eunice Cho
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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98
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Andell P, James S, Östlund O, Yndigegn T, Sparv D, Pernow J, Jernberg T, Lindahl B, Herlitz J, Erlinge D, Hofmann R. Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial. Eur Heart J Acute Cardiovasc Care 2019; 9:984-992. [PMID: 31081342 DOI: 10.1177/2048872619848978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction. METHODS AND RESULTS A total of 6629 patients with suspected acute myocardial infarction were randomly assigned in the DETO2X-AMI trial to oxygen or ambient air. In the oxygen group (n=3311) and the ambient air group (n=3318), 155 and 141 patients, respectively, had chronic obstructive pulmonary disease (prevalence of 4.5%). Patients with chronic obstructive pulmonary disease were older, had more comorbid conditions and experienced a twofold higher risk of death at one year (chronic obstructive pulmonary disease: 32/296 (10.8%) vs. non-chronic obstructive pulmonary disease: 302/6333 (4.8%)). Oxygen therapy compared to ambient air was not associated with improved outcomes at 365 days (chronic obstructive pulmonary disease: all-cause mortality hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.50-1.99, Pinteraction=0.96); cardiovascular death HR 0.80, 95% CI 0.32-2.04, Pinteraction=0.59); rehospitalisation with acute myocardial infarction or death HR 1.27, 95% CI 0.71-2.28, Pinteraction=0.46); hospitalisation for heart failure or death HR 1.08, 95% CI 0.61-1.91, Pinteraction=0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions. CONCLUSIONS Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings. CLINICAL TRIALS REGISTRATION NCT02290080.
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Affiliation(s)
- Pontus Andell
- Unit of Cardiology, Karolinska Institutet, Sweden
- Department of Cardiology, Lund University, Sweden
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Sweden
- Department of Medical Sciences, Uppsala University, Sweden
| | - Ollie Östlund
- Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - David Sparv
- Department of Cardiology, Lund University, Sweden
| | - John Pernow
- Unit of Cardiology, Karolinska Institutet, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Johan Herlitz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
- Department of Health Sciences, University of Borås, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
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99
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Celli BR, Anderson JA, Brook R, Calverley P, Cowans NJ, Crim C, Dixon I, Kim V, Martinez FJ, Morris A, Newby DE, Yates J, Vestbo J. Serum biomarkers and outcomes in patients with moderate COPD: a substudy of the randomised SUMMIT trial. BMJ Open Respir Res 2019; 6:e000431. [PMID: 31258919 PMCID: PMC6561388 DOI: 10.1136/bmjresp-2019-000431] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 03/29/2019] [Indexed: 11/25/2022] Open
Abstract
Rationale Systemic levels of C reactive protein (CRP), surfactant protein D (SPD), fibrinogen, soluble receptor of activated glycogen end-product (sRAGE) and club cell protein 16 (CC-16) have been associated with chronic obstructive pulmonary disease (COPD) outcomes. However, they require validation in different cohorts. Objectives Relate systemic levels of those proteins to forced expiratory volume in 1 s (FEV1) decline, exacerbations, hospitalisations and mortality in COPD patients (FEV1 of ≥50 and ≤70% predicted) and heightened cardiovascular risk in a substudy of the Study to Understand Mortality and MorbidITy trial. Methods Participants were randomised to daily inhalations of placebo, vilanterol 25 µg (VI), fluticasone furoate 100 µg (FF) or their combination (VI 25/FF 100) and followed quarterly until 1000 deaths in the overall 16 485 participants occurred. Biomarker blood samples were available from 1673 patients. The FEV1 decline (mL/year), COPD exacerbations, hospitalisations and death were determined. Associations between biomarker levels and outcomes were adjusted by age and gender. Results Systemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen did not relate to baseline FEV1, FEV1 decline, exacerbations or hospitalisations. Fibrinogen and CRP were related to mortality over a median follow-up of 2.3 years. Only the CC-16 changed with study therapy (VI, FF and FF/VI, p<0.01) at 3 months. Conclusions In COPD, systemic levels of CC-16, CRP, sRAGE, SPD and fibrinogen were not associated with FEV1 decline, exacerbations or hospitalisations. These results cast doubts about the clinical usefulness of the systemic levels of these proteins as surrogate markers of these COPD outcomes. The study confirms that CRP and fibrinogen are associated with increased risk of death in patients with COPD. Trial registration number NCT01313676.
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Affiliation(s)
- Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie A Anderson
- Research & Development, GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
| | - Robert Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Calverley
- Department of Medicine, Clinical Sciences Centre, University of Liverpool, University Hospital Aintree, Liverpool, Liverpool, UK
| | - Nicholas J Cowans
- GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
- Veramed Ltd, Twickenham, UK
| | - Courtney Crim
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - Ian Dixon
- GlaxoSmithKline Plc Stockley Park, Uxbridge, Middlesex, UK
- Veramed Ltd, Twickenham, UK
| | - Victor Kim
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine Samuel J Wood Library, New York City, New York, USA
| | - Andrea Morris
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Julie Yates
- GlaxoSmithKline Research Triangle Park, Research Triangle Park, North Carolina, USA
| | - Joergen Vestbo
- Division of Infection, Immunity and Respiratory Medicine and Allergy, Manchester Academic Health Science Centre, The University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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100
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Trethewey SP, Edgar RG, Morlet J, Mukherjee R, Turner AM. Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV. Respir Med 2019; 151:128-132. [PMID: 31047109 DOI: 10.1016/j.rmed.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) refractory to medical management in patients with COPD. This study investigated the relationship between time from hospital presentation to diagnosis of AHRF and in-hospital mortality. METHODS Retrospective analysis of hospitalised COPD patients treated with a first episode of ward-based NIV for AHRF at a large UK teaching hospital between 2004 and 2017. Data collected prospectively as part of NIV service evaluation. Multivariable logistic regression performed to identify predictors of in-hospital mortality. RESULTS In total, 547 unique patients were studied comprising 245 males (44.8%), median age 70.6 years, median FEV1% predicted 34%. Overall in-hospital mortality was 19% (n = 104); median survival was 1.7 years. In univariate analysis, a longer time between hospital presentation to diagnosis of AHRF was associated with in-hospital mortality (median [IQR]: 8.7 [0.7-75.8] hours vs. 1.9 [0.3-13.6] hours, p < 0.0001). In multivariable logistic regression, significant predictors of in-hospital mortality were AHRF >24 h after hospital presentation (odds ratio [95% CI]: 2.29 [1.33-3.95], p = 0.003), pneumonia on admission (1.81 [1.07-3.08], p = 0.027), increased age (1.10 [1.07-1.14], p < 0.001) and NIV as ceiling of treatment (5.86 [2.87-11.94], p < 0.001). CONCLUSIONS Hospitalised COPD patients with late presentation of AHRF, requiring acute ward-based NIV, may have increased in-hospital mortality. These patients may benefit from closer monitoring and earlier specialist respiratory review.
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Affiliation(s)
- Samuel P Trethewey
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ross G Edgar
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julien Morlet
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rahul Mukherjee
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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