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Wang X, Cui X, Fan H, Hu T. Elevated Triglyceride-Glucose (TyG) Index Predicts Poor Clinical Outcomes in Critically Ill AECOPD Patients: A Retrospective Study. Int J Chron Obstruct Pulmon Dis 2024; 19:2217-2228. [PMID: 39371919 PMCID: PMC11453155 DOI: 10.2147/copd.s477268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 09/22/2024] [Indexed: 10/08/2024] Open
Abstract
Purpose The triglyceride-glucose (TyG) index is a surrogate biomarker of insulin resistance which has been widely used in intensive care unit (ICU) to predict prognosis. However, its role in critically ill acute exacerbation of COPD (AECOPD) patients remains largely unknown. Material and methods A total of 645 AECOPD patients were induced in this retrospective cohort study, which extracted data from the eICU Collaborative Research Database (eICU-CRD). The TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). The primary endpoint includes in-hospital mortality and ICU mortality. The secondary endpoint was sepsis, acute kidney injury (AKI), and acute respiratory failure (ARF). Results Multivariable Cox regression analysis revealed that the TyG index was independently associated with an increased risk of in-hospital mortality (hazard ratio, HR: 1.45, 95% CI: 1.04-2.01, P = 0.028) and ICU mortality (HR: 2.13, 95% CI: 1.28-3.54, P = 0.004). Moreover, the TyG index was independently associated with an increased risk of sepsis (odds ratio, OR: 1.54, 95% CI: 1.24-1.93, P < 0.001), AKI (OR: 1.57, 95% CI: 1.26-2.02, P < 0.001) and ARF (OR: 1.50, 95% CI: 1.20-1.87, P < 0.001). Kaplan-Meier survival analysis revealed that higher TyG indexes were also related to increased in-hospital mortality and ICU mortality. In addition, the restricted cubic splines regression model demonstrated that the in-hospital mortality and ICU mortality increased linearly with increasing TyG index (P for non-linearity = 0.897, P for non-linearity = 0.897, respectively). Conclusion Elevated TyG index was independently associated with an increased risk of poor clinical outcomes in critically ill AECOPD patients. A prospective study to define TyG as a biomarker for prognosis prediction in critically ill AECOPD patients is warranted.
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Affiliation(s)
- Xin Wang
- Department of Respiratory and Critical Care Medicine, Deyang People’s Hospital, Deyang, Sichuan, 618099, People’s Republic of China
| | - Xuerong Cui
- Department of Respiratory Medicine, People’s Hospital of Shizhu Tujia Autonomous County, Chongqing, 409199, People’s Republic of China
| | - Huaping Fan
- Department of Cardiology, 63650 Military Hospital, Urumqi, Xinjiang, 841700, People’s Republic of China
| | - Tianyang Hu
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
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Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
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Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Wang JJ, Zhou Z, Zhang LY. Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure. World J Clin Cases 2023; 11:6040-6050. [PMID: 37731551 PMCID: PMC10507537 DOI: 10.12998/wjcc.v11.i26.6040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND At present, understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease (COPD) patients experiencing acute worsening symptoms and respiratory failure remains relatively limited. This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation. AIM To determine whether pressure-controlled ventilation (PCV) can lower peak airway pressures (PAPs) and reduce the incidence of barotrauma compared to volume-controlled ventilation (VCV), without compromising clinical outcomes and oxygenation parameters. METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation, with 400 receiving mechanical ventilation for the respiratory failure. The participants were divided into two different groups, who were administered either VCV or PCV, along with appropriate management. We thereafter observed patients' attributes, clinical factors, and laboratory, radiographic, and arterial blood gas evaluations at the start and during their stay in the intensive care unit (ICU). We have also employed appropriate statistical methods for the data analysis. RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate, tidal volume, and arterial blood gas values during their time in the ICU. However, no significant distinctions were detected between the groups in terms of oxygenation indices (partial pressures of oxygen/raction of inspired oxygen ratio) and partial pressures of carbon dioxide improvements. There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality (32% vs 28%, P = 0.53), the number of days of ICU stay [median interquartile range (IQR): 9 (6-14) d vs 8 (5-13) d, P = 0.41], or the duration of the mechanical ventilation [median (IQR): 6 (4-10) d vs 5 (3-9) d, P = 0.47]. The PCV group displayed lower PAPs compared to the VCV group (P < 0.05) from the beginning of mechanical ventilation until extubation or ICU departure. The occurrence of barotrauma was considerably lower in the PCV group in comparison to the VCV group (6% vs 16%, P = 0.03). CONCLUSION Both VCV and PCV were found to be effective in treating patients with acute COPD exacerbation. However, PCV was associated with lower PAPs and a significant decrease in barotrauma, thus indicating that it might be a safer ventilation method for this group of patients. However, further large-scale study is necessary to confirm these findings and to identify the best ventilation approach for patients experiencing an acute COPD exacerbation.
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Affiliation(s)
- Jun-Jun Wang
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Yangquan City, Yangquan 045000, Shanxi Province, China
| | - Zhong Zhou
- Department of Respiratory and Critical Care Medicine, Guiyang Public Health Treatment Center, Guiyang 550001, Guizhou Province, China
| | - Li-Ying Zhang
- Department of Respiratory and Critical Care Medicine, The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200023, China
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Khan KS, Jawaid S, Memon UA, Perera T, Khan U, Farwa UE, Jindal U, Afzal MS, Razzaq W, Abdin ZU, Khawaja UA. Management of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations in Hospitalized Patients From Admission to Discharge: A Comprehensive Review of Therapeutic Interventions. Cureus 2023; 15:e43694. [PMID: 37724212 PMCID: PMC10505355 DOI: 10.7759/cureus.43694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common and debilitating condition that often necessitates hospitalization for exacerbations. Since COPD exacerbations can cause significant morbidity and mortality, managing them is crucial for patient care. Effective management of COPD exacerbations is essential to prevent complications, as COPD exacerbations are associated with increased healthcare costs and decreased quality of life. This review aims to comprehensively discuss the management of COPD exacerbations, covering various pharmacologic and non-pharmacologic strategies. These include inhaled bronchodilators, systemic steroids, antibiotics, invasive and non-invasive ventilation, oxygen therapy, smoking cessation, immunization with pneumococcal vaccine, inhalers at discharge, pulmonary rehabilitation, long-term oxygen therapy (LTOT), ambulatory oxygen therapy, short-burst oxygen therapy, extracorporeal membrane oxygenation (ECMO), lung volume reduction surgery (LVRS), endobronchial procedures, and lung transplant. It is drawn upon various sources, including clinical studies, systemic reviews, and observational studies, to provide a comprehensive overview of current practices and identify areas for future research and innovation in managing COPD exacerbations. Addressing these areas of interest can improve patient outcomes and quality of life.
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Affiliation(s)
- Khizar S Khan
- Basic Sciences, Foundation University Medical College, Islamabad, PAK
| | - Sanyah Jawaid
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Unaib Ahmed Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Tharindu Perera
- General Medicine, Grodno State Medical University, Grodno, BLR
| | - Usman Khan
- General Practice, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Umm E Farwa
- Emergency Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Urmi Jindal
- Internal Medicine, KJ Somaiya Medical College, Mumbai, IND
| | | | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Uzzam Ahmed Khawaja
- Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Clinical and Translational Research, Dr Ferrer BioPharma, South Miami, USA
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Liu W, Guo H, Wang J, Ding F. Effect of spontaneous breathing trial on extubation in patients with acute exacerbation of chronic obstructive pulmonary disease under mechanical ventilation. BMC Emerg Med 2022; 22:112. [PMID: 35729524 PMCID: PMC9210748 DOI: 10.1186/s12873-022-00672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate how spontaneous breathing trial (SBT) affects successful extubation and prognosis in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients under mechanical ventilation. Methods AECOPD patients under invasive mechanical ventilation were recruited into the study and divided into the SBT and non-SBT groups. SBT patients received SBT for 60 min before extubation, while non-SBT patients that met weaning criteria were immediately extubated without SBT. Results A total of 64 patients were enrolled in analysis, including 32 in SBT group and 32 in non-SBT group. Patients in the two groups had similar baseline demographics and clinical characteristics (all parameters: p = > 0.05). Four (12.5%) patients in the SBT group and 5 (15.6%) in the non-SBT group were reintubated in 48 h of extubation (p = 0.821). During the 28-day follow-up after extubation, 3 patients died, 1 (3.1%) in the SBT group and 2 (6.3%) in the non-SBT group (p = 0.554). Conclusion Our findings indicate that SBT did not affect extubation success, in-hospital mortality, and 28-day survival in AECOPD patients under mechanical ventilation.
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Affiliation(s)
- Wenjing Liu
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, 053000, China.
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital Affiliated to Hebei Medical University, 180 Middle Renmin Road, Hengshui, 053000, China
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, 053000, China
| | - Fang Ding
- Department of Gerontology, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, 053000, China
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Li Z, Zhang Y, Wang J, Xu D, Jing J, Jiang M, Li F. Difference of body surface temperature in stable chronic obstructive pulmonary disease patients with different degree of airflow limitation. Heart Lung 2022; 52:130-135. [PMID: 35016108 DOI: 10.1016/j.hrtlng.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to investigate the changes of body surface temperature of stable chronic obstructive pulmonary disease (COPD) patients and explore its clinical significance for the progression of COPD. OBJECTIVES The aim of this study was to explore the correlation between body surface temperature and disease severity in COPD patients. METHODS From May 2015 to May 2016, the patients who were diagnosed as COPD at stable phase (n = 148) were enrolled in this study. The subjects in control group (n = 49) were healthy people. The patients' general condition modified Medical Research Council (mMRC) dyspnea scale and the COPD assessment test (CAT) score were recorded, and pulmonary function of patients was determined. Back average temperature measurement was made using a thermal infrared imager (DT-9875, CEM, China). RESULTS Patients in the COPD group had significantly lower mean temperatures of the back than those in the control group. The mean temperature of the back presented a decreased tendency with the aggravation of airflow limitation. Correlation analysis revealed that in the COPD group, the back temperature was negatively correlated with smoking index and mMRC score. FEV1%, FVC% and FEV1/FVC were positively correlated with pulmonary function. Smoking showed a tendency to lower the back temperature of COPD patients. CONCLUSIONS This study preliminarily suggested that the body surface temperature of COPD patients decreased compared with that of healthy people, which may be associated with the dysfunction of autonomic nerve, increased basal metabolic rate, metabolic syndrome and peripheral nerve injury in COPD patients.
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Affiliation(s)
- Zheng Li
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China
| | - Yanxin Zhang
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China
| | - Jing Wang
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China; Key Laboratory of Xinjiang Uygur Autonomous Region (Respiratory Disease), Xinjiang, China
| | - Dan Xu
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China
| | - Jing Jing
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China
| | - Min Jiang
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China; Key Laboratory of Xinjiang Uygur Autonomous Region (Respiratory Disease), Xinjiang, China
| | - Fengsen Li
- The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Xinjiang, China; National Clinical Research Base of Traditional Chinese Medicine, Xinjiang, China.
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Richness of sputum microbiome in acute exacerbations of eosinophilic chronic obstructive pulmonary disease. Chin Med J (Engl) 2020; 133:542-551. [PMID: 32053571 PMCID: PMC7065869 DOI: 10.1097/cm9.0000000000000677] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The eosinophilic chronic obstructive pulmonary disease (COPD) is known to be more sensitive to corticosteroid. The sputum microbiome has been shown to affect COPD prognosis, but its role in acute exacerbations of eosinophilic COPD is unclear. This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD. METHODS Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups. Patients with eosinophils ≥300 cells/μL in the peripheral venous blood were assigned to the eosinophilic group (Eos) and the rest to the non-eosinophilic group (Noneos). All patients received similar treatment including inhaled budesonide according to the guidelines. The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA (rRNA) method. The levels of interleukin (IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells. Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test. Categorical data were evaluated using Chi-squared test or Fisher's exact test. RESULTS Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group. Prior to treatment, the alpha diversity (Shannon index) (2.65 ± 0.63 vs. 2.56 ± 0.54, t = 0.328, P = 0.747) and the structure of the sputum microbiome were similar in the Eos group and the Noneos group. After 7 days of treatment, alpha diversity increased in both groups, while the microbiome richness (Ace index) was significantly lower in the Eos group (561.87 ± 109.13 vs. 767.88 ± 148.48, t = -3.535, P = 0.002). At the same time, IL-6 (12.09 ± 2.85 pg/mL vs. 15.54 ± 2.45 pg/mL, t = -4.913, P < 0.001) and IL-8 (63.64 ± 21.69 pg/mL vs. 78.97 ± 17.13 pg/mL, t = -2.981, P = 0.004) decreased more significantly in the Eos group, and the percentages of inhibition of IL-8 at dexamethasone concentrations 10 to 10 mol/L were significantly higher in the Eos group than those in the Noneos group (all P < 0.05). CONCLUSIONS The induced sputum microbiome richness decreased more significantly following treatment in the Eos patients compared to the Noneos patients. The lower plasma inflammatory factor levels and the higher percentage of inhibition of IL-8 might be due to higher corticosteroid sensitivity in Eos patients.
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Li F, Xu D, Wang J, Jing J, Li Z, Jin X. Comparative proteomics analysis of patients with quick development and slow development Chronic Obstructive Pulmonary Disease (COPD). Life Sci 2020; 256:117829. [PMID: 32454159 DOI: 10.1016/j.lfs.2020.117829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The development of Chronic Obstructive Pulmonary Disease (COPD) has been assessed and divided into slow development (SD), normal development (ND) and quick development (QD). Little is known about the plasma proteome characters among these three phenotypes. METHODS We performed a comparative proteomic analysis in the plasma of normal control (NC), SD, ND and QD phenotype COPD patients using isobaric tags for relative and absolute quantitation (iTRAQ) technique. RESULTS A total of 683 proteins were successfully identified in the plasma samples, of which 394 were considered as high-quality proteins (95% confidential peptides ≥ 2). Further, a total of 25, 19 and 27 different abundant proteins (DAPs) were identified in SD, ND and QD groups, respectively. Gene ontology (GO) classification analysis of all DAPs showed that immune system process (GO:0002376) were the most significant. The pathway enrichment analysis showed that innate immune response (GO:0045087), receptor-mediated endocytosis (GO:0006898) and proteolysis (GO:0006508) were the branch-end terms. Notably, the 15 QD special DAPs were considered as potential markers for identify patient might have quick development COPD, and thus provided more aggressive treatment strategy for these patients. CONCLUSION This work provides an insight into global plasma proteome profiles among the SD, ND and QD phenotypes of COPD patients. The most significant GO terms that the DAPs enriched in were immune system related terms. In addition, the 15 QD specific DPAs provided candidates of potential markers to predict the development types of COPD patients.
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Affiliation(s)
- Fengsen Li
- National Clinical Research Base of Traditional Chinese Medicine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China.
| | - Dan Xu
- National Clinical Research Base of Traditional Chinese Medicine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | - Jing Wang
- Xinjiang Key Laboratory Respiratory Disease Research, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | - Jing Jing
- National Clinical Research Base of Traditional Chinese Medicine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | - Zheng Li
- National Clinical Research Base of Traditional Chinese Medicine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | - Xiang Jin
- Shenzhen Omics Medical Research Center, Shenzhen 518053, China
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COVID-19 Hospitalizations in Mexico, Carrillo G, Méndez-domínguez N, Santos-zaldivar KD, Rochel-pérez A, Azuela-morales M, Cuevas-koh O, Álvarez-baeza A. Clinical course and severity outcome indicators among COVID-19 hospitalized patients in relation to comorbidities distribution: Mexican cohort.. [DOI: 10.1101/2020.07.31.20165480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
AbstractIntroductionCOVID-19 affected worldwide, causing to date, around 500,000 deaths. In Mexico, by April 29, the general case fatality was 6.52%, with 11.1% confirmed case mortality and hospital recovery rate around 72%. Once hospitalized, the odds for recovery and hospital death rates depend mainly on the patients’ comorbidities and age. In Mexico, triage guidelines use algorithms and risk estimation tools for severity assessment and decision-making. The study’s objective is to analyze the underlying conditions of patients hospitalized for COVID-19 in Mexico concerning four severity outcomes.Materials and MethodsRetrospective cohort based on registries of all laboratory-confirmed patients with the COVID-19 infection that required hospitalization in Mexico. Independent variables were comorbidities and clinical manifestations.Dependent variables were four possible severity outcomes(a) pneumonia, (b) mechanical ventilation (c) intensive care unit, and (d) death; all of them were coded as binary Results: We included 69,334 hospitalizations of laboratory-confirmed and hospitalized patients to June 30, 2020. Patients were 55.29 years, and 62.61% were male. Hospital mortality among patients aged<15 was 9.11%, 51.99% of those aged >65 died. Male gender and increasing age predicted every severity outcome. Diabetes and hypertension predicted every severity outcome significantly. Obesity did not predict mortality, but CKD, respiratory diseases, cardiopathies were significant predictors.ConclusionObesity increased the risk for pneumonia, mechanical ventilation, and intensive care admittance, but it was not a predictor of in-hospital death. Patients with respiratory diseases were less prone to develop pneumonia, to receive mechanical ventilation and intensive care unit assistance, but they were at higher risk of in-hospital death.
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Shin B, Kim SH, Yong SJ, Lee WY, Park S, Lee SJ, Lee SJ, Lee MK. Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chron Respir Dis 2020; 16:1479972318809480. [PMID: 30428701 PMCID: PMC6301835 DOI: 10.1177/1479972318809480] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. Pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. We performed a prospective cohort study to evaluate the prognosis of AECOPD patients with or without community-acquired pneumonia (CAP) who hospitalized from January 2012 to December 2015. We investigated mortality and readmission rates within 6 months after the first admission between two groups and analyzed the difference of survival rate according to readmission duration (≤30 vs. >30 days) or intensive care unit (ICU) treatment. Total 308 AECOPD patients (134 with CAP and 174 without CAP) were enrolled. The mean age was 72.3 ± 9.5 years old, and 235 patients (76.3%) were male. The 180-day mortality was higher in AECOPD with CAP than without CAP (24.6% vs. 13.2%; hazard ratio (HR): 1.982; 95% CI: 1.164–3.375; p = 0.012). However, readmission rate showed no significant difference between two groups (51.5% vs. 46.6%; HR: 1.172; 95% CI: 0.850–1.616; p = 0.333). It showed a significantly lower survival rate in AECOPD with CAP rather than without CAP when were readmitted within 30 days (HR: 1.738; 95% CI:1.063–3.017; p = 0.031). According to ICU treatment, survival rate was not significantly different between two groups. Multivariate analysis revealed the readmission within 30 days (p < 0.001), serum hemoglobin concentration (p = 0.010), and albumin level (p = 0.049) were significantly associated with 180-day mortality of AECOPD with CAP. AECOPD with CAP showed lower survival rate than AECOPD without CAP during 6 months. Early readmission within 30 days was significantly associated with an increased risk of mortality.
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Affiliation(s)
- Beomsu Shin
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sang-Ha Kim
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Suk Joong Yong
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Won-Yeon Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sunmin Park
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sang Jun Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Seok Jeong Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Myoung Kyu Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea.,2 Department of Evidence Based Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
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11
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Gong C, Yang Y, Chen M, Xie Z. Effect of procalcitonin on the prognosis of patients with COPD. Biomed Rep 2020; 12:313-318. [PMID: 32382415 PMCID: PMC7201139 DOI: 10.3892/br.2020.1298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to investigate the effect of procalcitonin levels on the prognosis of chronic obstructive pulmonary disease (COPD), and its relationship with other indices of infection. Inpatients diagnosed with acute aggravation of COPD between January 2017 and June 2018 were enrolled in the present study. Troponin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, percentage of neutrophils (NE%), hospitalization days and hospitalization expenses were collected and followed up for half a year to observe the survival rate in patients with COPD and the risk of acute aggravation. There were 246 patients with procalcitonin (PCT) levels <0.1 ng/ml, among whom 55 were randomly selected and assigned to a PCT negative group; and another 55 patients with PCT levels ≥0.1 ng/ml were assigned to a PCT positive group. The serum CRP, ESR, WBC count, NE% and hospitalization expenses in the PCT positive group were significantly higher compared with the PCT negative group (P<0.05). There was a positive association between PCT levels and CRP, WBC, NE% and hospitalization expenses, but not between PCT and ESR. The number of AECOPD events occurring within half a year between the two groups was statistically significant (χ²=5.923; P<0.05), and there was no significant correlation between PCT and recurrence frequency. Together, the results of the present study suggest that the levels of PCT in patients with acute aggravation may reflect the severity of COPD and may be used as a reference value for prognostic risk assessment. Serum PCT levels may be used as an indicator to predict duration and cost of hospitalization.
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Affiliation(s)
- Chen Gong
- Geriatrics Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Ying Yang
- Geriatrics Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Minli Chen
- Geriatrics Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Zhengfu Xie
- Geriatrics Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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12
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Azzini AM, Dorizzi RM, Sette P, Vecchi M, Coledan I, Righi E, Tacconelli E. A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:610. [PMID: 32566636 PMCID: PMC7290560 DOI: 10.21037/atm-20-1855] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Biomarkers to guide antibiotic treatment decisions have been proposed as an effective way to enhancing a more appropriate use of antibiotics. As a biomarker, procalcitonin (PCT) has been found to have good specificity to distinguish bacterial from non-bacterial inflammations. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT serum concentration. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. As outlined by the Evidence Based Laboratory Medicine (EBLM), not only the pre-test probability but also the positive likelihood ratio influence the performance of a test do be really diagnostic. This aspect should be taken into account in the interpretation of the results of clinical trials evaluating the performance of PCT in guiding antibiotic therapy.
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Affiliation(s)
- Anna Maria Azzini
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Romolo Marco Dorizzi
- Clinical Pathology Unit, Department of Pathology, Transfusion and Laboratory Medicine, Ravenna, Italy
| | - Piersandro Sette
- Hospital Management and Organization Department, Hospital of San Bonifacio, San Bonifacio, VR, Italy
| | - Marta Vecchi
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ilaria Coledan
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elda Righi
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tubingen, Tubingen, Germany
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Ruby D. The Impact of Community-acquired Pneumonia on Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients as Regards In-hospital Complications and Early Readmission. Open Respir Med J 2020; 14:10-15. [PMID: 32509036 PMCID: PMC7254821 DOI: 10.2174/1874306402014010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/06/2020] [Accepted: 03/20/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pneumonia is a major reason for hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease patients (AECOPD). There is limited data available on the outcomes of AECOPD patients with or without pneumonia. Therefore, the study investigates the prognosis of AECOPD patients with or without Community-acquired Pneumonia (CAP), concerning the Length of Hospital Stay (LOS), in-hospital complications and early readmission. METHODS This study was carried out on 100 male COPD patients without CAP, 90 patients with CAP who were admitted to the chest department of Ain Shams University hospital over a 1-year period. Data collection about LOS, in-hospital complications, was recorded and they were followed for 30 days to detect acute readmission. RESULTS The mean age was 64± 8 years old in COPD patients without CAP to 62± 12year old in patients with CAP, LOS in COPD patients with CAP was 11.30 ± 3.23 days to 7.57 ± 2.24 in patients without CAP, COPD patients with CAP had a higher rate of complications in comparison to those without CAP as 45.6%, 13% were admitted to Intensive Care Unit (ICU) respectively, 15.6%, 3% were mechanically ventilated respectively. LOS and C- Reactive Protein (CRP) were significant causes for readmission in COPD patients with and without CAP. CONCLUSION COPD patients with CAP had longer LOS and more short term complications as ICU admission, mechanical ventilation and higher readmission rate in comparison to COPD patients without CAP.
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Affiliation(s)
- Dina Ruby
- Chest Department, Ain Shams University, Cairo, Egypt
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14
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Hogea SP, Tudorache E, Fildan AP, Fira-Mladinescu O, Marc M, Oancea C. Risk factors of chronic obstructive pulmonary disease exacerbations. CLINICAL RESPIRATORY JOURNAL 2020; 14:183-197. [PMID: 31814260 DOI: 10.1111/crj.13129] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/07/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterised by persistent respiratory symptoms and airflow limitation. COPD has a major impact on public health, mainly because of its increasing prevalence, morbidity and mortality. The natural course of COPD is aggravated by episodes of respiratory symptom worsening termed exacerbations that contribute to disease progression. Acute Exacerbations of COPD (AECOPD) can be triggered by a multitude of different factors, including respiratory tract infections, various exposures, prior exacerbations, non-adherence to treatment and associated comorbidities. AECOPD are associated with an inexorable decline of lung function and a significantly worse survival outcome. This review will summarise the most important aspects regarding the impact of different factors that contribute to COPD exacerbations.
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Affiliation(s)
- Stanca-Patricia Hogea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Ariadna Petronela Fildan
- Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta Faculty of Medicine, Constanta, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Monica Marc
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
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Gu YL, Pang J, Sun ZX, Hu J, Sun Y, Wu XW, Guo JJ, Yang GS. Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis. J Clin Pharm Ther 2020; 45:419-429. [PMID: 31954070 DOI: 10.1111/jcpt.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/14/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Corticosteroids are recommended by almost all international guidelines for the management of exacerbations of chronic obstructive pulmonary disease (COPD). Nevertheless, due to their side effects, there are still concerns regarding the use of systemic corticosteroids (SCs). The Global Initiative for Chronic Obstructive Lung Disease guideline states nebulized budesonide (NB) may be a suitable alternative to SCs for treating COPD exacerbations. We conducted this study to systematically compare the efficacies of NB and SCs by using a meta-analysis. METHODS PubMed, EMBASE and Cochrane Library databases were searched from database inception to 10 October 2019. Our main end points were change in pulmonary function and blood gas analysis. Secondary end points were numbers of exacerbations and hyperglycaemia. RESULTS AND DISCUSSION Of 645 identified studies, 6 were eligible and were included in our analysis (N = 867 participants). Compared with SCs, NB was non-inferior on the change in FEV1 %predicted at 24 hours, 48-72 hours and 5-7 days; FEV1 at 5-7 days; FEV1 /FVC at 7 days. For blood gas analysis, our meta-analysis indicated that PaO2 , PaCO2 at 24 hours, 48-72 hours and 7-10 days and SaO2 at 24 hours and 7-10 days showed a non-significant difference in both groups, whereas the SaO2 was significant higher in NB group at 48-72 hours after treatment. Hyperglycaemia was less frequent with NB (odds ratio, 0.1; 95% CI, 0.01-0.85; P = .04). WHAT IS NEW AND CONCLUSION Based on our meta-analysis, NB was not inferior to SCs when used in the treatment of COPD exacerbations. However, additional well-designed prospective studies are needed to identify the optimal dose of nebulized budesonide and the effects of nebulized budesonide in outpatients, or patients in ICU settings.
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Affiliation(s)
- Yong-Li Gu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Jie Pang
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Zeng-Xian Sun
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Jing Hu
- Department of Pharmacy, Jiangsu Province Hospital, Nanjing, China
| | - Ying Sun
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiao-Wen Wu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Jin-Juan Guo
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Guang-Sheng Yang
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China
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16
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Park HJ, Kim SH, Kim HC, Lee BY, Lee SW, Lee JS, Lee SD, Seo JB, Oh YM. Utility of Computed Tomography in a Differential Diagnosis for the Patients with an Initial Diagnosis of Chronic Obstructive Pulmonary Disease Exacerbation. Tuberc Respir Dis (Seoul) 2019; 82:234-241. [PMID: 31172705 PMCID: PMC6609529 DOI: 10.4046/trd.2018.0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background The utility of computed tomography (CT) in the differential diagnosis of patients with chronic obstructive pulmonary disease (COPD) exacerbation remains uncertain. However, due to the low cost associated with CT scan along with the impact of Koreas' health insurance system, there has been a rise in the number of CT scans in the patients with initial diagnosis of COPD exacerbations. Therefore, the utility of CT in the differential diagnosis was investigated to determine whether performing CT scans affect the clinical outcomes of the patients with an initial diagnosis of COPD exacerbation. Methods This study involved 202 COPD patients hospitalized with an initial diagnosis of COPD exacerbation. We evaluated the change in diagnosis or treatment after performing a CT scan, and compared the clinical outcomes of patient groups with vs. without performing CT (non-CT group vs. CT group). Results After performing CT, the diagnosis was changed for two (3.0%) while additional diagnoses were made for 27 of the 64 patients (42.1%). However, the treatment changed for only one (1.5%), and six patients (9.3%) received supplementary medication. There were no difference in the median length of hospital stay (8 [6–13] days vs. 8 [6–12] days, p=0.786) and intensive care unit care (14 [10.1%] vs. 11 [16.7%], p=0.236) between the CT and non-CT groups, respectively. These findings remained consistent even after the propensity score matching. Conclusion Utility of CT in patients with acute COPD exacerbation might not be helpful; therefore, we do not recommend chest CT scan as a routine initial diagnostic tool.
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Affiliation(s)
- Hyung Jun Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Han Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Young Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won 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
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Beom Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sun J, Zhao G. Clinical effects of lentinan combined with budesonide inhalation in treating acute exacerbation of chronic obstructive pulmonary disease under mechanical ventilation. Exp Ther Med 2019; 17:1503-1508. [PMID: 30867684 PMCID: PMC6395996 DOI: 10.3892/etm.2019.7149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022] Open
Abstract
In the present study, the clinical efficacy of the immune modulator lentinan combined with inhalation of the corticosteroid budesonide in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) under mechanical ventilation was assessed. A total of 72 cases of AECOPD treated at Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Shanghai, China) between June 2016 and September 2017 were enrolled. The AECOPD patients were randomly divided into an experimental group (n=36) and a control group (n=36). All of the patients received ventilator support and endotracheal intubation was performed. The experimental group was orally administered lentinan and budesonide was administered via atomization inhalation through a Y-tube and the control group received only budesonide via Y-tube. After the treatment, airway pressure, the time of mechanical ventilation and the time of stay at the intensive care unit for the experimental group were significantly lower than those for the control group (P<0.001). The plasma levels of adiponectin, D-dimer, interleukin-17 and high-sensitivity C-reactive protein, as well as the pressure of CO2 in the experimental group were significantly lower than those in control group (P<0.001). Furthermore, the partial O2 pressure in the experimental group was significantly higher than that in the control group (P<0.001). After the combined treatment, the proportions of CD3+ and CD4+T-cells in the blood were elevated, while the proportion of CD8+T-cells was decreased, compared with those in the experimental group at baseline or the control group post-treatment. In conclusion, the strategy of lentinan treatment combined with budesonide inhalation for AECOPD patients under mechanical ventilation demonstrated improved clinical efficacy compared with budesonide alone. (Chinese Clinical Trial Registry no. ChiCTR1800019088).
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Affiliation(s)
- Jian Sun
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Gang Zhao
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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18
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Qiao Z, Yu J, Yu K, Zhang M. The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e11631. [PMID: 30075543 PMCID: PMC6081095 DOI: 10.1097/md.0000000000011631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To compare the clinical values of bronchoscopic sputum suction and general sputum suction in respiratory failure patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with sequential invasive-noninvasive mechanical ventilation at the pulmonary infection control (PIC) window (period of lower sputum production, with thinner viscosity and lighter color, and alleviated clinical signs of infection). METHODS Patients with AECOPD-induced respiratory failure received orotracheal intubation mechanical ventilation and were randomly divided into bronchoscopic sputum suction group or general sputum suction group, and who were then treated with sequential invasive-noninvasive mechanical ventilation at PIC window (both groups). Baseline data, postoperative blood gas conditions, and postoperative clinical parameters of the patients such as appearance of PIC window, time of invasive ventilation, total time of ventilation, hospital stay, weaning success rate, reintubation rate, ventilator-associated pneumonia (VAP) incidence, and fatality rate were measured to compare the effect of 2 different ways of sputum suction. RESULTS There was no significant difference in baseline characteristics, postoperative blood gas conditions, between 2 groups (all P > .05). Nevertheless, the bronchoscopic sputum suction group showed earlier appearance of PIC window, shorter time of invasive ventilation, total time of ventilation and hospital stay, lower reintubation rate, VAP incidence and fatality rate, and higher weaning success rate than the general sputum suction group (all P < .05). CONCLUSION Bronchoscopic sputum suction combined with sequential invasive-noninvasive mechanical ventilation at PIC window showed clinical effects in treating respiratory failure patients with AECOPD.
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Affiliation(s)
- Zhihao Qiao
- Department of Critical Care Medicine, Guangdong Tongjiang Hospital, Foshan, Guangdong
| | - Jianghong Yu
- Department of Critical Care Medicine, Guangdong Tongjiang Hospital, Foshan, Guangdong
| | - Kai Yu
- Department of Critical Care Medicine, The First Hospital of Quanzhou, Quanzhou, Fujian, China
| | - Mengya Zhang
- Department of Critical Care Medicine, Guangdong Tongjiang Hospital, Foshan, Guangdong
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Pavliša G, Labor M, Puretić H, Hećimović A, Jakopović M, Samaržija M. Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation. Croat Med J 2018; 58:395-405. [PMID: 29308831 PMCID: PMC5778679 DOI: 10.3325/cmj.2017.58.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim To determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years. Results Of 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit). Conclusion High in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.
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Affiliation(s)
| | - Marina Labor
- Marina Labor, Department of Pulmonology, University Hospital Center Osijek, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia,
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Cruz C, Santos PS, Esquinas A. Acute exacerbations of COPD: reflections of an unfinished story. THE CLINICAL RESPIRATORY JOURNAL 2018; 12:362. [PMID: 27117626 DOI: 10.1111/crj.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/19/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Cristiana Cruz
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra - Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Pedro Silva Santos
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra - Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Antonio Esquinas
- Intensive Care Unit, Hospital Morales Meseguer, Av Marqués de los Vélez, Murcia, 30008, Spain
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Poon T, Paris DG, Aitken SL, Patrawalla P, Bondarsky E, Altshuler J. Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients. J Intensive Care Med 2017; 35:257-263. [PMID: 29161935 DOI: 10.1177/0885066617741470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous literature has suggested that a short course of corticosteroids is similarly effective as an extended course for managing an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, there are limited data regarding the optimal corticosteroid regimen in critically ill patients and the dosing strategies remain highly variable in this population. METHODS This retrospective cohort study evaluated patients with AECOPD admitted to the intensive care unit within a 2-year period. Patients were divided into short-course (≤5 days) or extended-course (>5 days) corticosteroid taper groups. The primary end point was treatment failure, defined as the need for intubation, reintubation, or noninvasive mechanical ventilation. Secondary end points included the duration of mechanical ventilation, hospital and intensive care unit length of stay, and adverse events. RESULTS Of the 151 patients who met the inclusion criteria, 94 received an extended taper and 57 received a short taper. Treatment failure occurred in 3 patients, who were all in the extended taper group (P = .17). In a propensity score-matched cohort, the hospital length of stay was 7 days in the short taper group compared to 11 days in the extended taper group (P < .0001). No differences in adverse events were observed. CONCLUSION A short-course corticosteroid taper in critically ill patients with AECOPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure. A prospective randomized trial is warranted.
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Affiliation(s)
| | | | - Samuel L Aitken
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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A randomized, controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2016; 121:39-47. [PMID: 27888990 DOI: 10.1016/j.rmed.2016.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Almost all international guidelines recommend corticosteroids for management of exacerbations of chronic obstructive pulmonary disease (COPD), because it leads to improved outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Nevertheless, due to its side effects, there are still concerns regarding the use of systemic corticosteroid (SC). Inhaled corticosteroids (IC) can be used as an alternative to SC, while reducing the risk of occurrence of side effects. PURPOSE To measure the clinical efficacy and side effects of nebulized budesonide and systemic methylprednisolone in AECOPD. METHODS Valid data from 410 AECOPD patients in 10 hospitals was collected. Patients were randomly divided into 2 groups; budesonide group, treated with nebulized budesonide (2 mg 3 times/day); and methylprednisolone group, treated with intravenously injected methylprednisolone (40 mg/day). COPD assessment test (CAT), arterial blood gas analysis, hospitalization days, adverse effects, fasting blood glucose, serum creatinine, alanine aminotransferase levels, and blood drug were measured and analyzed in both groups. RESULTS Symptoms, pulmonary function and arterial blood gas analysis were significantly improved after treatment in both groups (P < 0.05), with no significant differences between them (P > 0.05), while incidence of adverse events in the budesonide group was lower (P < 0.05). No significant differences in CAT score, days of admission, blood gas analysis results and physiological and biochemical indexes were found between the two groups. Patients treated with methylprednisolone showed a higher degree of PaO2 level improvement. CONCLUSION Results show that inhalation of budesonide (2 mg 3 times/day) and systemic methylprednisolone (40 mg/day) had similar clinical outcome in AECOPD. In conclusion, inhaled budesonide is an alternative to systemic corticosteroids in AECOPD treatment.
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Gross RD, Prigent H. Chronic Obstructive Pulmonary Disease and Occult Aspiration: A Review of the Recent Literature. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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