1
|
Zhang J, Feng L, Wu H, Fang S. Predictive value of the CURB-65, qSOFA, and APACHE II for in-hospital mortality in patients with acute exacerbation chronic obstructive pulmonary disease. Medicine (Baltimore) 2024; 103:e40022. [PMID: 39465785 DOI: 10.1097/md.0000000000040022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2024] Open
Abstract
This study aimed to evaluate the efficacy of Quick Sequential Organ Failure Assessment, Confusion, Urea, Respiratory Rate, Blood Pressure, and Age Above or Below 65 Years (CURB-65), and Acute Physiology and Chronic Health Evaluation (APACHE) II in predicting the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This retrospective study was conducted on 1583 hospitalized patients diagnosed with AECOPD from 2017 to 2019. Appropriate clinical data were retrieved from medical records from the time of admission up until the patients were discharged. The patients' most severe physiological condition and laboratory data within the first 24 hours of admission were used to determine CURB-65, Quick Sequential Organ Failure Assessment, and APACHE II scores. The accuracy of these 3 instruments in predicting the in-hospital mortality of patients with AECOPD was compared. It was observed that patients who had died had significantly higher APACHE II and CURB-65 scores (P < .05). Binary logistic regression analysis confirmed their significant association with mortality. The APACHE II score had a sensitivity of 91.6% and a specificity of 89.2%, while CURB-65 had a sensitivity of 94% and a specificity of 67.2%. The receiver operating characteristic curves for APACHE II and CURB-65 showed high predictive accuracy (area under the curve, 0.965 and 0.882, P < .001), respectively. Mortality rates substantially increased with higher scores (P < .001), reaching 38.2% for APACHE II scores ≥16 and 15.8% for CURB-65 scores ≥2. Our findings reveal a clear link between higher mortality rates and higher APACHE II and CURB-65 scores. The receiver operating characteristic curves' strong predictive ability highlights the dependability of these scoring systems in assessing the risk of in-hospital mortality, making them useful tools for predicting the outcomes in critical care.
Collapse
Affiliation(s)
- Jingliang Zhang
- Department of Respiratory and Critical Care Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua, China
| | | | | | | |
Collapse
|
2
|
Morantes-Caballero JA, Fajardo Rodriguez HA. Effects of air pollution on acute exacerbation of chronic obstructive pulmonary disease: a descriptive retrospective study (pol-AECOPD). Int J Chron Obstruct Pulmon Dis 2019; 14:1549-1557. [PMID: 31371940 PMCID: PMC6628952 DOI: 10.2147/copd.s192047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/30/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Acute exacerbation of COPD (AECOPD) is among the most frequent causes for hospital admission, causing morbidity and mortality. Infection is the most frequent cause, and studies on pollution have shown higher hospital admission and mortality with inconsistent results. The objective was to identify if there is a change in levels of particulate matter (PM) during the days leading up to the symptom onset. Patients and methods A retrospective study was carried out on medical records of patients with AECOPD from a University Hospital. PM values of the consultation day, onset symptoms, and up to three previous days were recorded. Moreover, clinical presentation, laboratory findings, treatments, and hospital outcomes were recorded. Results A total of 250 medical records were included, mean age of 77 years, hospital stay mean of 6.7 days, 26.8% with no previous exposure was identified, coexistence with asthma was 5%, Obstructive Sleep Apnea Syndrome 15%, Pulmonary Hypertension 34%, antibiotic use 62%, ICU admission of 14% with non-invasive mechanical ventilation of 68%, and in-patient mortality of 2.4%. PM 2.5 of 48 hrs before onset symptoms median was 20.1 μg/m3 versus 15 and 16.5 for the day of symptoms and 3 days prior to onset symptoms (p<0.001). PM 10 of 46.65 μg/m3, versus 39 and 35.6, respectively (p<0.001). Expectoration OR 4.74; Purulence OR 6.58; Pleuritic pain OR 3.62; Antibiotic use OR 2.87, and corticoids use OR 2.62, all with p<0.05. Conclusions Patients with AECOPD have a higher median of particulate matter 48 hrs prior to symptomatic onset, as well as greater use of antibiotics and corticosteroids.
Collapse
Affiliation(s)
- Jairo A Morantes-Caballero
- Department of Internal Medicine, School of Medicine, Universidad Nacional De Colombia, Hospital Universitario Nacional De Colombia, Bogotá, Colombia
| | - Hugo Alberto Fajardo Rodriguez
- Department of Internal Medicine, School of Medicine, Universidad Nacional De Colombia, Hospital Universitario Nacional De Colombia, Bogotá, Colombia
| |
Collapse
|
3
|
Parry A, Higginson R, Gleeson A. End-of-life prognostic indicators in patients with COPD: part 2. Int J Palliat Nurs 2017; 22:560-567. [PMID: 27885911 DOI: 10.12968/ijpn.2016.22.11.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However, exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.
Collapse
Affiliation(s)
- Andy Parry
- Senior Lecturer in Critical Care, School of Care Sciences, Glyntaf Campus, University of South Wales
| | - Ray Higginson
- Senior Lecturer in Critical Care, School of Care Sciences, Glyntaf Campus, University of South Wales
| | - Aoife Gleeson
- Consultant in Palliative Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach
| |
Collapse
|
4
|
Toft-Petersen AP, Torp-Pedersen C, Weinreich UM, Rasmussen BS. Assisted ventilation in COPD - association between previous hospitalizations and mortality. Int J Chron Obstruct Pulmon Dis 2016; 11:935-43. [PMID: 27217743 PMCID: PMC4860999 DOI: 10.2147/copd.s97830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In general, previous studies have shown an association between prior exacerbations and mortality in COPD, but this association has not been demonstrated in the subpopulation of patients in need of assisted ventilation. We examined whether previous hospitalizations were independently associated with mortality among patients with COPD ventilated for the first time. PATIENTS AND METHODS In the Danish National Patient Registry, we established a cohort of patients with COPD ventilated for the first time from 2003 to 2011 and previously medicated for obstructive airway diseases. We assessed the number of hospitalizations for COPD in the preceding year, age, sex, comorbidity, mode of ventilation, survival to discharge, and days to death beyond discharge. RESULTS The cohort consisted of 6,656 patients of whom 66% had not been hospitalized for COPD in the previous year, 18% once, 8% twice, and 9% thrice or more. In-hospital mortality was 45%, and of the patients alive at discharge, 11% died within a month and 39% within a year. In multivariate models, adjusted for age, sex, mode of ventilation, and comorbidity, odds ratios for in-hospital death were 1.26 (95% confidence interval [CI]: 1.11-1.44), 1.43 (95% CI: 1.19-1.72), and 1.56 (95% CI: 1.30-1.87) with one, two, and three or more hospitalizations, respectively. Hazard ratios for death after discharge from hospital were 1.32 (95% CI: 1.19-1.46), 1.76 (95% CI: 1.52-2.02), and 2.07 (95% CI: 1.80-2.38) with one, two, and three or more hospitalizations, respectively. CONCLUSION Preceding hospitalizations for COPD are associated with in-hospital mortality and after discharge in the subpopulation of patients with COPD with acute exacerbation treated with assisted ventilation for the first time.
Collapse
Affiliation(s)
- Anne Pernille Toft-Petersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Denmark
| | - Bodil Steen Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
5
|
Andelid K, Andersson A, Yoshihara S, Åhrén C, Jirholt P, Ekberg-Jansson A, Lindén A. Systemic signs of neutrophil mobilization during clinically stable periods and during exacerbations in smokers with obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1253-63. [PMID: 26170654 PMCID: PMC4493974 DOI: 10.2147/copd.s77274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It is still unclear whether signs of neutrophil mobilization in the blood of patients with chronic obstructive pulmonary disease represent true systemic events and how these relate to bacterial colonization in the airways. In this study, we evaluated these issues during clinically stable periods and during exacerbations in smokers with obstructive pulmonary disease and chronic bronchitis (OPD-CB). METHODS Over a period of 60 weeks for each subject, blood samples were repeatedly collected from 60 smokers with OPD-CB during clinically stable periods, as well as during and after exacerbations. Myeloperoxidase (MPO) and neutrophil elastase (NE) protein and mRNA, growth of bacteria in sputum, and clinical parameters were analyzed. Ten asymptomatic smokers and ten never-smokers were included as controls. RESULTS We found that, during clinically stable periods, neutrophil and NE protein concentrations were increased in smokers with OPD-CB and in the asymptomatic smokers when compared with never-smokers. During exacerbations, neutrophil and MPO protein concentrations were further increased in smokers with OPD-CB, without a detectable increase in the corresponding mRNA during exacerbations. However, MPO and NE protein and mRNA displayed positive correlations. During exacerbations, only increased neutrophil concentrations were associated with growth of bacteria in sputum. Among patients with low transcutaneous oxygen saturation during exacerbations, PaO2 (partial oxygen pressure) correlated with concentrations of MPO and NE protein and neutrophils in a negative manner. CONCLUSION There are signs of systemic neutrophil mobilization during clinically stable periods and even more so during exacerbations in chronic obstructive pulmonary disease. In this condition, MPO and NE may share a cellular origin, but its location remains uncertain. Factors other than local bacteria, including hypoxemia, may be important for driving systemic signs of neutrophil mobilization.
Collapse
MESH Headings
- Bronchitis, Chronic/blood
- Bronchitis, Chronic/diagnosis
- Bronchitis, Chronic/immunology
- Bronchitis, Chronic/microbiology
- Bronchitis, Chronic/physiopathology
- Case-Control Studies
- Cross-Sectional Studies
- Disease Progression
- Female
- Humans
- Leukocyte Elastase/blood
- Leukocyte Elastase/genetics
- Longitudinal Studies
- Lung/immunology
- Lung/microbiology
- Lung/physiopathology
- Male
- Neutrophil Activation
- Neutrophils/immunology
- Neutrophils/metabolism
- Peroxidase/blood
- Prospective Studies
- Pulmonary Disease, Chronic Obstructive/blood
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/immunology
- Pulmonary Disease, Chronic Obstructive/microbiology
- Pulmonary Disease, Chronic Obstructive/physiopathology
- RNA, Messenger/blood
- Risk Factors
- Smoking/adverse effects
- Smoking/blood
- Smoking/immunology
- Sputum/microbiology
- Time Factors
Collapse
Affiliation(s)
- Kristina Andelid
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Andersson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Christina Åhrén
- Department of Bacteriology, Institute of Laboratory Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Jirholt
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ann Ekberg-Jansson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindén
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Xiao K, Guo C, Su L, Yan P, Li X, Xie L. Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation. J Thorac Dis 2015; 7:329-36. [PMID: 25922710 DOI: 10.3978/j.issn.2072-1439.2014.11.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/14/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) represents an increasing healthcare concern as a leading cause of morbidity and mortality worldwide. Our objective was to predict the outcome of COPD patients associated with multiple organ dysfunction syndrome (MODS) by scoring models. METHODS A retrospective study was performed on severe COPD patients within 24 hours of the onset of MODS. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score II (SAPS II), and Sepsis-related Organ Failure Assessment (SOFA) scores were calculated for patients. RESULTS A total of 153 elderly patients were recruited. Compared to 30-day survivors, the number of failing organs and all of the scoring models were significantly higher in 30-day non-survivors. The SOFA showed the highest sensitivity and area under the curve (AUC) for predicting the prognosis of patients with MODS induced by acute exacerbation of COPD. The results of logistic regression indicated that factors that were correlated with the prognosis of COPD included the exacerbation history, SOFA score, number of failing organs, and duration of ICU stay. The value of exacerbation frequency for predicting the outcome of COPD was excellent (AUC: 0.892), with a sensitivity of 0.851 and a specificity of 0.797. CONCLUSIONS The SOFA score, determined at the onset of MODS in elderly patients with COPD, was a reliable predictor of the prognosis. The exacerbation frequency, number of failing organs, and the SOFA score were risk factors of a poor prognosis, and the exacerbation frequency could also effectively predict the outcome of COPD.
Collapse
Affiliation(s)
- Kun Xiao
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Chao Guo
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Longxiang Su
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Peng Yan
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Xin Li
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Lixin Xie
- 1 Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China ; 2 Department of Cardiology, Fuwai Hospital CAMS & PUMC, Beijing 100037, China ; 3 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100032, China ; 4 Department of Internal Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| |
Collapse
|
7
|
Garcia-Gutierrez S, Quintana JM, Barrio I, Bare M, Fernandez N, Vidal S, Gonzalez N, Lafuente I, Arteta E, Esteban C, Pulido E. Application of appropriateness criteria for hospitalization in COPD exacerbation. Intern Emerg Med 2013; 8:349-57. [PMID: 23508735 DOI: 10.1007/s11739-013-0927-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
Abstract
The IRYSS-COPD appropriateness study was developed in 16 hospitals belonging to the Spanish National Health Service from June 2008 to September 2010 (n = 2,877). The objectives were to apply a set of explicit criteria for the appropriateness of hospital admission created by the RAND/UCLA methodology to patients evaluated in the emergency department (ED) for exacerbations of COPD. This is a prospective cohort study. We explored the relationship between appropriateness of admission as defined by the explicit criteria and the final decision to admit or discharge. A total of 2,877 patients were included for analysis; of these, 1,747 (60.7 %) were admitted and 1,130 (39.3 %) were discharged from the ED to home. Among patients classified by the explicit criteria as appropriate for hospital admission, 81.3 % were admitted, compared with 64.81 % of those classified as uncertain and 48.65 % of those classified as inappropriate for admission. Severity of exacerbation was the most influencing variable in the decision. Application of our explicit criteria for appropriate hospital admission among a large sample of patients experiencing an exacerbation of COPD in the ED setting suggests that these criteria could be used as the basis for clinical decision-making and health-care assessment.
Collapse
Affiliation(s)
- Susana Garcia-Gutierrez
- Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Llor C, Moragas A, Miravitlles M. Usefulness of a patient symptom diary card in the monitoring of exacerbations of chronic bronchitis and chronic obstructive pulmonary disease. Int J Clin Pract 2012; 66:711-7. [PMID: 22698424 DOI: 10.1111/j.1742-1241.2012.02930.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the usefulness of a patient diary card of symptoms for monitoring the evolution of an exacerbation of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) in primary care. METHOD Multicentre, observational study. Patients with an exacerbation filled out a diary every day before bedtime during 10 days. The diary score ranged from 0 (best) to 28 (worst). A visit was performed at day 15 to collect the patient diaries. RESULTS Of the 1101 patients studied 921 returned the diaries (83.7%). Clinical failure was found in 236 patients (25.6%). The mean global score on day 1 was 21.5 ± 3.8. Patients considered as cured at day 10 presented a lower score at day 1 (21.1 ± 3.9) vs. those who failed (22.6 ± 4.2; p < 0.001). When no reduction was observed in the score from days 1 to 3, the percentage of failures was 36.1%, being only 11.6% with a reduction of 5 points or more (p < 0.001). The strongest correlation with failure was observed with general status, breathing, symptom scale and the need for extra inhaler doses. CONCLUSION A symptom diary card seems to be a valuable tool to monitor the evolution of an acute exacerbation of CB/COPD in primary care.
Collapse
Affiliation(s)
- C Llor
- Primary Care Centre Jaume I, Tarragona, Spain.
| | | | | |
Collapse
|
9
|
Shafiek HA, Abd-Elwahab NH, Baddour MM, El-Hoffy MM, Degady AAE, Khalil YM. Assessment of some inflammatory biomarkers as predictors of outcome of acute respiratory failure on top of chronic obstructive pulmonary disease and evaluation of the role of bacteria. ISRN MICROBIOLOGY 2012; 2012:240841. [PMID: 23724320 PMCID: PMC3658585 DOI: 10.5402/2012/240841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/18/2012] [Indexed: 11/23/2022]
Abstract
Objective. To study the value of the inflammatory markers (interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP)) in predicting the outcome of noninvasive ventilation (NIV) in the management of acute respiratory failure (ARF) on top of chronic obstructive pulmonary disease (COPD) and the role of bacteria in the systemic inflammation. Methods. Thirty three patients were subjected to standard treatment plus NIV, and accordingly, they were classified into responders and nonresponders. Serum samples were collected for IL-6, IL-8, and CRP analysis. Sputum samples were taken for microbiological evaluation. Results. A wide spectrum of bacteria was revealed; Gram-negative and atypical bacteria were the most common (31% and 28% resp.; single or copathogen). IL-8 and dyspnea grade was significantly higher in the non-responder group (P = 0.01 and 0.023 resp.). IL-6 correlated positivity with the presence of infection and type of pathogen (P = 0.038 and 0.034 resp.). Gram-negative bacteria were associated with higher significant IL-6 in comparison between others (196.4 ± 239.1 pg/dL; P = 0.011) but insignificantly affected NIV outcome (P > 0.05). Conclusions. High systemic inflammation could predict failure of NIV. G-ve bacteria correlated with high IL-6 but did not affect the response to NIV.
Collapse
|
10
|
Antimikrobielle Therapie bei intensivpflichtigen Patienten mit akuter Exazerbation einer COPD. Med Klin Intensivmed Notfmed 2012; 107:179-84. [DOI: 10.1007/s00063-011-0066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 02/06/2012] [Indexed: 11/27/2022]
|
11
|
Marín Royo M, Pellicer Císcar C, González Villaescusa C, Bueso Fabra MJ, Aguar Benito C, Andreu Rodríguez AL, Herrejón Silvestre A, Soler Cataluña JJ. [Physical activity and its relationship with the state of health of stable COPD patients]. Arch Bronconeumol 2011; 47:335-42. [PMID: 21514712 DOI: 10.1016/j.arbres.2011.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 03/04/2011] [Accepted: 03/08/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous studies have shown that physical activity (PA) in COPD is associated with a better quality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stable COPD patients, outside the setting of a pulmonary rehabilitation program. MATERIAL AND METHODS Observational, descriptive and transversal multi-center study in patients with stable COPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical Activity Index (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiate the following groups according to the energy expenditure: inactive (less than 1,000 kilocalories per week), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than 3,000 kilocalories per week). We analyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients. RESULTS A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1 was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between 1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchial obstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT. CONCLUSIONS Stable COPD patients perform low levels of PA. Lower PA is associated with poorer health and with more severe disease.
Collapse
|