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Zhu Y, Choi D, Somanath PR, Zhang D. Lipid-Laden Macrophages in Pulmonary Diseases. Cells 2024; 13:889. [PMID: 38891022 PMCID: PMC11171561 DOI: 10.3390/cells13110889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Pulmonary surfactants play a crucial role in managing lung lipid metabolism, and dysregulation of this process is evident in various lung diseases. Alternations in lipid metabolism lead to pulmonary surfactant damage, resulting in hyperlipidemia in response to lung injury. Lung macrophages are responsible for recycling damaged lipid droplets to maintain lipid homeostasis. The inflammatory response triggered by external stimuli such as cigarette smoke, bleomycin, and bacteria can interfere with this process, resulting in the formation of lipid-laden macrophages (LLMs), also known as foamy macrophages. Recent studies have highlighted the potential significance of LLM formation in a range of pulmonary diseases. Furthermore, growing evidence suggests that LLMs are present in patients suffering from various pulmonary conditions. In this review, we summarize the essential metabolic and signaling pathways driving the LLM formation in chronic obstructive pulmonary disease, pulmonary fibrosis, tuberculosis, and acute lung injury.
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Affiliation(s)
- Yin Zhu
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA (D.C.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
| | - Dooyoung Choi
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA (D.C.)
| | - Payaningal R. Somanath
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA (D.C.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA (D.C.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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2
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [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: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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3
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Yoon EC, Koo SM, Park HY, Kim HC, Kim WJ, Kim KU, Jung KS, Yoo KH, Yoon HK, Yoon HY. Predictive Role of White Blood Cell Differential Count for the Development of Acute Exacerbation in Korean Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:17-31. [PMID: 38192972 PMCID: PMC10773455 DOI: 10.2147/copd.s435921] [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: 08/18/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic inflammation. Acute exacerbation of COPD (AECOPD) manifests as acute worsening of respiratory symptoms and is associated with high morbidity and mortality. The aim of the present study was to evaluate the predictive value of white blood count (WBC) and its derived inflammatory biomarkers for AECOPD. Methods From the Korean COPD Subgroup Study cohort, a prospective and multicenter observational study, 826 patients who had baseline complete blood count (CBC) and 3-year AECOPD data were included. Follow-up CBC data at 1 (n = 385), 2 (n = 294), and 3 (n = 231) years were collected for available patients. The primary outcome was the occurrence of AECOPD at 3 years. The risk of AECOPD was evaluated using a binary logistic analysis. Results The cumulative incidences of 12-, 24-, and 36-month AECOPD were 47.6%, 60.5%, and 67.6%, respectively. Patients with AECOPD at 3 years had higher baseline WBC counts, neutrophil counts, neutrophil/lymphocyte ratio (NLR), and neutrophil/monocyte ratio than those without AECOPD. Higher WBC count, neutrophil count, and NLR were associated with the 3-year occurrence of AECOPD in the univariate analysis, but only the higher neutrophil count was a significant risk factor (odds ratio [OR] = 1.468; 95% confidence interval [CI]: 1.024-2.104) in the covariates-adjusted analysis. In the analysis of changes in inflammatory parameters, a decrease in the platelet count (OR = 0.502; 95% CI: 0.280-0.902) and NLR (OR = 0.535; 95% CI: 0.294-0.974) at 2 years and an increase in the eosinophil count (OR = 2.130; 95% CI: 1.027-4.416) at 3 years were significantly associated with AECOPD in the adjusted analysis. Conclusion Our data suggest that a high baseline WBC count, particularly neutrophil count, was associated with a higher incidence of long-term AECOPD.
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Affiliation(s)
- Eun Chong Yoon
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - So-My Koo
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hye Yun Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyoung Kyu Yoon
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Young Yoon
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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Angriman F, Ferreyro BL, Harhay MO, Wunsch H, Rosella LC, Scales DC. Accounting for Competing Events When Evaluating Long-Term Outcomes in Survivors of Critical Illness. Am J Respir Crit Care Med 2023; 208:1158-1165. [PMID: 37769125 PMCID: PMC10868356 DOI: 10.1164/rccm.202305-0790cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/18/2023] [Indexed: 09/30/2023] Open
Abstract
The clinical trajectory of survivors of critical illness after hospital discharge can be complex and highly unpredictable. Assessing long-term outcomes after critical illness can be challenging because of possible competing events, such as all-cause death during follow-up (which precludes the occurrence of an event of particular interest). In this perspective, we explore challenges and methodological implications of competing events during the assessment of long-term outcomes in survivors of critical illness. In the absence of competing events, researchers evaluating long-term outcomes commonly use the Kaplan-Meier method and the Cox proportional hazards model to analyze time-to-event (survival) data. However, traditional analytical and modeling techniques can yield biased estimates in the presence of competing events. We present different estimands of interest and the use of different analytical approaches, including changes to the outcome of interest, Fine and Gray regression models, cause-specific Cox proportional hazards models, and generalized methods (such as inverse probability weighting). Finally, we provide code and a simulated dataset to exemplify the application of the different analytical strategies in addition to overall reporting recommendations.
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Affiliation(s)
- Federico Angriman
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, and
| | - Bruno L. Ferreyro
- Interdepartmental Division of Critical Care Medicine
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, and
- Department of Critical Care Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael O. Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, and
- ICES, Toronto, Ontario, Canada; and
| | - Laura C. Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada; and
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Damon C. Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, and
- ICES, Toronto, Ontario, Canada; and
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Man W, Chaplin E, Daynes E, Drummond A, Evans RA, Greening NJ, Nolan C, Pavitt MJ, Roberts NJ, Vogiatzis I, Singh SJ. British Thoracic Society Clinical Statement on pulmonary rehabilitation. Thorax 2023; 78:s2-s15. [PMID: 37770084 DOI: 10.1136/thorax-2023-220439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- William Man
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alistair Drummond
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire Nolan
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Matthew J Pavitt
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Nicola J Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumberland University Newcastle, Newcastle Upon Tyne, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
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Gillespie D, Francis N, Ahmed H, Hood K, Llor C, White P, Thomas-Jones E, Stanton H, Sewell B, Phillips R, Naik G, Melbye H, Lowe R, Kirby N, Cochrane A, Bates J, Alam MF, Butler C. Associations with Post-Consultation Health-Status in Primary Care Managed Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:383-394. [PMID: 35210767 PMCID: PMC8859472 DOI: 10.2147/copd.s340710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods Participants were contacted for follow-up at one- and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08–0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
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Affiliation(s)
- David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
- Correspondence: David Gillespie, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, England, OX2 6GG, UK, Email
| | - Nick Francis
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, UK
| | - Haroon Ahmed
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Carl Llor
- University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Patrick White
- School of Population Health and Environmental Sciences, Kings College London, London, England, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Helen Stanton
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UK
| | - Rhiannon Phillips
- Cardiff School of Sport & Health Science, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Gurudutt Naik
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Rachel Lowe
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Nigel Kirby
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, England, UK
| | - Janine Bates
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
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7
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Mekanimitdee P, Morasert T, Patumanond J, Phinyo P. The MAGENTA model for individual prediction of in-hospital mortality in chronic obstructive pulmonary disease with acute exacerbation in resource-limited countries: A development study. PLoS One 2021; 16:e0256866. [PMID: 34449823 PMCID: PMC8396787 DOI: 10.1371/journal.pone.0256866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common undesirable event associated with significant morbidity and mortality. Several clinical prediction tools for predicting in-hospital mortality in patients with AECOPD have been developed in the past decades. However, some issues concerning the validity and availability of some predictors in the existing models may undermine their clinical applicability in resource-limited clinical settings. METHODS We developed a multivariable model for predicting in-hospitality from a retrospective cohort of patients admitted with AECOPD to one tertiary care center in Thailand from October 2015 to September 2017. Multivariable logistic regression with fractional polynomial algorithms and cluster variance correction was used for model derivation. RESULTS During the study period, 923 admissions from 600 patients with AECOPD were included. The in-hospital mortality rate was 1.68 per 100 admission-day. Eleven potential predictors from the univariable analysis were included in the multivariable logistic regression. The reduced model, named MAGENTA, incorporated seven final predictors: age, body temperature, mean arterial pressure, the requirement of endotracheal intubation, serum sodium, blood urea nitrogen, and serum albumin. The model discriminative ability based on the area under the receiver operating characteristic curve (AuROC) was excellent at 0.82 (95% confidence interval 0.77, 0.86), and the calibration was good. CONCLUSION The MAGENTA model consists of seven routinely available clinical predictors upon patient admissions. The model can be used as an assisting tool to aid clinicians in accurate risk stratification and making appropriate decisions to admit patients for intensive care.
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Affiliation(s)
| | - Thotsaporn Morasert
- Department of Internal Medicine, Surat Thani Hospital, Surat Thani, Thailand
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, Surat Thani Hospital, Surat Thani, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translation Research (MSTR) Cluster, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
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Thomas EE, Taylor ML, Banbury A, Snoswell CL, Haydon HM, Gallegos Rejas VM, Smith AC, Caffery LJ. Factors influencing the effectiveness of remote patient monitoring interventions: a realist review. BMJ Open 2021; 11:e051844. [PMID: 34433611 PMCID: PMC8388293 DOI: 10.1136/bmjopen-2021-051844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions. DESIGN Realist review-a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015-2020 and used RPM to monitor an individual's biometric data (eg, heart rate, blood pressure) from a distance. PRIMARY AND SECONDARY OUTCOME MEASURES Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations). RESULTS Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care. CONCLUSION While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Victor M Gallegos Rejas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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9
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Alnajada AA, Blackwood B, Mobrad A, Akhtar A, Pavlov I, Shyamsundar M. High flow nasal oxygen for acute type two respiratory failure: a systematic review. F1000Res 2021; 10:482. [PMID: 34621510 PMCID: PMC8453312 DOI: 10.12688/f1000research.52885.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO 2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO 2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO 2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO 2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 - 7.7 vs NIV median 7.6, IQR 6.3 - 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO 2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.
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Affiliation(s)
- Asem Abdulaziz Alnajada
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Abdulmajeed Mobrad
- Prince Sultan college for emergency medical services, King Saud University, Riyadh, Saudi Arabia
| | - Adeel Akhtar
- Emergency department, Royal Victoria Hospital, Belfast, Belfast, UK
| | - Ivan Pavlov
- Emergency department, Hôpital de Verdun, Montréal, Canada
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
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10
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Alnajada AA, Blackwood B, Mobrad A, Akhtar A, Pavlov I, Shyamsundar M. High flow nasal oxygen for acute type two respiratory failure: a systematic review. F1000Res 2021; 10:482. [PMID: 34621510 PMCID: PMC8453312.2 DOI: 10.12688/f1000research.52885.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO 2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO 2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO 2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO 2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 - 7.7 vs NIV median 7.6, IQR 6.3 - 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO 2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.
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Affiliation(s)
- Asem Abdulaziz Alnajada
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Abdulmajeed Mobrad
- Prince Sultan college for emergency medical services, King Saud University, Riyadh, Saudi Arabia
| | - Adeel Akhtar
- Emergency department, Royal Victoria Hospital, Belfast, Belfast, UK
| | - Ivan Pavlov
- Emergency department, Hôpital de Verdun, Montréal, Canada
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
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11
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Morasert T, Jantarapootirat M, Phinyo P, Patumanond J. Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study. BMJ Open Respir Res 2021; 7:7/1/e000488. [PMID: 32467292 PMCID: PMC7259855 DOI: 10.1136/bmjresp-2019-000488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/29/2022] Open
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common and deteriorating event leading to in-hospital morbidity and mortality. Identification of predictors for in-hospital mortality of AECOPD patients could aid clinicians in identifying patients with a higher risk of death during their hospitalisation. Objective To explore potential prognostic indicators associated with in-hospital mortality of AECOPD patients. Setting General medical ward and medical intensive care unit of a university-affiliated tertiary care centre. Methods A prognostic factor research was conducted with a retrospective cohort design. All admission records of AECOPD patients between October 2015 and September 2016 were retrieved. Stratified Cox’s regression was used for the primary analysis. Results A total of 516 admission records of 358 AECOPD patients were included in this study. The in-hospital mortality rate of the cohort was 1.9 per 100 person-day. From stratified Cox’s proportional hazard regression, the predictors of in-hospital mortality were aged 80 years or more (HR=2.16, 95% CI: 1.26 to 3.72, p=0.005), respiratory failure on admission (HR=2.50, 95% CI: 1.12 to 5.57, p=0.025), body temperature more than 38°C (HR=2.97, 95% CI: 1.61 to 5.51, p=0.001), mean arterial pressure lower than 65 mm Hg (HR=4.01, 95% CI: 1.88 to 8.60, p<0.001), white blood cell count more than 15 x 109/L (HR=3.51, 95% CI: 1.90 to 6.48, p<0.001) and serum creatinine more than 1.5 mg/dL (HR=2.08, 95% CI: 1.17 to 3.70, p=0.013). Conclusion Six independent prognostic indicators for in-hospital mortality of AECOPD patients were identified. All of the parameters were readily available in routine practice and can be used as an aid for risk stratification of AECOPD patients.
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Affiliation(s)
- Thotsaporn Morasert
- Pulmonary and Critical care Medicine, Department of Internal Medicine, Suratthani Hospital, Surat Thani, Suratthani, Thailand
| | - Methus Jantarapootirat
- Pulmonary and Critical care Medicine, Department of Internal Medicine, Suratthani Hospital, Surat Thani, Suratthani, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
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12
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Brat K, Svoboda M, Hejduk K, Plutinsky M, Zatloukal J, Volakova E, Popelkova P, Novotna B, Engova D, Franssen FM, Vanfleteren LE, Spruit MA, Koblizek V. Introducing a new prognostic instrument for long-term mortality prediction in COPD patients: the CADOT index. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:139-145. [DOI: 10.5507/bp.2020.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
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13
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Ceco E, Celli D, Weinberg S, Shigemura M, Welch LC, Volpe L, Chandel NS, Bharat A, Lecuona E, Sznajder JI. Elevated CO 2 Levels Delay Skeletal Muscle Repair by Increasing Fatty Acid Oxidation. Front Physiol 2021; 11:630910. [PMID: 33551852 PMCID: PMC7859333 DOI: 10.3389/fphys.2020.630910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Muscle dysfunction often occurs in patients with chronic obstructive pulmonary diseases (COPD) and affects ventilatory and non-ventilatory skeletal muscles. We have previously reported that hypercapnia (elevated CO2 levels) causes muscle atrophy through the activation of the AMPKα2-FoxO3a-MuRF1 pathway. In the present study, we investigated the effect of normoxic hypercapnia on skeletal muscle regeneration. We found that mouse C2C12 myoblasts exposed to elevated CO2 levels had decreased fusion index compared to myoblasts exposed to normal CO2. Metabolic analyses of C2C12 myoblasts exposed to high CO2 showed increased oxidative phosphorylation due to increased fatty acid oxidation. We utilized the cardiotoxin-induced muscle injury model in mice exposed to normoxia and 10% CO2 for 21 days and observed that muscle regeneration was delayed. High CO2-delayed differentiation in both mouse C2C12 myoblasts and skeletal muscle after injury and was restored to control levels when cells or mice were treated with a carnitine palmitoyltransfearse-1 (CPT1) inhibitor. Taken together, our data suggest that hypercapnia leads to changes in the metabolic activity of skeletal muscle cells, which results in impaired muscle regeneration and recovery after injury.
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Affiliation(s)
- Ermelinda Ceco
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Diego Celli
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Samuel Weinberg
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Masahiko Shigemura
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lynn C Welch
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lena Volpe
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Navdeep S Chandel
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ankit Bharat
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Emilia Lecuona
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jacob I Sznajder
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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14
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Huang X, Du Y, Ma Z, Zhang H, Jun L, Wang Z, Lin M, Ni F, Li X, Tan H, Tan S. High-flow nasal cannula oxygen versus conventional oxygen for hypercapnic chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. CLINICAL RESPIRATORY JOURNAL 2020; 15:437-444. [PMID: 33280252 DOI: 10.1111/crj.13317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/14/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Low-concentration oxygen is an established way for the treatment of chronic obstructive pulmonary disease (COPD) with Type II respiratory failure. Hypercapnia can complicate both COPD exacerbations and stable COPD. Treating with noninvasive ventilation (NIV) can reduce carbon dioxide tension in arterial (PaCO2 ) in hypercapnic COPD. As an open system, high-flow nasal cannula oxygen (HFNC) is easy to tolerate and use. More researches are needed to focus on how HFNC is used to treat COPD patients with hypercapnic respiratory failure. METHODS The Cochrane Library, Medline, EMBASE, and CINAHL database were retrieved from inception to October 2019. Eligible trials were clinical randomized controlled trials comparing the effects of HFNC and conventional oxygen on hypercapnic COPD patients. Two researchers assessed the quality of each study and extracted the data into RevMan 5.3 independently. The primary outcome was PaCO2 and the secondary outcome was PaO2 . RESULTS Four RCTs with 329 patients were included. The research results indicated that PaCO2 in the HFNC group was similar to the conventional oxygen group. No significant difference were observed in PaCO2 (MD -0.98, CI: -2.67 to 0.71, Z = 1.14, p = 0.25) and PaO2 (MD -0.72, CI: -6.99 to 5.55, Z = 0.23, p = 0.82) between the HFNC group and conventional oxygen group. CONCLUSIONS Our meta-analysis showed no difference in PO2 and PCO2 between the HFNC and conventional oxygen. But we should treat this conclusion with caution because the number of studies and participants is small and, there is heterogeneity in the PaO2 and PCO2 measurements between stable and AECOPD.
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Affiliation(s)
- Xuan Huang
- School of Medicine, Xiamen University, Xiamen, China
| | - Yanping Du
- Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Zhiyi Ma
- Pulmonary and Critical Care Medicine, The First Hospital of Longyan Affiliated to Fujian Medical University, Longyan, China
| | - Huaping Zhang
- Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Liu Jun
- Pulmonary and Critical Care Medicine, The Second Hospital of Longyan, The Teaching Hospital of Putian University, Longyan, China
| | - Zhiyong Wang
- Pulmonary and Critical Care Medicine, The First Hospital of Putian, The Teaching Hospital of Fujian Medical University, Putian, China
| | - Meixia Lin
- Pulmonary and Critical Care Medicine, The First Hospital of Putian, The Teaching Hospital of Fujian Medical University, Putian, China
| | - Fayu Ni
- Pulmonary and Critical Care Medicine, Fuqing Hospital Affiliated to Fujian Medical University, Fuqing, China
| | - Xi Li
- Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Hui Tan
- Pulmonary and Critical Care Medicine, Chenzhou No. 1 People's Hospital, The First Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Shifan Tan
- Pulmonary and Critical Care Medicine, Maoming People's Hospital, Maoming, China
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15
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Huang Q, He C, Xiong H, Shuai T, Zhang C, Zhang M, Wang Y, Zhu L, Lu J, Jian L. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open 2020; 10:e037923. [PMID: 33127631 PMCID: PMC7604856 DOI: 10.1136/bmjopen-2020-037923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the association between the Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to evaluate the specific predictive and prognostic value of DECAF scores and to explore the effectiveness of different cut-off values in risk stratification of patients with AECOPD. DESIGN Systematic review and meta-analysis. PARTICIPANTS Adult patients diagnosed with AECOPD (over 18 years of age). PRIMARY AND SECONDARY OUTCOME MEASURES Electronic databases, including the Cochrane Library, PubMed, the Embase and the WOS, and the reference lists in related articles were searched for studies published up to September 2019. The identified studies reported the prognostic value of DECAF scores in patients with AECOPD. RESULTS Seventeen studies involving 8329 participants were included in the study. Quantitative analysis demonstrated that elevated DECAF scores were associated with high mortality risk (weighted mean difference=1.87; 95% CI 1.19 to 2.56). In the accuracy analysis, DECAF scores showed good prognostic accuracy for both in-hospital and 30-day mortality (area under the receiver operating characteristic curve: 0.83 (0.79-0.86) and 0.79 (0.76-0.83), respectively). When the prognostic value was compared with that of other scoring systems, DECAF scores showed better prognostic accuracy and stable clinical values than the modified DECAF; COPD and Asthma Physiology Score; BUN, Altered mental status, Pulse and age >65; Confusion, Urea, Respiratory Rate, Blood pressure and age >65; or Acute Physiology and Chronic Health Evaluation II scores. CONCLUSION The DECAF score is an effective and feasible predictor for short-term mortality. As a specific and easily scored predictor for patients with AECOPD, DECAF score is superior to other prognostic scores. The DECAF score can correctly identify most patients with AECOPD as low risk, and with the increase of cut-off value, the risk stratification of DECAF score in high-risk population increases significantly.
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Affiliation(s)
- Qiangru Huang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Chengying He
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Huaiyu Xiong
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Tiankui Shuai
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Chuchu Zhang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Meng Zhang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Yalei Wang
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Lei Zhu
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Jiaju Lu
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Liu Jian
- ICU, Lanzhou University First Affiliated Hospital, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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16
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Şancı E, Ercan Coşkun F, Bayram B. Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department. Cureus 2020; 12:e10516. [PMID: 33094057 PMCID: PMC7571782 DOI: 10.7759/cureus.10516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: High-flow nasal cannula (HFNC) oxygen is becoming an integral part of respiratory failure management. Effects of HFNC on arterial blood gas (ABG) parameters especially partial carbon dioxide (PaCO2) require further investigation to provide insight into the efficacy and safety of the treatment. Methods: Acute respiratory failure patients with sequential ABG parameters before and after initiating HFNC between June 2015 and June 2017 were analyzed in a tertiary academic center. Patients' baseline characteristics were evaluated and sequential ABG changes were compared and subgrouped as chronic obstructive pulmonary disease (COPD), respiratory acidosis, hypercapnia, and high lactate. Results: A total of 120 patients were enrolled in the study. There was a significant difference between the mean partial pressure of oxygen in arterial blood (PaO2), lactate, and peripheral oxygen saturation (SpO2) values between sequential ABGs after HFNC (P <0.001). In the COPD group (n=32), there was a significant difference between initial ABG means of PaO2, lactate, and SpO2 values and sequential ABG means (p<0.001). Hypercapnic patients PaCO2 levels were significantly lower after HFNC (p<0.001), while in the COPD group there was no significant change in PaCO2 values (p=0.068). Conclusions: Treatment with HFNC produced improvement of blood gas parameters in subjects with acute respiratory failure in the emergency department (ED). These results suggest that HFNC can be used in hypercapnic patients as well as hypoxemic patients. Further randomized controlled studies required to establish the impact of HFNC in the ED.
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Affiliation(s)
- Emre Şancı
- Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, TUR
| | - Feride Ercan Coşkun
- Emergency Department, İzmir Çiğli Training and Research Hospital, Izmir, TUR
| | - Basak Bayram
- Emergency Department, Dokuz Eylul University, Izmir, TUR
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17
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Zhang Y, Liang LR, Zhang S, Lu Y, Chen YY, Shi HZ, Lin YX. Blood Eosinophilia and Its Stability in Hospitalized COPD Exacerbations are Associated with Lower Risk of All-Cause Mortality. Int J Chron Obstruct Pulmon Dis 2020; 15:1123-1134. [PMID: 32547000 PMCID: PMC7245431 DOI: 10.2147/copd.s245056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Peripheral blood eosinophilic counts are susceptible to many factors and have variability over time. There are limited studies on association of blood eosinophilia with long-term mortality of chronic obstructive pulmonary disease (COPD) patients and these results remain controversial. Our aims were to explore the association of blood eosinophilia at index hospitalization and stability of blood eosinophilia stability over 5 years with all-cause mortality of patients hospitalized for acute exacerbation of COPD (AECOPD). Patients and Methods Eight hundred twenty-nine patients hospitalized for AECOPD between 2013 and 2014 were included in this study and grouped into two groups according to blood eosinophil with 150 cells/μL used as the cutoff value to form eosinophilic and non-eosinophilic groups. Two hundred forty-one COPD inpatients with at least three blood eosinophils measured from different hospitalizations were used for analysis of longitudinally eosinophilic stability and divided into three groups according to the same cutoff value: predominantly (PE), intermittently (IE) and rarely (RE) eosinophilic groups. Cox regression analysis was used to determine the association of blood eosinophilia and all-cause mortality. Results In patients hospitalized for AECOPD, 261 (31.5%) at baseline and 41 (17%) based on at least three measurements of blood eosinophils had increased blood eosinophils. For all-cause mortality, eosinophilic COPD patients at index hospitalization had a lower all-cause mortality compared with non-eosinophilic COPD patients (hazard ratio 0.77, 95% confidence interval 0.6–0.99, P=0.04). In patients readmitted for AECOPD by longitudinal eosinophil stability, with the RE group used as reference, the PE group was associated with a lower all-cause mortality of AECOPD patients (hazard ratio 0.43, 95% confidence interval 0.22–0.85, P=0.016), compared to the IE group (hazard ratio 0.72, 95% confidence interval 0.47–1.11, P=0.133). Conclusion Patients with increased eosinophils (using eosinophil 150 cells/μL as a cutoff value), especially predominantly increased eosinophil levels based on multiple measurements, had a lower risk of all-cause mortality. Blood eosinophilia can be used as a biomarker in hospitalized COPD exacerbations for predicting the risk of all-cause mortality. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/RroTKw3Hisg
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Affiliation(s)
- Ying Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Li-Rong Liang
- Clinical Epidemiology and Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Yong Lu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Yang-Yu Chen
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Ying-Xiang Lin
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
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18
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Njoku CM, Alqahtani JS, Wimmer BC, Peterson GM, Kinsman L, Hurst JR, Bereznicki BJ. Risk factors and associated outcomes of hospital readmission in COPD: A systematic review. Respir Med 2020; 173:105988. [PMID: 33190738 DOI: 10.1016/j.rmed.2020.105988] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD. AIM To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies. RESULTS Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8-44.8% at 31-90 days, 17.9-63.0% at 6 months, and 25.0-87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs. CONCLUSIONS Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.
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Affiliation(s)
- Chidiamara M Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, New South Wales, Australia
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Bonnie J Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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19
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Bansal AG, Gaude GS. Predictors of mortality in acute exacerbations of chronic obstructive pulmonary disease using the dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score. Lung India 2020; 37:19-23. [PMID: 31898616 PMCID: PMC6961099 DOI: 10.4103/lungindia.lungindia_114_19] [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] [Indexed: 11/18/2022] Open
Abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and often fatal; however, accurate prognosis of patients hospitalized with an exacerbation is difficult. The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score uses indices routinely available at the time of hospital admission and can accurately predict the inhospital mortality and outcomes in patients hospitalized with AECOPD. Methodology: A cross-sectional study was conducted in Jawaharlal Nehru Medical College, Belagavi, from January 2016 to June 2018. Consecutive patients hospitalized with an exacerbation of chronic obstructive pulmonary disease were included. DECAF indices and inhospital death rates were recorded. The prognostic value of DECAF was assessed by comparing the total score with the inhospital mortality. Statistical analysis was done using SPSS version 20. Results: Two hundred and twenty-eight patients were recruited. The mean (standard deviation) age was 61.09 ± 10.6 years; 73.68% were male and 48 patients (21.05%) died in hospital. One hundred and twelve patients were identified as low risk (DECAF: 0–1) with 6 (5.4%) patients dying in the hospital and 56 patients were identified as high risk (DECAF: 3–6) with an inhospital mortality of 60.1%. Length of stay for scores of 0–1, 2, and ≥3 was 6.42, 7.47, and 9.64 days, respectively, with P < 0.05. The receiver operating characteristic curve analysis showed P < 0.001, thereby proving that the DECAF is a significant predictor of mortality in AECOPD. Conclusion: This study proved that with an increase in the DECAF score, the mortality among patients in AECOPD increased. The DECAF score helps clinicians predict prognosis accurately by identifying low-risk patients potentially suitable for home-based care or early hospital discharge and high-risk patients requiring escalated palliation with high-level care to improve their outcome.
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Affiliation(s)
- Avya Gopal Bansal
- Department of Chest Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Gajanan S Gaude
- Department of Respiratory Medicine, KLE's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
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20
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Mendez Y, Ochoa-Martinez FE, Ambrosii T. Chronic Obstructive Pulmonary Disease and Respiratory Acidosis in the Intensive Care Unit. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666181127141410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic obstructive lung disease is a common and preventable disease. One of its
pathophysiological consequences is the presence of carbon dioxide retention due to hypoventilation
and ventilation/perfusion mismatch, which in consequence will cause a decrease in the acid/base
status of the patient. Whenever a patient develops an acute exacerbation, acute respiratory
hypercapnic failure will appear and the necessity of a hospital ward is a must. However, current
guidelines exist to better identify these patients and make an accurate diagnosis by using clinical
skills and laboratory data such as arterial blood gases. Once the patient is identified, rapid treatment
will help to diminish the hospital length and the avoidance of intensive care unit. On the other hand,
if there is the existence of comorbidities such as cardiac failure, gastroesophageal reflux disease,
pulmonary embolism or depression, it is likely that the patient will be admitted to the intensive care
unit with the requirement of intubation and mechanical ventilation.
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Affiliation(s)
- Yamely Mendez
- Faculty of Medicine “Dr. Alberto Romo Caballero”, Universidad Autonoma de Tamaulipas, Tampico, Mexico
| | - Francisco E. Ochoa-Martinez
- Faculty of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital “Dr. Jose Eleuterio Gonzalez”, Monterrey, Mexico
| | - Tatiana Ambrosii
- Chair of Anesthesiology and Reanimatology “Valeriu Ghereg”, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova, Republic of
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21
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Sweed RA, Shaheen MAEM, El Gendy EA. Usefulness of different prognostic scores for AECOPD: APACHE II, BAP65, 2008, and CAPS scores. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Bonnevie T, Elkins M, Paumier C, Medrinal C, Combret Y, Patout M, Muir JF, Cuvelier A, Gravier FE, Prieur G. Nasal High Flow for Stable Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. COPD 2019; 16:368-377. [DOI: 10.1080/15412555.2019.1672637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia
- Centre for Education and Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Clément Paumier
- School of Physiotherapy, Rouen University Hospital, Rouen, France
| | - Clément Medrinal
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Yann Combret
- Physiotherapy Department, Le Havre Hospital, Le Havre, France
- Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Institute of Experimental and Clinical Research (IREC), Brussels, Belgium
| | - Maxime Patout
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Guillaume Prieur
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
- Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Institute of Experimental and Clinical Research (IREC), Brussels, Belgium
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23
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Memon MA, Faryal S, Brohi N, Kumar B. Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Cureus 2019; 11:e4826. [PMID: 31403014 PMCID: PMC6682392 DOI: 10.7759/cureus.4826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. In 2012, a comprehensive score was developed to predict the risk of in-hospital mortality in AECOPD called the dyspnoea, eosinopenia, consolidation, acidemia, and atrial fibrillation (DECAF) score. We conducted this study to assess the value of the DECAF score as a clinical prediction tool that claims to stratify all patients with AECOPD by risk accurately. Methods We conducted a prospective study of patients admitted to the intensive care unit (ICU) of the Department of Pulmonology in Civil Hospital, Jamshoro, from January 2016 to December 2018. Our inclusion criteria were that the patient must be age 35 years or older, have a primary clinical diagnosis of AECOPD, spirometry consistent with airflow obstruction, and have a smoking history of ≥10 cigarette pack per year. We excluded patients who had domiciliary ventilation, survival-limiting comorbidities (such as metastatic malignancy), and a primary reason for admission other than AECOPD. All sociodemographic data were collected at the time of admission, including age, gender, co-morbidities, housebound status, and number of previous AECOPD. Clinical data collected included plain chest x-ray, spirometry, electrocardiogram, arterial blood gases analysis, complete blood count, kidney function test, liver function test, and serum electrolytes. A DECAF score was applied to each patient. We noted in-hospital mortality and compared the characteristics of survivors and non-survivors. Data were analyzed using IBM SPSS for Windows, version 19.0 (IBM Corp, Armonk, NY). Results A total of 162 patients were included in the study. The mortality rate was 13% (n=21). More survivors had a DECAF score from zero to three than non-survivors. The difference in the number of survivors vs. non-survivors was statistically significant for DECAF scores zero and one. For DECAF scores four and five, there were more patients in the “non-survivors” group, and the differences were statistically significant. None of the patients scored six on DECAF. Conclusion Patients with a DECAF score of four or higher have a significant risk of mortality. DECAF is a simple tool that predicts mortality that incorporates routinely available indices to stratify AECOPD patients into mortality risk categories.
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Affiliation(s)
| | | | | | - Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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24
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Russell R, Beer S, Pavord ID, Pullinger R, Bafadhel M. The acute wheezy adult with airways disease in the emergency department: a retrospective case-note review of exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:971-977. [PMID: 31190783 PMCID: PMC6514127 DOI: 10.2147/copd.s190085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/04/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: There has been an increase in interest in the peripheral blood eosinophil count as a biomarker in COPD. Few studies have examined the eosinophil count in patients attending the emergency department (ED) with acute exacerbations of COPD (AECOPD). We investigated the relationship between the blood eosinophil and other variables collected routinely at ED presentation and outcomes. Methods: Retrospective case note review of patients attending the ED with an AECOPD over 18 months. Demographic, clinical and pharmacological data were analyzed at the time of presentation, and clinical outcomes relating to hospital admission, length of hospital stay and mortality were investigated. Results: There were 743 AECOPD index events in 537 patients. Over half (57%) of all attendees were admitted to hospital. They were older, reported an increased number of exacerbations and higher levels of total leukocytes and neutrophils. Length of stay was shorter in patients with a blood eosinophil count ≥2% compared to <2% (median (IQR) 3 days (1–7) vs 4 days (2–8) respectively, p<0.05). Length of stay correlated with peripheral blood neutrophils (r=0.12, p=0.021), peripheral blood absolute and relative eosinophils (r=−0.12, p=0.024 and r=−0.11, p=0.035, respectively) and CRP (r=0.16, p=0.027). Non-eosinophilic AECOPD were associated with an increased risk of mortality during an exacerbation (χ2 5.9, OR 3.08, 95% CI 1.19–7.96, p=0.015). Conclusion: In exacerbations of COPD presenting to ED, a higher blood eosinophil count is associated with a shorter length of stay and reduced mortality.
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Affiliation(s)
- Rek Russell
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - S Beer
- Department of Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I D Pavord
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - R Pullinger
- Department of Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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25
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Fazekas AS, Aboulghaith M, Kriz RC, Urban M, Breyer MK, Breyer-Kohansal R, Burghuber OC, Hartl S, Funk GC. Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation. Wien Klin Wochenschr 2018; 130:561-568. [PMID: 30066095 PMCID: PMC6209011 DOI: 10.1007/s00508-018-1364-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) is used to treat acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD); however, long-term outcomes following discharge are largely unknown. This study aimed to characterize long-term outcomes and identify associated markers in patients with COPD after surviving the first episode of HRF requiring NIV. METHODS This study retrospectively analyzed 122 patients, mean age 62 ± 8 years, 52% female and forced expiratory volume in 1 s (FEV1) predicted 30 ± 13%, admitted with an acute hypercapnic exacerbation of COPD and receiving a first-ever NIV treatment between 2000 and 2012. RESULTS A total of 40% of the patients required hospital readmission due to respiratory reasons within 1 year. Persistent hypercapnia leading to the prescription of domiciliary NIV, older age and lower body mass index (BMI) were risk factors for readmission due to respiratory reasons. Survival rates were 79% and 63% at 1 and 2 years after discharge, respectively. A shorter time to readmission and recurrent hypercapnic failure, lower BMI and acidemia on the first admission, as well as hypercapnia at hospital discharge were correlated with a decreased long-term survival. CONCLUSION Patients with COPD surviving their first episode of AHRF requiring NIV are at high risk for readmission and death. Severe respiratory acidosis, chronic respiratory failure and a lower BMI imply shorter long-term survival.
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Affiliation(s)
- Andreas S Fazekas
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Mei Aboulghaith
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Ruxandra C Kriz
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Matthias Urban
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Marie-Kathrin Breyer
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Otto-Chris Burghuber
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria.
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
- Medical University of Vienna, Vienna, Austria.
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A Closer Look at the Bivariate Association between Ambient Air Pollution and Allergic Diseases: The Role of Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081625. [PMID: 30071675 PMCID: PMC6121458 DOI: 10.3390/ijerph15081625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/22/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
Although previous ecological studies investigating the association between air pollution and allergic diseases accounted for temporal or seasonal relationships, few studies address spatial non-stationarity or autocorrelation explicitly. Our objective was to examine bivariate correlation between outdoor air pollutants and the prevalence of allergic diseases, highlighting the limitation of a non-spatial correlation measure, and suggesting an alternative to address spatial autocorrelation. The 5-year prevalence data (2011⁻2015) of allergic rhinitis, atopic dermatitis, and asthma were integrated with the measures of four major air pollutants (SO₂, NO₂, CO, and PM10) for each of the 423 sub-districts of Seoul. Lee's L statistics, which captures how much bivariate associations are spatially clustered, was calculated and compared with Pearson's correlation coefficient for each pair of the air pollutants and allergic diseases. A series of maps showing spatiotemporal patterns of allergic diseases at the sub-district level reveals a substantial degree of spatial heterogeneity. A high spatial autocorrelation was observed for all pollutants and diseases, leading to significant dissimilarities between the two bivariate association measures. The local L statistics identifies the areas where a specific air pollutant is considered to be contributing to a type of allergic disease. This study suggests that a bivariate correlation measure between air pollutants and allergic diseases should capture spatially-clustered phenomenon of the association, and detect the local instability in their relationships. It highlights the role of spatial analysis in investigating the contribution of the local-level spatiotemporal dynamics of air pollution to trends and the distribution of allergic diseases.
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27
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Chan HS, Ko FWS, Chan JWM, So LKY, Lam DCL, Chan VL, Tam CY, Yu WC. Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong - computerized data collection and analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1913-1925. [PMID: 29942124 PMCID: PMC6005303 DOI: 10.2147/copd.s163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | - Cheuk Yin Tam
- Department of Medicine and Geriatrics, Tuen Mun Hospital
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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Kalhan R, Mutharasan RK. Reducing Readmissions in Patients With Both Heart Failure and COPD. Chest 2018; 154:1230-1238. [PMID: 29908152 DOI: 10.1016/j.chest.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 01/27/2023] Open
Abstract
Patients with both COPD and heart failure (HF) pose particularly high costs to the health-care system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Here we present 10 practical tips to reduce readmissions in this challenging population: (1) diagnose the population accurately, (2) detect admissions for exacerbations early and consider risk stratification, (3) use specialist management in hospital, (4) modify the underlying disease substrate, (5) apply and intensify evidence-based therapies, (6) activate the patient and develop critical health behaviors, (7) setup feedback loops, (8) arrange an early follow-up appointment prior to discharge, (9) consider and address other comorbidities, and (10) consider ancillary support services at home. The multidisciplinary care teams needed to support these care models pose expense to the health-care system. Although these costs may more easily be recouped under financial models such as accountable care organizations and bundled payments, the opportunity cost of an admission for COPD or HF may represent an underrecognized financial lever.
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Affiliation(s)
- Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Raja Kannan Mutharasan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
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29
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Jones SE, Barker RE, Nolan CM, Patel S, Maddocks M, Man WDC. Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:S1390-S1399. [PMID: 29928521 PMCID: PMC5989101 DOI: 10.21037/jtd.2018.03.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 12/25/2022]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are one of the most common causes of emergency hospital admission and place great burden upon healthcare systems. Furthermore, AECOPD represent an important life event for patients, and are associated with significant reductions in physical activity, skeletal muscle function, exercise tolerance and health-related quality of life. Pulmonary rehabilitation, an intervention comprising supervised exercise-training and education, may counteract these negative consequences and target modifiable risk factors for hospital readmission. A recent Cochrane systematic review included 20 randomized controlled trials comparing pulmonary rehabilitation after exacerbation of COPD versus conventional care. Overall, the evidence supports moderate to large effects on health-related quality of life and exercise capacity. However, there is substantial heterogeneity across studies, and more recent studies have been more equivocal, including around hospital readmissions, particularly when rehabilitation is started in the inpatient setting. In this narrative review, we examine the rationale for pulmonary rehabilitation following AECOPD with a particular focus on skeletal muscle function, review the current evidence for pulmonary rehabilitation in the AECOPD setting, and identify areas that require future research, including the structure and nature of the intervention, improving uptake and adherence, and the role of alternative rehabilitation strategies for patients with AECOPD.
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Affiliation(s)
- Sarah E. Jones
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ruth E. Barker
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Claire M. Nolan
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Suhani Patel
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Matthew Maddocks
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - William D. C. Man
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK
- National Heart and Lung Institute, Imperial College, London, UK
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30
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Brat K, Plutinsky M, Hejduk K, Svoboda M, Popelkova P, Zatloukal J, Volakova E, Fecaninova M, Heribanova L, Koblizek V. Respiratory parameters predict poor outcome in COPD patients, category GOLD 2017 B. Int J Chron Obstruct Pulmon Dis 2018; 13:1037-1052. [PMID: 29628761 PMCID: PMC5877495 DOI: 10.2147/copd.s147262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Respiratory parameters are important predictors of prognosis in the COPD population. Global Initiative for Obstructive Lung Disease (GOLD) 2017 Update resulted in a vertical shift of patients across COPD categories, with category B being the most populous and clinically heterogeneous. The aim of our study was to investigate whether respiratory parameters might be associated with increased all-cause mortality within GOLD category B patients. Methods The data were extracted from the Czech Multicentre Research Database, a prospective, noninterventional multicenter study of COPD patients. Kaplan-Meier survival analyses were performed at different levels of respiratory parameters (partial pressure of oxygen in arterial blood [PaO2], partial pressure of arterial carbon dioxide [PaCO2] and greatest decrease of basal peripheral capillary oxygen saturation during 6-minute walking test [6-MWT]). Univariate analyses using the Cox proportional hazard model and multivariate analyses were used to identify risk factors for mortality in hypoxemic and hypercapnic individuals with COPD. Results All-cause mortality in the cohort at 3 years of prospective follow-up reached 18.4%. Chronic hypoxemia (PaO2 <7.3 kPa), hypercapnia (PaCO2 >7.0 kPa) and oxygen desaturation during the 6-MWT were predictors of long-term mortality in COPD patients with forced expiratory volume in 1 second ≤60% for the overall cohort and for GOLD B category patients. Univariate analyses confirmed the association among decreased oxemia (<7.3 kPa), increased capnemia (>7.0 kPa), oxygen desaturation during 6-MWT and mortality in the studied groups of COPD subjects. Multivariate analysis identified PaO2 <7.3 kPa as a strong independent risk factor for mortality. Conclusion Survival analyses showed significantly increased all-cause mortality in hypoxemic and hypercapnic GOLD B subjects. More important, PaO2 <7.3 kPa was the strongest risk factor, especially in category B patients. In contrast, the majority of the tested respiratory parameters did not show a difference in mortality in the GOLD category D cohort.
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Affiliation(s)
- Kristian Brat
- Department of Respiratory Diseases, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Karel Hejduk
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | | | - Eva Volakova
- Pulmonary Department, University Hospital, Olomouc, Czech Republic
| | | | - Lucie Heribanova
- Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic
| | - Vladimir Koblizek
- Pulmonary Department, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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31
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Viana RCTP, Pincelli MP, Pizzichini E, Silva AP, Manes J, Marconi TD, Steidle LJM. Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up. Rev Bras Ter Intensiva 2018; 29:47-54. [PMID: 28444072 PMCID: PMC5385985 DOI: 10.5935/0103-507x.20170008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/03/2017] [Indexed: 11/20/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. Methods: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. Results: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. Conclusion: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.
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Affiliation(s)
- Renata Cristina Teixeira Pinto Viana
- Clínica Médica, Universidade do Vale do Itajaí - Itajaí (SC), Brasil.,Terapia Intensiva e Cuidados Paliativos, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Mariangela Pimentel Pincelli
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.,Terapia Intensiva, Hospital Nereu Ramos - Florianópolis (SC), Brasil
| | - Emílio Pizzichini
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | | | - Joice Manes
- Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | | | - Leila John Marques Steidle
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
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Esteban C, Castro-Acosta A, Alvarez-Martínez CJ, Capelastegui A, López-Campos JL, Pozo-Rodriguez F. Predictors of one-year mortality after hospitalization for an exacerbation of COPD. BMC Pulm Med 2018; 18:18. [PMID: 29370849 PMCID: PMC5785839 DOI: 10.1186/s12890-018-0574-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/04/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Identifying factors related to mortality 1 year after hospitalization could help determine interventions to reduce mortality. METHODS In a prospective, observational, multicentre study, we evaluated data from two cohorts: the Spanish audit of hospital COPD exacerbation care (our derivation sample) and the Spanish cohort of the European audit of COPD exacerbation care (our validation sample). The endpoint was all-cause mortality. Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain. RESULTS In the multivariate analysis, factors independently related to an increase in mortality were older age, cardio-cerebro-vascular and/or dementia comorbidities, PaCO2 > 55 mmHg measured at emergency department arrival, hospitalizations for COPD exacerbations in the previous year, and hospital characteristics. The area under the receiver-operating curve for this model was 0.75 in the derivation cohort and 0.76 in the validation cohort. CONCLUSION One-year mortality following the index hospitalization for an exacerbation of COPD was related to clinical characteristics of the patient and of the index event, previous events of similar severity, and characteristics of the hospital where the patient was treated.
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Affiliation(s)
- Cristóbal Esteban
- Pulmonary Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia Spain
- Network and Health Services Research Chronic Diseases (REDISSEC), Bilbao, Bizkaia Spain
| | - Ady Castro-Acosta
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Carlos Jose Alvarez-Martínez
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - José Luis López-Campos
- Hospital Universitario Virgen del Rocío, Medical- Surgical Unit of Respiratory Diseases, Seville, Spain
| | - Francisco Pozo-Rodriguez
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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33
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Andersen IC, Thomsen TG, Bruun P, Bødtger U, Hounsgaard L. The experience of being a participant in one's own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study. Int J Qual Stud Health Well-being 2017; 12:1371994. [PMID: 28875771 PMCID: PMC5613917 DOI: 10.1080/17482631.2017.1371994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE In healthcare related to hospital discharge and follow-up, it is acknowledged that patient participation can strengthen self-management in patients with chronic obstructive pulmonary disease. However, the meaning of participation in care following a severe acute exacerbation is less described. Therefore, the aim of this part of a larger study was to explore patients' experiences of participating in their care around discharge and in their subsequent day-to-day care at home. METHOD The study was designed as a qualitative, longitudinal study. Data were collected by repeated participant observations and in-depth interviews with 15 patients within a period of 18 months post-discharge. A phenomenological-hermeneutic approach was used to interpret the data. RESULTS Before discharge, the patients struggled to regain a sense of control in their efforts to build up strength, and acquire sufficient clarity and confidence to face self-management at home. At home, the patients strived to comply with advice and encouragement in a struggle to stay motivated and confident, and to ask for help. CONCLUSIONS With more knowledge about patients' participation in care, healthcare professionals can encounter patients in ways that are sensitive to their specific care and support needs and, thereby, contribute to the promotion of patients' health and well-being.
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Affiliation(s)
- Ingrid Charlotte Andersen
- Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Thora Grothe Thomsen
- Zealand University Hospital, Roskilde and Koege, Denmark and Institute of Regional Health Research, University of Southern Denmark, OdenseDenmark
| | - Poul Bruun
- Health Sciences Research Center, University College Lillebaelt, Denmark
| | - Uffe Bødtger
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Center, University College Lillebaelt, Denmark
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Halpin DMG, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis 2017; 12:2891-2908. [PMID: 29062228 PMCID: PMC5638577 DOI: 10.2147/copd.s139470] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.
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Affiliation(s)
- David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Norbert Metzdorf
- Respiratory Medicine, Boehringer Ingelheim Pharma GmBH & Co KG, Ingelheim am Rhein, Germany
| | - Bartolomé Celli
- Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA
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Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, Giménez-Giménez LM, Escolar-Reina P, Medina-Mirapeix F. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Ther Adv Respir Dis 2017; 11:383-392. [PMID: 28849736 PMCID: PMC5933665 DOI: 10.1177/1753465817726314] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Readmission after hospital discharge is common in patients with acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Although frailty predicts hospital readmission in patients with chronic nonpulmonary diseases, no multidimensional frailty measures have been validated to stratify the risk for patients with COPD. AIM The aim of this study was to explore multidimensional frailty as a potential risk factor for readmission due to a new exacerbation episode during the 90 days after hospitalization for AE-COPD and to test whether frailty could improve the identification of patients at high risk of readmission. We hypothesized that patients with moderate-to-severe frailty would be at greater risk for readmission within that period of follow up. A secondary aim was to test whether frailty could improve the accuracy with which to discriminate patients with a high risk of readmission. Our investigation was part of a wider study protocol with additional aims on the same study population. METHODS Frailty, demographics, and disease-related factors were measured prospectively in 102 patients during hospitalization for AE-COPD. Some of the baseline data reported were collected as part of a previously study. Readmission data were obtained on the basis of the discharge summary from patients' electronic files by a researcher blinded to the measurements made in the previous hospitalization. The association between frailty and readmission was assessed using bivariate analyses and multivariate logistic regression models. Whether frailty better identifies patients at high risk for readmission was evaluated by area under the receiver operator curve (AUC). RESULTS Severely frail patients were much more likely to be readmitted than nonfrail patients (45% versus 18%). After adjusting for age and relevant disease-related factors in a final multivariate model, severe frailty remained an independent risk factor for 90-day readmission (odds ratio = 5.19; 95% confidence interval: 1.26-21.50). Age, number of hospitalizations for exacerbations in the previous year and length of stay were also significant in this model. Additionally, frailty improved the predictive accuracy of readmission by improving the AUC. CONCLUSIONS Multidimensional frailty predicts the risk of early hospital readmission in patients hospitalized for AE-COPD. Frailty improved the accuracy of discriminating patients at high risk for readmission. Identifying patients with frailty for targeted interventions may reduce early readmission rates.
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Affiliation(s)
- Roberto Bernabeu-Mora
- Division of Pneumology, Hospital General
Universitario Jose M Morales Meseguer, Avda. Marqués de los Velez s/n.
Murcia 30008, Spain
| | - Gloria García-Guillamón
- Departamento de Fisioterapia, Facultad de
Medicina, Campus de Espinardo, Universidad de Murcia, España
| | - Elisa Valera-Novella
- Departamento de Fisioterapia, Facultad de
Medicina, Campus de Espinardo, Universidad de Murcia, España
| | | | - Pilar Escolar-Reina
- Departamento de Fisioterapia, Facultad de
Medicina, Campus de Espinardo, Universidad de Murcia, España
| | - Francesc Medina-Mirapeix
- Departamento de Fisioterapia, Facultad de
Medicina, Campus de Espinardo, Universidad de Murcia, España
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Duenk RG, Verhagen C, Bronkhorst EM, van Mierlo P, Broeders M, Collard SM, Dekhuijzen P, Vissers K, Heijdra Y, Engels Y. Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial. Int J Chron Obstruct Pulmon Dis 2017; 12:2795-2806. [PMID: 29033560 PMCID: PMC5628666 DOI: 10.2147/copd.s141974] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and aim Patients with advanced chronic obstructive pulmonary disease (COPD) have poor quality of life. The aim of this study was to assess the effects of proactive palliative care on the well-being of these patients. Trial registration This trial is registered with the Netherlands Trial Register, NTR4037. Patients and methods A pragmatic cluster controlled trial (quasi-experimental design) was performed with hospitals as cluster (three intervention and three control) and a pretrial assessment was performed. Hospitals were selected for the intervention group based on the presence of a specialized palliative care team (SPCT). To control for confounders, a pretrial assessment was performed in which hospitals were compared on baseline characteristics. Patients with COPD with poor prognosis were recruited during hospitalization for acute exacerbation. All patients received usual care while patients in the intervention group received additional proactive palliative care in monthly meetings with an SPCT. Our primary outcome was change in quality of life score after 3 months, which was measured using the St George Respiratory Questionnaire (SGRQ). Secondary outcomes were, among others, quality of life at 6, 9 and 12 months; readmissions: survival; and having made advance care planning (ACP) choices. All analyses were performed following the principle of intention to treat. Results During the year 2014, 228 patients (90 intervention and 138 control) were recruited and at 3 months, 163 patients (67 intervention and 96 control) completed the SGRQ. There was no significant difference in change scores of the SGRQ total at 3 months between groups (−0.79 [95% CI, −4.61 to 3.34], p=0.70). However, patients who received proactive palliative care experienced less impact of their COPD (SGRQ impact subscale) at 6 months (−6.22 [−11.73 to −0.71], p=0.04) and had more often made ACP choices (adjusted odds ratio 3.26 [1.49–7.14], p=0.003). Other secondary outcomes were not significantly different. Conclusion Proactive palliative care did not improve the overall quality of life of patients with COPD. However, patients more often made ACP choices which may lead to better quality of care toward the end of life.
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Affiliation(s)
- R G Duenk
- Department of Anesthesiology, Pain and Palliative Medicine
| | - C Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine
| | - E M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen
| | - Pjwb van Mierlo
- Department of Supportive and Palliative Medicine.,Department of Geriatric Medicine, Rijnstate Hospital, Arnhem
| | - Meac Broeders
- Department of Pulmonary Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch
| | - S M Collard
- Department of Pulmonary Diseases, Meander Medical Center, Amersfoort
| | - Pnr Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kcp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Heijdra
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Y Engels
- Department of Anesthesiology, Pain and Palliative Medicine
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37
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McKinstry S, Pilcher J, Bardsley G, Berry J, Van de Hei S, Braithwaite I, Fingleton J, Weatherall M, Beasley R. Nasal high flow therapy and PtCO2in stable COPD: A randomized controlled cross-over trial. Respirology 2017; 23:378-384. [DOI: 10.1111/resp.13185] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/06/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Steven McKinstry
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - George Bardsley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - James Berry
- Medical Research Institute of New Zealand; Wellington New Zealand
| | | | - Irene Braithwaite
- Medical Research Institute of New Zealand; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - Mark Weatherall
- Capital and Coast District Health Board; Wellington New Zealand
- School of Medicine and Health Sciences; University of Otago Wellington; Wellington New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
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Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is expected to increase as the population ages. Patients have a high symptom burden, low healthcare quality of life, and unmet needs at the end of life. This review highlights specific palliative care needs of patients with advanced COPD and opportunities to integrate palliative care into standard practice. RECENT FINDINGS There are many barriers to providing integrated palliative care in COPD, including difficulty with prognostication, communication barriers surrounding advance care planning, and lack of access to specialty palliative care. Because of the unique disease trajectory, emphases on early and primary palliative care are being studied in this patient population. SUMMARY Palliative care is appropriate for patients with COPD and should be integrated with disease-specific therapies. The line between life prolonging and palliative care undoubtedly overlaps and maximizing quality of life throughout the continuum of care should be prioritized for patients with this progressive illness.
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39
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Duenk RG, Verhagen C, Bronkhorst EM, Djamin RS, Bosman GJ, Lammers E, Dekhuijzen P, Vissers K, Engels Y, Heijdra Y. Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care. Int J Chron Obstruct Pulmon Dis 2017; 12:2121-2128. [PMID: 28790815 PMCID: PMC5530053 DOI: 10.2147/copd.s140037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Our objective was to develop a tool to identify patients with COPD for proactive palliative care. Since palliative care needs increase during the disease course of COPD, the prediction of mortality within 1 year, measured during hospitalizations for acute exacerbation COPD (AECOPD), was used as a proxy for the need of proactive palliative care. Patients and methods Patients were recruited from three general hospitals in the Netherlands in 2014. Data of 11 potential predictors, a priori selected based on literature, were collected during hospitalization for AECOPD. After 1 year, the medical files were explored for the date of death. An optimal prediction model was assessed by Lasso logistic regression, with 20-fold cross-validation for optimal shrinkage. Missing data were handled using complete case analysis. Results Of 174 patients, 155 patients were included; of those 30 (19.4%) died within 1 year. The optimal prediction model was internally validated and had good discriminating power (AUC =0.82, 95% CI 0.81–0.82). This model relied on the following seven predictors: the surprise question, Medical Research Council dyspnea questionnaire (MRC dyspnea), Clinical COPD Questionnaire (CCQ), FEV1% of predicted value, body mass index, previous hospitalizations for AECOPD and specific comorbidities. To ensure minimal miss out of patients in need of proactive palliative care, we proposed a cutoff in the model that prioritized sensitivity over specificity (0.90 over 0.73, respectively). Our model (ProPal-COPD tool) was a stronger predictor of mortality within 1 year than the CODEX (comorbidity, age, obstruction, dyspnea, and previous severe exacerbations) index. Conclusion The ProPal-COPD tool is a promising multivariable prediction tool to identify patients with COPD for proactive palliative care.
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Affiliation(s)
- R G Duenk
- Department of Anesthesiology, Pain and Palliative Medicine
| | - C Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine
| | - E M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen
| | - R S Djamin
- Department of Respiratory Medicine, Amphia Hospital, Breda
| | - G J Bosman
- Department of Respiratory Medicine, Slingeland Hospital, Doetinchem
| | - E Lammers
- Department of Respiratory Medicine, Gelre Hospitals, Zutphen
| | - Pnr Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kcp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Engels
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Heijdra
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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40
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Delclaux B. [Severity and prognostic factors in acute COPD exacerbations]. Rev Mal Respir 2017; 34:353-358. [PMID: 28476413 DOI: 10.1016/j.rmr.2017.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Delclaux
- Service de pneumologie et oncologie thoracique, centre hospitalier de Troyes, 101, avenue Anatole-France, 10003 Troyes cedex, France.
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41
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Pilcher J, Eastlake L, Richards M, Power S, Cripps T, Bibby S, Braithwaite I, Weatherall M, Beasley R. Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial. Respirology 2017; 22:1149-1155. [DOI: 10.1111/resp.13050] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Leonie Eastlake
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Sharon Power
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Terrianne Cripps
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Susan Bibby
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
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Neo HY, Xu HY, Wu HY, Hum A. Prediction of Poor Short-Term Prognosis and Unmet Needs in Advanced Chronic Obstructive Pulmonary Disease: Use of the Two-Minute Walking Distance Extracted from a Six-Minute Walk Test. J Palliat Med 2017; 20:821-828. [PMID: 28353374 DOI: 10.1089/jpm.2016.0449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Prognostic challenges hinder the identification of patients with advanced chronic obstructive pulmonary disease (COPD) for timely palliative interventions. We postulate that a two-minute derivative (two-minute walking distance [2MWD]) of a standard six-minute walk test (6MWT) can identify frail subjects with poorer survival for early palliative intervention. The primary outcome of interest is mortality at 18 months. Secondary objectives include evaluation of the relationship between the 2MWD and ability to self-care, dyspnea-related disabilities, nutrition, forced expiratory volume in first second (FEV1), quality of life (QoL), and comorbidity burden. DESIGN AND SETTING One hundred twenty-four subjects with stage 3 and 4 COPD were recruited and followed up. Ability to self-care, dyspnea-related disabilities, airflow limitation, nutrition, and QoL were measured by using modified Barthel index (MBI), Modified Medical Research Council (MMRC) dyspnea scale, FEV1 (% predicted), BODE [BMI(B), FEV1(O), MMRC(D), 6MWT(E)] index, updated ADO [Age(A), MMRC(D), FEV1(O)] index, Subjective Global Assessment (SGA), and St. George's Respiratory Questionnaire (SGRQ), respectively. Survival data were prospectively collected and analyzed. RESULTS The 2MWD correlates highly with BODE and predicts updated ADO independent of age, co-morbidities, long-term oxygen therapy (LTOT), body mass index, and FEV1. Log-rank test performed with Kaplan-Meier plots demonstrates that 2MWD ≤80 m significantly predicts survival time (p < 0.05). Cox proportional hazard regression shows a 3.6-time greater probability of 18-month mortality (hazard ratio [HR] 3.57; 95% confidence interval [CI] 1.26-10.13; p < 0.05). In addition, 2MWD strongly predicted MBI and MMRC, independent of age, co-morbidities, LTOT, body mass index, and FEV1. Subjects with 2MWD ≤80 m have a poorer ability to self-care (median MBI 90 vs. 100), lower FEV1 (32.9% ± 9.8% vs. 38.1% ± 9.4%), poorer QoL (mean SGRQ 46.6 ± 16.2 vs. 36.6 ± 13.3), and greater dyspnea-related disability (mean MMRC 1.7 ± 0.7 vs. 0.9 ± 0.6), and they are more malnourished (40.4% vs. 9.7%; RR 1.51) (all p < 0.001). CONCLUSION 2MWD ≤80 m identifies subjects with higher mortality, greater functional dependence, poorer in nutrition, greater dyspnea, and lower QoL. Incorporation of 2MWD into composite prognostic indices can enhance predictive accuracy and identify patients requiring early proactive palliative interventions.
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Affiliation(s)
- Han-Yee Neo
- 1 Department of Palliative Medicine, Tan Tock Seng Hospital , Singapore, Singapore
| | - Hui-Ying Xu
- 2 Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital , Singapore, Singapore
| | - Huei-Yaw Wu
- 1 Department of Palliative Medicine, Tan Tock Seng Hospital , Singapore, Singapore
| | - Allyn Hum
- 1 Department of Palliative Medicine, Tan Tock Seng Hospital , Singapore, Singapore
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43
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García-Sanz MT, Cánive-Gómez JC, Senín-Rial L, Aboal-Viñas J, Barreiro-García A, López-Val E, González-Barcala FJ. One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease. J Thorac Dis 2017; 9:636-645. [PMID: 28449471 DOI: 10.21037/jtd.2017.03.34] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Identifying potentially-modifiable predictors of mortality could help optimize COPD patient management. The aim of this study is to determine long-term mortality following hospitalization due to acute exacerbations of COPD (AECOPD), as well as AECOPD mortality predictors. METHODS We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. In order to identify variables independently associated with mortality, we conducted a multivariate Cox proportional hazard regression analysis including those variables which proved to be significant in the univariate analysis. RESULTS Seven hundred and fifty seven patients were assessed. Patient mean age was 74.8 years and males accounted for 77% of all patients. Mean stay was 12.2 days. Three point six percent of all patients required intensive care. As for mortality rates, 1-year mortality was 26.2%, and 5-year mortality was 64.3%. In both scenarios, the most frequent causes of death were respiratory and cardiovascular disorders. Factors independently associated with mortality were older age, hospitalization by internal medicine (IMU), length of stay, the need for mechanical ventilation (MV) or noninvasive mechanical ventilation (NIV), early readmission, and history of atrial fibrillation (AF) and dementia. CONCLUSIONS In patients with COPD, age, exacerbation severity and comorbidity have long-term prognostic significance.
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Affiliation(s)
| | | | - Laura Senín-Rial
- Nursing Staff, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jorge Aboal-Viñas
- Regional Department of Health, San Caetano s/n, Santiago de Compostela, Spain
| | | | - Eva López-Val
- Nursing Staff, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco-Javier González-Barcala
- Medicine Department, University of Santiago de Compostela, Santiago de Compostela, Spain.,Spanish Biomedical Research Networking Centre-CIBERES, Santiago de Compostela, Spain.,Respiratory Medicine Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD. Thorax 2017; 72:686-693. [PMID: 28235886 PMCID: PMC5537524 DOI: 10.1136/thoraxjnl-2016-209298] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
Background One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. Methods In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. Results Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. Conclusions The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. Trial registration number UKCRN ID 14214.
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Affiliation(s)
- C Echevarria
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - J Steer
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK
| | - K Heslop-Marshall
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - S C Stenton
- Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - P M Hickey
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | - R Hughes
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | | | - R N Harrison
- University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
| | - N Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G J Gibson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S C Bourke
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
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45
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Flattet Y, Garin N, Serratrice J, Perrier A, Stirnemann J, Carballo S. Determining prognosis in acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:467-475. [PMID: 28203070 PMCID: PMC5293360 DOI: 10.2147/copd.s122382] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Acute exacerbations are the leading causes of hospitalization and mortality in patients with COPD. Prognostic tools for patients with chronic COPD exist, but there are scarce data regarding acute exacerbations. We aimed to identify the prognostic factors of death and readmission after exacerbation of COPD. Methods This was a retrospective study conducted in the Department of Internal Medicine of Geneva University Hospitals. All patients admitted to the hospital with a diagnosis of exacerbation of COPD between 2008 and 2011 were included. The studied variables included comorbidities, Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification, and biological and clinical parameters. The main outcome was death or readmission during a 5-year follow-up. The secondary outcome was death. Survival analysis was performed (log-rank and Cox). Results We identified a total of 359 patients (195 men and 164 women, average age 72 years). During 5-year follow-up, 242 patients died or were hospitalized for the exacerbation of COPD. In multivariate analysis, age (hazard ratio [HR] 1.03, 95% CI 1.02–1.05; P<0.0001), severity of airflow obstruction (forced expiratory volume in 1 s <30%; HR 4.65, 95% CI 1.42–15.1; P=0.01), diabetes (HR 1.47, 95% CI 1.003–2.16; P=0.048), cancer (HR 2.79, 95% CI 1.68–4.64; P<0.0001), creatinine (HR 1.003, 95% CI 1.0004–1.006; P=0.02), and respiratory rate (HR 1.03, 95% CI 1.003–1.05; P=0.028) on admission were significantly associated with the primary outcome. Age, cancer, and procalcitonin were significantly associated with the secondary outcome. Conclusion COPD remains of ominous prognosis, especially after exacerbation requiring hospitalization. Baseline pulmonary function remains the strongest predictor of mortality and new admission. Demographic factors, such as age and comorbidities and notably diabetes and cancer, are closely associated with the outcome of the patient. Respiratory rate at admission appears to be the most prognostic clinical parameter. A prospective validation is, however, still required to enable the identification of patients at higher risk of death or readmission.
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Affiliation(s)
- Yves Flattet
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva
| | - Nicolas Garin
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva; Service of Internal Medicine, Riviera Chablais Hospital, Monthey, Switzerland
| | - Jacques Serratrice
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva
| | - Arnaud Perrier
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva
| | - Jérome Stirnemann
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva
| | - Sebastian Carballo
- Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva
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46
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Duenk RG, Verhagen C, Dekhuijzen P, Vissers K, Engels Y, Heijdra Y. The view of pulmonologists on palliative care for patients with COPD: a survey study. Int J Chron Obstruct Pulmon Dis 2017; 12:299-311. [PMID: 28176900 PMCID: PMC5261600 DOI: 10.2147/copd.s121294] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results The 256 respondents (31.8%) covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2%) indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%), communication between pulmonologist and general practitioner (77%), and identification of the palliative phase (75.8%), while the latter was considered the most important aspect for improvement (67.6%). Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%), while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT). In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%). Conclusion To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification criteria. Furthermore, pulmonologists should improve their skills of palliative care, and the members of the SPCT should be better informed about the management of COPD to improve care during hospitalization. Communication between pulmonologist and general practitioner should be emphasized in training to improve palliative care in the ambulatory setting.
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Affiliation(s)
- R G Duenk
- Department of Anesthesiology, Pain and Palliative Medicine
| | - C Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Pnr Dekhuijzen
- Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Kcp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Engels
- Department of Anesthesiology, Pain and Palliative Medicine
| | - Y Heijdra
- Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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47
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García-Rivero JL, Esquinas C, Barrecheguren M, Bonnin-Vilaplana M, García-Sidro P, Herrejón A, Martinez-Rivera C, Malo de Molina R, Marcos PJ, Mayoralas S, Naval E, Ros JA, Valle M, Miravitlles M. Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models. COPD 2016; 14:164-169. [PMID: 27983876 DOI: 10.1080/15412555.2016.1260538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD). We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1 < 45%, Charlson ≥ 3, hemoglobin (Hb)<13 g/L, PCO2 ≥ 46 mmHg, fibrinogen ≥ 554 g/L, C-reactive protein (CRP)≥45 mg/L, leukocyte count < 9810 × 109/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT ≥ 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95%CI 1.09-6.36), CRP ≥ 45 mg/L (OR = 2.91, 95%CI: 1.11-7.49) and LTOT (3.07, 95%CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT ≥ 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.
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Affiliation(s)
| | - Cristina Esquinas
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Miriam Barrecheguren
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | | | | | | | | | | | | | | | - Elsa Naval
- j Hospital de La Ribera , Alzira , Spain
| | | | - Manuel Valle
- g Hospital Puerta del Hierro , Majadahonda , Spain
| | - Marc Miravitlles
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
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48
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Duenk RG, Verhagen SC, Janssen MA, Dekhuijzen RP, Vissers KC, Engels Y, Heijdra Y. Consistency of medical record reporting of a set of indicators for proactive palliative care in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2016; 14:63-71. [PMID: 27872166 DOI: 10.1177/1479972316661922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To identify patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD) who have a poor prognosis and might benefit from proactive palliative care, a set of indicators had been developed from the literature. A patient is considered eligible for proactive palliative care when meeting ≥2 criteria of the proposed set of 11 indicators. In order to develop a doctor-friendly and patient-convenient tool, our primary objective was to examine whether these indicators are documented consistently in the medical records. Besides, percentage of patients with a poor prognosis and prognostic value were explored. We conducted a retrospective medical record review of 33 patients. Five indicators; non-invasive ventilation (NIV), comorbidity, body mass index (BMI), previous admissions for acute exacerbation COPD and age were always documented. Three indicators; hypoxaemia and/or hypercapnia, professional home care and actual forced expiratory volume1% (FEV1%) were documented in more than half of the records, whereas the clinical COPD questionnaire (CCQ), medical research council dyspnoea (MRC dyspnoea) and the surprise question were never registered. Besides, 78.8% of the patients met ≥2 criteria and there was a significant association between meeting ≥2 criteria and mortality within 1 year (one-sided Fisher's exact test, p = 0.04). The set of indicators for proactive palliative care in patients with COPD appeared to be user-friendly and feasible.
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Affiliation(s)
- Ria G Duenk
- 1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Stans C Verhagen
- 1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Mireille Ae Janssen
- 1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard Pnr Dekhuijzen
- 2 Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Kris Cp Vissers
- 1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Yvonne Engels
- 1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Yvonne Heijdra
- 2 Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Bove DG, Zakrisson AB, Midtgaard J, Lomborg K, Overgaard D. Undefined and unpredictable responsibility: a focus group study of the experiences of informal caregiver spouses of patients with severe COPD. J Clin Nurs 2016; 25:483-93. [PMID: 26818373 DOI: 10.1111/jocn.13076] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To explore how spouses of patients with severe chronic obstructive pulmonary disease experience their role as informal caregiver. BACKGROUND Informal caregiver spouses are of pivotal importance in the way that patients with chronic obstructive pulmonary disease cope with their daily life, including their opportunity to stay at home and avoid hospitalisations in the last stages of the disease. However, caregiving is associated with increased morbidity and mortality among caregivers. Further understanding of the role as an informal caregiver spouse of patients with severe chronic obstructive pulmonary disease is needed to develop supportive interventions aimed at reducing the caregiver burden. DESIGN The study had a qualitative exploratory design. The data collection and analysis were based on framework method. Framework method is a thematic methodology and consists of five key stages: familiarisation, identifying a thematic framework, indexing, charting and mapping & interpretation. METHODS Three focus groups were conducted in November 2013 with 22 spouses of patients with severe chronic obstructive pulmonary disease. RESULTS Undefined and unpredictable responsibility was found to be the overarching theme describing the informal caregiver role. Underlying themes were: being constantly in a state of alertness, social life modified, maintaining normality, ambivalence in the relationship and a willingness to be involved. CONCLUSIONS The informal caregiver spouses experienced ambiguity about expectations from their private and the health professionals' surroundings. The informal caregiver spouses wanted to provide meaningful care for their partners, but sought knowledge and support from the health professionals. RELEVANCE TO CLINICAL PRACTICE We recommend that nurses take on the responsibility for including the informal caregiver spouses in those aspects of decision-making that involve the common life of the patients and their spouses.
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Affiliation(s)
- Dorthe Gaby Bove
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, University of Copenhagen, Denmark
| | - Ann-Britt Zakrisson
- University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Sweden.,Centre for Assessment of Medical Technology, Örebro University, Sweden
| | - Julie Midtgaard
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,The University Hospital Centre for Health Research, Copenhagen University Hospital, Rigshospitalet, København Ø, Denmark
| | - Kirsten Lomborg
- Section for Nursing, Department of Clinical Medicine and Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus N, Danmark
| | - Dorthe Overgaard
- Research Unit, Nordsjaellands Hospital, University of Copenhagen, Department of Nursing, Metropolitan University College, Copenhagen, Denmark
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50
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Sharafkhaneh A, Spiegelman AM, Main K, Tavakoli-Tabasi S, Lan C, Musher D. Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia. COPD 2016; 14:23-29. [PMID: 27661473 DOI: 10.1080/15412555.2016.1220513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.
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Affiliation(s)
- Amir Sharafkhaneh
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | | | - Kevin Main
- d Allied Health Sciences, Baylor College of Medicine , Houston , TX , USA
| | - Shahriar Tavakoli-Tabasi
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
| | - Charlie Lan
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Daniel Musher
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
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