1
|
Şiklar Z. Management of endocrinological problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2163-2169. [PMID: 38088200 DOI: 10.1002/ppul.26800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Children with home invasive mechanical ventilation (HIMV) face numerous difficulties, including endocrine problems that can arise as a consequence of their condition. Endocrine problems seen in children treated with HIMV may develop due to the underlying disease, drugs used, or prolonged mechanical ventilation. METHOD This manuscript will review the most common endocrine problems encountered in children with HIMV, including problems in glucose metabolism, thyroid dysfunction, bone metabolism, adrenal dysfunctions, growth, and puberty. CONCLUSION Close monitoring, multidisciplinary care, and regular assessments are essential to optimize the endocrine system functions of children requiring home mechanical ventilation. By understanding these complications, it can develop effective management strategies to optimize the health and well-being of these vulnerable individuals.
Collapse
Affiliation(s)
- Zeynep Şiklar
- Division of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
Liu Z, Sun Z, Hu H, Yin Y, Zuo B. Development and validation of a prospective study to predict the risk of readmission within 365 days of respiratory failure: based on a random survival forest algorithm combined with COX regression modeling. BMC Pulm Med 2024; 24:82. [PMID: 38355552 PMCID: PMC10865688 DOI: 10.1186/s12890-024-02862-9] [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: 08/03/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND There is a need to develop and validate a widely applicable nomogram for predicting readmission of respiratory failure patients within 365 days. METHODS We recruited patients with respiratory failure at the First People's Hospital of Yancheng and the People's Hospital of Jiangsu. We used the least absolute shrinkage and selection operator regression to select significant features for multivariate Cox proportional hazard analysis. The Random Survival Forest algorithm was employed to construct a model for the variables that obtained a coefficient of 0 following LASSO regression, and subsequently determine the prediction score. Independent risk factors and the score were used to develop a multivariate COX regression for creating the line graph. We used the Harrell concordance index to quantify the predictive accuracy and the receiver operating characteristic curve to evaluate model performance. Additionally, we used decision curve analysiso assess clinical usefulness. RESULTS The LASSO regression and multivariate Cox regression were used to screen hemoglobin, diabetes and pneumonia as risk variables combined with Score to develop a column chart model. The C index is 0.927 in the development queue, 0.924 in the internal validation queue, and 0.922 in the external validation queue. At the same time, the predictive model also showed excellent calibration and higher clinical value. CONCLUSIONS A nomogram predicting readmission of patients with respiratory failure within 365 days based on three independent risk factors and a jointly developed random survival forest algorithm has been developed and validated. This improves the accuracy of predicting patient readmission and provides practical information for individualized treatment decisions.
Collapse
Affiliation(s)
- Zhongxiang Liu
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Zhixiao Sun
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Hang Hu
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Yuan Yin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical Univesity, Nanjing, 210029, China
| | - Bingqing Zuo
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China.
| |
Collapse
|
3
|
Poole JA, Gaurav R, Schwab A, Nelson AJ, Gleason A, Romberger DJ, Wyatt TA. Post-endotoxin exposure-induced lung inflammation and resolution consequences beneficially impacted by lung-delivered IL-10 therapy. Sci Rep 2022; 12:17338. [PMID: 36243830 PMCID: PMC9569365 DOI: 10.1038/s41598-022-22346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
Although lung diseases typically result from long-term exposures, even a robust, one-time exposure can result in long-lasting consequences. Endotoxin is a ubiquitous environmental/occupational inflammatory agent often used to model airway inflammation. Using a murine model, the return to lung homeostasis following high dose inhalant lipopolysaccharide (LPS, 10-100 μg) exposure were delineated over 2 weeks. LPS-induced rapid weight loss, release of proinflammatory mediators, and inflammatory cell influx with prolonged persistence of activated macrophages CD11c+CD11b+ and recruited/transitioning CD11cintCD11b+ monocyte-macrophages out to 2 weeks. Next, lung-delivered recombinant (r) interleukin (IL)-10 was intratracheally administered for 3 doses initiated 5 h following LPS (10 μg) exposure for 2 days. IL-10 therapy reduced LPS-induced weight loss and increased blood glucose levels. Whereas there was no difference in LPS-induced bronchoalveolar lavage airway fluid cellular influx, total lung cell infiltrates were reduced (37%) with rIL-10 treatment. Post-LPS exposure treatment with rIL-10 strikingly reduced lavage fluid and lung homogenate levels of tumor necrosis factor-α (88% and 93% reduction, respectively), IL-6 (98% and 94% reduction), CXCL1 (66% and 75% reduction), and CXCL2 (47% and 67% reduction). LPS-induced recruited monocyte-macrophages (CD11cintCD11b+) were reduced (68%) with rIL-10. Correspondingly, LPS-induced lung tissue CCR2+ inflammatory monocyte-macrophage were reduced with rIL-10. There were also reductions in LPS-induced lung neutrophils, lymphocyte subpopulations, collagen content, and vimentin expression. These findings support the importance of studying resolution processes for the development of treatment after unintended environmental/occupational biohazard exposures. Short-term, lung-delivered rIL-10 favorably hastened inflammatory recovery processes following acute, high dose inhalant LPS exposure.
Collapse
Affiliation(s)
- Jill A. Poole
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Rohit Gaurav
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Aaron Schwab
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Amy J. Nelson
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Angela Gleason
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Debra J. Romberger
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Todd A. Wyatt
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA ,grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| |
Collapse
|
4
|
Motamed B, Alavi Foumani A, Tangestaninezhad A, Almasi M, Faraji N, Jafarinezhad A. The relationship between glycated hemoglobin A1c levels and exacerbation status in the patients with chronic obstructive pulmonary disease. BMC Res Notes 2022; 15:326. [PMID: 36243756 PMCID: PMC9571465 DOI: 10.1186/s13104-022-06217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study was performed in Razi Hospital, Rasht, Iran, between March 2016 and August 2018 on a population of chronic obstructive pulmonary disease (COPD) patients (56 as COPD exacerbation group and 56 as COPD stable group). Study variables include age, sex, occupation, body mass index (BMI), cigarette consumption, duration of COPD, annual hospitalization, dyspnea, glycated hemoglobin (HbA1c), FEV1, and FEV1/FVC indices. RESULT The mean age of the participants was 63.92 ± 10.75 years. There was a significant difference in the hospitalization between the patients with both exacerbation and normal state of COPD (P ≤ 0.001). HbA1c in the patients with exacerbation of COPD was significantly higher than stable status (P = 0.001). Logistic regression showed that HbA1c levels and hospitalization were predictors of exacerbation of COPD. HbA1c levels were statistically significant in terms of hospitalization in patients with COPD exacerbation. There was a significant difference between the HbA1c levels and MMRC in patients with COPD. The percentage of HbA1c was associated with exacerbation of COPD and HbA1c is a good predictor of disease severity in patients with COPD. It also shows that patients with COPD exacerbation and severe COPD are at the higher risk of hyperglycemia.
Collapse
Affiliation(s)
- Behrang Motamed
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Alavi Foumani
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Azita Tangestaninezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Almasi
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- grid.411874.f0000 0004 0571 1549Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- grid.411874.f0000 0004 0571 1549Inflammatory Lung Diseases Research Center, Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
5
|
Edriss H, Molehin AJ, Gavidia R, Selvan K, Nugent K. Association between acute respiratory failure requiring mechanical ventilation and the production of advanced glycation end products. J Investig Med 2020; 68:1235-1240. [PMID: 32859644 DOI: 10.1136/jim-2020-001419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/04/2022]
Abstract
Patients with acute respiratory failure often have hyperglycemia. Elevated glucose levels could cause acute lung injury through the production of advanced glycation end products. We measured glucose, advanced glycation end products, glycated albumin, circulating glycated hemoglobin, and soluble receptor for advanced glycation end product (sRAGE) levels on admission, at 24 hours, and at 72 hours in 40 patients with acute respiratory failure requiring mechanical ventilation. We compared these values with healthy control subjects. The mean age was 63.3±11.2 years. Fifty percent of the patients were women. Thirteen patients (32.5%) died during this hospitalization. The mean maximum glucose level on the day of admission was 215.7±171.1 mg/dL. Compared with control subjects, there was a significant reduction in advanced glycation end product levels (p=0.0001) in the patients at all 3 time points. Circulating glycated hemoglobin levels were significantly higher in patients compared with control subjects. We also observed a moderate increase in glycated albumin levels on admission and at 24 hours when compared with the control samples. Overall sRAGE levels were similar to controls, but patients with dense infiltrates on chest X-ray had increased levels compared with patients who did not have these dense infiltrates on the day of admission. Patients with acute respiratory failure requiring mechanical ventilation have decreased levels of advanced glycation end products and increased levels of circulating glycated hemoglobin. The results from this pilot study suggest that the acute stress associated with respiratory failure might create glycated proteins which could contribute to disease pathogenesis.
Collapse
Affiliation(s)
- Hawa Edriss
- Pulmonary and Critical Care Medicine, CHI Saint Joseph Hospital, Lexington, Kentucky, United States
| | - Adebayo J Molehin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA .,Center for Tropical Medicine and Infectious Diseases, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Rocio Gavidia
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kavitha Selvan
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| |
Collapse
|
6
|
Mcgrade P, Yang S, Nugent K. The association between admission glucose levels and outcomes in adults admitted to a tertiary care hospital. J Community Hosp Intern Med Perspect 2019; 9:195-202. [PMID: 31258857 PMCID: PMC6586082 DOI: 10.1080/20009666.2019.1611318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Hyperglycemia at the time of hospital admission has been associated with poor outcomes in several patient groups, but there is little information about this association in hospitalized patients with diverse diagnoses. Methods: We identified all adult patients admitted between 10/1/2015 and 9/30/2016 who had glucose levels measured during the first 24 h after admission to the hospital. Clinical information included age, gender, glucose levels, diagnoses based on ICD 10 discharge coding, length of stay (LOS), and mortality. Patients were classified into quartiles based on glucose levels and into clinically relevant glucose categories. Results: This study included 18,478 adult patients admitted to a tertiary care hospital. The median age was 53 years, the median LOS was 4 days, and the overall in-hospital mortality was 3.8%. The median admission glucose level was 117 mg/dL. Mortality increased in each glucose quartile; it was also highest in patients admitted with a glucose <55 mg/dL or with a glucose >200 mg/dL. The LOS was significantly shorter in patients in glucose quartiles 1 and 2. Conclusions: Admission glucose levels were associated with in-hospital mortality and LOS in this cohort of hospitalized patients. Attention to glucose levels can help identify patients at risk for poor outcomes.
Collapse
Affiliation(s)
- Patrick Mcgrade
- Departments of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Shengping Yang
- Departments of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kenneth Nugent
- Departments of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| |
Collapse
|
7
|
Yang CJ, Liao WI, Tang ZC, Wang JC, Lee CH, Chang WC, Hsu CW, Tang SE, Tsai SH. Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1923-1932. [PMID: 28740373 PMCID: PMC5505159 DOI: 10.2147/copd.s131232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute hyperglycemia is a common finding in patients presenting to emergency departments (EDs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Several studies have argued against the association between hyperglycemia at admission and adverse outcomes in patients with diabetes and an acute illness. Recent studies have shown that glucose-related variables (eg, glycemic gaps and stress hyperglycemia ratios) that are adjusted for glycated hemoglobin levels can indicate the severity of a variety of diseases. The objective of this study was to assess whether these hemoglobin A1c (HbA1c)-based adjusted average glycemic variables were associated with unfavorable outcomes in patients admitted to a hospital with AECOPD. We found that 1) pulmonary infection is a major risk factor for AECOPD; 2) a higher glycemic gap and modified stress hyperglycemia ratio were associated with the development of acute respiratory failure (ARF) in patients with diabetes admitted to an ED because of AECOPD; and 3) the glycemic gap and modified stress hyperglycemia ratio had superior discriminative power over acute hyperglycemia and HbA1c for predicting the development of ARF, although the HbA1c-adjusted glycemic variables alone were not independent risk factors for ARF.
Collapse
Affiliation(s)
- Chih-Jen Yang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Zun-Cheng Tang
- Department of Biological Imaging and Radiological Science, National Yang-Ming University
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chien-Hsing Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, College of Medicine.,Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University
| | - Shih-En Tang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| |
Collapse
|