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Dai L, Liang BM, Ou XM. Predictive value of neutrophil-to-lymphocyte ratio and bilirubin levels in the readmission of acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci 2023; 365:169-175. [PMID: 36167155 DOI: 10.1016/j.amjms.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 08/16/2021] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Th aim of this study was to analyze acute exacerbation of chronic obstructive pulmonary disease (AECOPD) readmission events and to determine whether neutrophil-to-lymphocyte ratio (NLR) and bilirubin levels were associated with readmission after discharge due to AECOPD. METHODS A total of 170 patients with AECOPD were included. Patients were stratified into the readmission group if patients had two or more readmissions within 2 years of the previous discharge, and the non-readmission group with one readmission or none within 2 years of the last discharge. Data were collected and compared between groups. The patients were separated by the cutoffs of NLR and bilirubin level. The number of all-cause readmissions within 2 years, time to first COPD-related readmission, 1-year/2-year COPD-related readmission, 1-year/2-year all-cause mortality were compared between groups, respectively. RESULTS Compared with the readmission group, patients of the non-readmission group had a shorter length of hospital stay, more systemic corticosteroid use, higher NLR, higher bilirubin levels, and lower eosinophils counts (p < 0.05). NLR and bilirubin levels on admission had significant association with the number of all-cause readmissions (p < 0.05). Lower bilirubin was associated with an increased risk of 1-year COPD-related readmission (OR 5.063) and 2-year COPD-related readmission (OR 4.699). CONCLUSIONS For patients with AECOPD, longer hospital stay, and less use of systemic corticosteroids may be associated with a higher risk of readmission. NLR and bilirubin levels on admission may be related to the number of all-cause readmissions. Bilirubin can be regarded as a biomarker to predict readmission rates within 2 years after discharged throughout the course of the disease.
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Affiliation(s)
- Lu Dai
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bin-Miao Liang
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Xue-Mei Ou
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China
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Zhou F, Chandra K, Sohi D, Robertson C, Fraser J, Scoville J, DeSousa N, Vaillancourt C, Atkinson PR. Do Guidelines Influence Emergency Department Staff Behaviours and Improve Patient Outcomes? Evaluation of a Multifaceted Intervention for the Implementation of Local Acute Exacerbations of Chronic Obstructive Pulmonary Disease Guidelines. Cureus 2018; 10:e3588. [PMID: 30680255 PMCID: PMC6338401 DOI: 10.7759/cureus.3588] [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: 11/27/2022] Open
Abstract
Introduction Published national guidelines on chronic obstructive pulmonary disease (COPD) highlight the importance of oxygen therapy, bronchodilators, corticosteroids, and appropriate antibiotics during acute exacerbations of COPD (AECOPD). We wished to assess how the implementation of local COPD guidelines affects emergency department (ED) staff awareness, knowledge, the use of such guidelines, and patient outcomes, including treatment failure and rates of return to the ED. Methods This study was conducted at a tertiary hospital ED. Local COPD guidelines were developed by a quality improvement group. Guidelines were posted in the department, and educational sessions were provided for staff. We conducted a retrospective chart review and looked at 1849 patient visits before and after COPD guideline implementation. All visits with a diagnosis of COPD or AECOPD were included in the study (for a total of 130 patient visits), and data were collected using a standardized abstraction tool. For non-admitted patients, we recorded 30-day return rates and treatment failures occurring within 30 days of presenting to the ED. Pre- and post-implementation outcomes were analyzed with Fisher’s exact tests. We also assessed ED staff awareness, knowledge, and use of COPD guidelines through surveys given out before implementation, and both one and 10 months after the implementation. We calculated proportions and 95% confidence intervals (CI) for our surveys. Pre- and post-implementation survey responses were compared with Fisher's exact tests. Results For ED physicians, the survey response rate was 78%, 79%, and 58% at pre-implementation, one-month follow-up, and 10-month follow-up, respectively. Prior to implementation, 14.3% (95% CI 4.1%-35.5%) were aware and 0% (0%-18.2%) reported using guidelines. One month after implementation, 90.9% (71.0%-98.7%) were aware and 81.8% (60.9%-93.3%) reported using guidelines. At 10 months, 100% (76.1%-100%) were aware and 100% (82%-100%) reported using local guidelines. Similar trends were seen among nurses and respiratory therapists. To assess actual guideline use, 130 visits were evaluated (51 visits prior to implementation and 79 post-implementation). Prior to implementation, 57% (43%-70%) received bronchodilators, systemic steroids, and antibiotics appropriately. Following guideline implementation, 57% (46%-67%) received the respective treatments (p=1.0). For patient-related outcomes, 86 non-admission patient visits were evaluated (35 visits prior to implementation and 51 post-implementation). Prior to guideline implementation, 17% (8%-33%) failed their initial AECOPD treatment, compared to 10% (4%-21%) following guideline implementation (p=0.34). Prior to guideline implementation, 23% (12%-39%) returned to the ED within 30 days in the pre-implementation period while 14% (7%-26%) returned post-implementation (p=0.39). Conclusion Our introduction of local COPD guidelines was successful at increasing self-reported awareness, knowledge, and the use of best practice guidelines among ED staff. At the 10-month follow-up, increased awareness, knowledge, and use of COPD guidelines among ED staff was maintained. However, in practice, guideline adherence, treatment failure, and return rates did not improve significantly after the implementation of local guidelines.
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Affiliation(s)
- Felix Zhou
- Emergency Medicine, Memorial University of Newfoundland, Saint John, CAN
| | - Kavish Chandra
- Emergency Medicine, Dalhousie University, Saint John, CAN
| | - Dylan Sohi
- Emergency Medicine, Dalhousie University, Saint John, CAN
| | | | | | - Josh Scoville
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
| | - Natasha DeSousa
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
| | | | - Paul R Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
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Marcos PJ, Nieto-Codesido I, de Jorge Dominguez-Pazos S, Huerta A, Márquez E, Maiso A, Verdeal R, Otero-González I, Blanco-Aparicio M, Montero-Martínez C. Treatment With Systemic Steroids in Severe Chronic Obstructive Pulmonary Disease Exacerbations: Use of Short Regimens in Routine Clinical Practice and Their Impact on Hospital Stay. Arch Bronconeumol 2017; 53:611-615. [PMID: 28461091 DOI: 10.1016/j.arbres.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION It is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice. METHOD Prospective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200-300mg for 5-6 days). Secondary variables were percentageof patients with duration or reduced dose, dose in the first 24hours, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS. RESULTS 158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200-1625) and 14 (4-36) days, respectively. We observed an association between days of SCSand LOS (P<.001) and doses of intrahospitalSCSand LOS (P<.001). Factors associated with LOS were doses of intrahospitalSCS received (.01 [95% CI:.007-.013]; P<0.001), days of steroid treatment (.14 [95% CI .03-.25], P=.009) and PAFI (pO2/FiO2 ratio) at admission (-.012 [95% CI: -.012 to -.002], P=.015). CONCLUSIONS The SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading toa longer hospital stay.
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Affiliation(s)
- Pedro J Marcos
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España.
| | - Irene Nieto-Codesido
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Santiago de Jorge Dominguez-Pazos
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Arturo Huerta
- Servicio de Neumología, Institut Clínic del Tòrax Hospital Clínic-IDIBAPS CIBER de Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Eduardo Márquez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Alejandro Maiso
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Rodrigo Verdeal
- Servicio de Medicina Interna, Instituto de Investigación Biomédica de A Coruña (INIBIC) Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Isabel Otero-González
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Marina Blanco-Aparicio
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
| | - Carmen Montero-Martínez
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España
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Wedzicha JA, Miravitlles M, Hurst JR, Calverley PMA, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, Sliwinski P, Tonia T, Vestbo J, Wilson KC, Krishnan JA. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017; 49:49/3/1600791. [PMID: 28298398 DOI: 10.1183/13993003.00791-2016] [Citation(s) in RCA: 319] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/15/2016] [Indexed: 01/20/2023]
Abstract
This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.
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Affiliation(s)
- Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Peter M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Richard K Albert
- Dept of Medicine, University of Colorado, Denver, Aurora, CO, USA
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Alberto Papi
- Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Klaus F Rabe
- Dept of Internal Medicine, Christian-Albrechts University, Kiel and LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Pawel Sliwinski
- 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Kevin C Wilson
- Dept of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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Liu S, Liu X, Chen S, Xiao Y, Zhuang W. Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0188644. [PMID: 29176905 PMCID: PMC5703548 DOI: 10.1371/journal.pone.0188644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/10/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intravenous glucocorticoids are recommended for multiple sclerosis (MS). However, they can be inconvenient and expensive. Due to their convenience and low cost, oral glucocorticoids may be an alternative treatment. Recently, several studies have shown that there is no difference in efficacy and safety between oral methylprednisolone (oMP) and intravenous methylprednisolone (ivMP). OBJECTIVES We sought to assess the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses in this meta-analysis. METHODS Randomized controlled trials (RCTs) evaluating the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses were searched in PubMed, Cochrane Library, Medline, EMBASE and China Biology Medicine until October 25, 2016, without language restrictions. The proportion of patients who had improved by day 28 was chosen as the efficacy outcome. We chose the risk ratio (RR) to analyze each trial with the 95% confidence interval (95% CI). We also used the fixed-effects model (Mantel-Haenszel approach) to calculate the pooled relative effect estimates. RESULTS A total of 5 trials were identified, which included 369 patients. The results of our meta-analysis revealed that no significant difference existed in relapse improvement at day 28 between oMP and ivMP (RR 0.96, 95% CI 0.84 to 1.10). No evidence of heterogeneity existed among the trials (P = 0.45, I2 = 0%). Both treatments were equally safe and well tolerated except that insomnia was more likely to occur in the oMP group compared to the ivMP group. CONCLUSION Our meta-analysis reveals strong evidence that oMP is not inferior to ivMP in increasing the proportion of patients experiencing clinical improvement at day 28. In addition, both routes of administration are equally well tolerated and safe. These findings suggest that we may be able to replace ivMP with oMP to treat MS relapses.
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Affiliation(s)
- Shuo Liu
- Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaoqiang Liu
- Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shuying Chen
- Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yingxiu Xiao
- Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Weiduan Zhuang
- Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- * E-mail:
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Giorgini P, Di Giosia P, Ferri L, Ferri C. Cardiovascular events in patients with chronic obstructive bronchopulmonary disease. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e23-e29. [DOI: 10.2459/jcm.0000000000000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Visentin E, Nieri D, Vagaggini B, Peruzzi E, Paggiaro P. An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014. Curr Med Res Opin 2016; 32:1493-502. [PMID: 27215310 DOI: 10.1080/03007995.2016.1182900] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION GOLD guideline recommendations are currently the "gold standard" for the treatment of COPD patients. OBJECTIVES The objective of this analysis was to evaluate compliance with GOLD guidelines in managing COPD patients' treatment by general practitioners (GPs) and pulmonologists. Since inhaled corticosteroid (ICS) use is defined as inappropriate in mild and moderate COPD patients, special attention was paid to ICS therapy use in these classes. METHODS The study was based on the Italian GP database IMS Health Longitudinal Patient Database (IMS Health LPD) and on the Patient Analyzer specialist IMS Health database. The observed cohort included all patients with a diagnosis of COPD, aged 40 years or more, with at least one ATC R03 class prescription, visited by GPs and pulmonologists during four timeframes: October 2012 - March 2013 (cohort 1), April 2013 - September 2013 (cohort 2), October 2013 - March 2014 (cohort 3); April 2014 - September 2014 (cohort 4). Patients were classified into disease severity groups following 2008 GOLD guidelines, based on FEV1 value. RESULTS Cohorts were quite similar in size (about two thousand patients per cohort). Pulmonologists visited more severe patients than GPs. About 50% of GPs' mild and moderate patients received treatments containing inhaled corticosteroids. Pulmonologists were more adherent to guidelines, with smaller percentages of mild patients treated with therapies containing ICS (ranging from 19.0% to 30.1%). An improvement in adherence was observed during the four time periods, with a decrease in the use of therapies containing ICS in mild and moderate patients. In absolute terms, it emerged that GPs more often prescribe ICS improperly to patients in the mild and moderate severity classes than pulmonologists. CONCLUSION Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.
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Affiliation(s)
- Elena Visentin
- a IMS Health Information Solutions Italy srl , Milan , Italy
| | - Dario Nieri
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
| | - Barbara Vagaggini
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
| | | | - Pierluigi Paggiaro
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
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Baker JM, Pace HA, Ladesich JB, Simon SD. Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Hosp Pharm 2016; 51:296-304. [PMID: 27303077 PMCID: PMC4896332 DOI: 10.1310/hpj5104-296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Guidelines recommend systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) albeit in lower doses than studies that cemented corticosteroids' place in therapy. Corticosteroids potentiate hyperglycemia, however it is undetermined how corticosteroid dose impacts hyperglycemia incidence. OBJECTIVES To establish whether a greater incidence of steroid-induced hyperglycemia (SIHGLY) exists for high- versus low-dose corticosteroids. METHODS Patients with primary discharge diagnosis 491.21/491.22 in a community hospital were retrospectively reviewed and divided into tertiles based on corticosteroid dosage. Baseline characteristics and primary endpoint were statistically assessed between tertiles using logistic regression analysis. A Cox proportional hazards (CPH) model adjusted for potential covariates. Post hoc analysis for primary outcome and CPH model was run removing non-insulin dependent diabetics because of disproportionate event count. A secondary endpoint used a Kaplan-Meier curve to evaluate time to event between tertiles. RESULTS Tertile divisions were 125 and 187.5 mg methylprednisolone equivalents. The primary outcome for incidence of SIHGLY was insignificant; post hoc analysis removing non-insulin-dependent diabetics narrowly missed significance between tertiles 1 and 3 (P = .056). CPH analysis found significant differences in SIHGLY between tertiles 1 and 2 (hazard ratio [HR], 1.68; 95% CI, 1.02-2.76) and tertile 1 and 3 (HR, 1.79; 95% CI, 1.13-2.84), further post hoc analysis resulted in a loss of significance for the CPH analysis. Of 21 non-insulin-dependent diabetics, 20 met event status. The Kaplan-Meier analysis results were insignificant. CONCLUSIONS Study results suggest that a link between larger corticosteroid doses and hyperglycemia incidence may exist, but it requires further study. RESULTS in non-insulin-dependent diabetics provide evidence for increased glucose monitoring upon initiation of corticosteroid therapy.
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Crisafulli E, Torres A, Huerta A, Guerrero M, Gabarrús A, Gimeno A, Martinez R, Soler N, Fernández L, Wedzicha JA, Menéndez R. Predicting In-Hospital Treatment Failure (≤ 7 days) in Patients with COPD Exacerbation Using Antibiotics and Systemic Steroids. COPD 2015; 13:82-92. [PMID: 26451913 DOI: 10.3109/15412555.2015.1057276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although pharmacological treatment of COPD exacerbation (COPDE) includes antibiotics and systemic steroids, a proportion of patients show worsening of symptoms during hospitalization that characterize treatment failure. The aim of our study was to determine in-hospital predictors of treatment failure (≤ 7 days). Prospective data on 110 hospitalized COPDE patients, all treated with antibiotics and systemic steroids, were collected; on the seventh day of hospitalization, patients were divided into treatment failure (n = 16) or success (n = 94). Measures of inflammatory serum biomarkers were recorded at admission and at day 3; data on clinical, laboratory, microbiological, and severity, as well data on mortality and readmission, were also recorded. Patients with treatment failure had a worse lung function, with higher serum levels of C-reactive protein (CRP), procalcitonin (PCT), tumour necrosis factor-alpha (TNF-α), interleukin (IL) 8, and IL-10 at admission, and CRP and IL-8 at day 3. Longer length of hospital stay and duration of antibiotic therapy, higher total doses of steroids and prevalence of deaths and readmitted were found in the treatment failure group. In the multivariate analysis, +1 mg/dL of CRP at admission (OR, 1.07; 95% CI, 1.01 to 1.13) and use of penicillins or cephalosporins (OR, 5.63; 95% CI, 1.26 to 25.07) were independent variables increasing risk of treatment failure, whereas cough at admission (OR, 0.20; 95% CI, 0.05 to 0.75) reduces risk of failure. In hospitalized COPDE patients CRP at admission and use of specific class of antibiotics predict in-hospital treatment failure, while presence of cough has a protective role.
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Affiliation(s)
- Ernesto Crisafulli
- a 1 Cardio-Thoracic Department, Pneumology and Respiratory Intensive Care Unit, "Carlo Poma" Hospital , Mantova , Italy
| | - Antoni Torres
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Arturo Huerta
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Mónica Guerrero
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Albert Gabarrús
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Alexandra Gimeno
- c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain
| | - Raquel Martinez
- c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain
| | - Néstor Soler
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Laia Fernández
- b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain
| | - Jadwiga A Wedzicha
- d 4 Centre for Respiratory Medicine, Royal Free Campus, University College London Medical School , London , United Kingdom
| | - Rosario Menéndez
- c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain
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Strategies for Reducing the Risk of Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease. High Blood Press Cardiovasc Prev 2015; 22:103-11. [DOI: 10.1007/s40292-015-0078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/23/2015] [Indexed: 01/06/2023] Open
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Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasziou PP, Rovers MM. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev 2014; 2014:CD008115. [PMID: 24664368 PMCID: PMC11179165 DOI: 10.1002/14651858.cd008115.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute sinusitis is the inflammation and swelling of the nasal and paranasal mucous membranes and is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. OBJECTIVES To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to February week 1, 2014) and EMBASE (January 2009 to February 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of the trials and extracted data. MAIN RESULTS Five RCTs with a total of 1193 adult participants met our inclusion criteria. We judged methodological quality to be moderate in four trials and high in one trial. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in four trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In four trials antibiotics were prescribed in addition to oral corticosteroids or control treatment, while one trial investigated the effects of oral corticosteroids as a monotherapy.When combining data from the five trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at days three to seven (risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1 to 1.6; risk difference (RD) 17%, 95% CI 6% to 29%) and at days four to 14 (RR 1.2, 95% CI 1.0 to 1.5; RD 14%, 95% CI 1% to 27%). A sensitivity analysis including the four trials with placebo as a control treatment showed similar results but with a lesser effect size: at days three to seven (RR 1.2, 95% CI 1.1 to 1.3; RD 11%, 95% CI 4% to 17%) and days four to 14 (RR 1.1, 95% CI 1.0 to 1.2; RD 8%, 95% CI 2% to 13%). Statistical heterogeneity was high for many analyses. Subgroup analyses revealed that corticosteroid monotherapy had no beneficial effects. Furthermore, scenario analysis showed that outcomes missing from the trial reports might have introduced attrition bias (a worst-case scenario showed no statistically significant beneficial effect of oral corticosteroids). No trial reported effects on relapse or recurrence rates. Reported side effects in patients treated with oral corticosteroids were mild (nausea, vomiting, gastric complaints) and did not significantly differ from those receiving placebo. AUTHORS' CONCLUSIONS Oral corticosteroids as a monotherapy appear to be ineffective for adult patients with clinically diagnosed acute sinusitis. Current data on the use of oral corticosteroids as an adjunctive therapy to oral antibiotics are limited: almost all trials are performed in secondary care settings and there is a significant risk of bias. This limited evidence suggests that oral corticosteroids in combination with antibiotics may be modestly beneficial for short-term relief of symptoms in acute sinusitis, with a number needed to treat to benefit of seven for resolution or symptom improvement. A large primary care factorial trial is needed to establish whether oral corticosteroids offer additional benefits over antibiotics in acute sinusitis.
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Affiliation(s)
- Roderick P Venekamp
- University Medical Center UtrechtDepartment of Otorhinolaryngology & Julius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA
| | - Matthew J Thompson
- University of WashingtonDepartment of Family MedicineBox 354696SeattleWAUSA98195‐4696
| | - Gail Hayward
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Carl J Heneghan
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Chris B Del Mar
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)University DriveRobinaGold CoastQueenslandAustralia4229
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Paul P Glasziou
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)University DriveRobinaGold CoastQueenslandAustralia4229
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical CentreDepartment of Operating RoomsHp 630, route 631PO Box 9101NijmegenNetherlands6500 HB
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Anexo 2 Preguntas respondidas por la UETS en la GPC para el tratamiento de pacientes con EPOC. Arch Bronconeumol 2012. [DOI: 10.1016/s0300-2896(12)70037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasziou PP, Rovers MM. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev 2011:CD008115. [PMID: 22161418 DOI: 10.1002/14651858.cd008115.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute sinusitis is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. OBJECTIVES To assess the effectiveness of systemic corticosteroids in relieving symptoms of acute sinusitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2011, which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects (DARE) and the NHS Health Economics Database, MEDLINE (1966 to June week 2, 2011) and EMBASE (January 2009 to June 2011). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed methodological quality of the trials and extracted data. MAIN RESULTS Four RCTs with a total of 1008 adult participants met our inclusion criteria. We judged studies to be of moderate methodological quality. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants received oral antibiotics and were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in three trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In all trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at Days 3 to 7, risk ratio (RR) 1.4, 95% CI 1.1 to 1.8; risk difference (RD) 20% (6% to 34%) and at Days 4 to 10 or 12, RR 1.3, 95% CI (1.0 to 1.7), RD 18% (3% to 33%). An analysis of the three trials with placebo as a control treatment showed similar results but with a lesser effect size: Days 3 to 6: RR 1.2, 95% CI (1.1 to 1.4), RD 12% (5% to 19%) and Days 4 to 10 or 12: RR 1.1, 95% CI (1.0 to 1.2), RD 10% (3% to 16%). Scenario analysis showed that outcomes missing from the trial reports might have introduced attrition bias (a worst-case scenario showed no statistically significant beneficial effect of oral corticosteroids). We did not identify any data on the long-term effects of oral corticosteroids on this condition, such as effects on relapse or recurrence rates. Reported side effects of oral corticosteroids were limited and mild. AUTHORS' CONCLUSIONS Current evidence suggests that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis. However, data are limited and there is a significant risk of bias. High quality trials assessing the efficacy of systemic corticosteroids both as an adjuvant and a monotherapy in primary care patients with acute sinusitis should be initiated.
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Affiliation(s)
- Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, Netherlands, 3508 GA
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