Hyperlipidemia in COPD is associated with decreased incidence of pneumonia and mortality: a nationwide health insurance data-based retrospective cohort study

Association of Hyperlipidemia With Perioperative Complications in Posterior Cervical Spine Fusion: A Comparative Retrospective Study

STUDY DESIGN

A retrospective database study.

OBJECTIVES

The purpose of the current study was to investigate the impact of hyperlipidemia (HLD) on the incidence of perioperative complications associated with posterior cervical spine fusion (PCF).

BACKGROUND

HLD is a very common disease that leads to atherosclerosis. Therefore, it can cause fatal diseases as well as lifestyle-related diseases. The possible impact of HLD on outcomes after PCF has not yet been investigated.

METHODS

Patients with cervical degeneration underwent initial PCF from 2010 through the third quarter of 2020 using the MSpine subset of the PearlDiver Patient Record Database. The incidence of perioperative complications was queried using relevant ICD-9, 10, and CPT codes. χ 2 analysis was performed in age-, sex-, and Charlson Comorbidity Index (CCI)-matched populations to compare between non-HLD and HLD patients in each single-level and multilevel PCF.

RESULTS

Through propensity score matching, 1600 patients each in the HLD and non-HLD groups were analyzed in the single-level PCF, 6855 patients were analyzed in the multilevel PCF were analyzed. The comorbidity of HLD significantly decreased the incidence of respiratory failure in single-level PCF (OR=0.58, P <0.01). In the multilevel PCF, the presence of HLD increased the incidence of cervicalgia (OR=1.26, P =0.030). On the contrary, the incident of spinal cord injury (OR=0.72, P <0.01), dysphagia (OR=0.81, P =0.023), respiratory failure (OR=0.85, P =0.030), pneumonia (OR=0.70, P =0.045), neurological bladder (OR=0.84, P =0.041), and urinary tract infection (OR=0.85, P =0.021) in the HLD group were significantly lower than those in non-HLD group.

CONCLUSIONS

In the current study, the presence of HLD significantly increased the incidence of postoperative cervicalgia in multilevel PCF. On the other hand, the incidence of some complications was significantly decreased with HLD. Further studies are needed taking into account other factors such as the treatment of HLD, its efficacy, and intraoperative events.

LEVEL OF EVIDENCE

Level III.

Low-density lipoprotein cholesterol and risk of COPD: Copenhagen General Population Study

Background

Randomised controlled trials found that low-density lipoprotein (LDL) cholesterol-lowering statins increase lung function and possibly decrease rate of exacerbations in individuals with COPD. However, it is unknown whether high levels of LDL cholesterol are associated with increased susceptibility to COPD.

Methods

We tested the hypothesis that high LDL cholesterol is associated with increased risk of COPD, severe COPD exacerbation and COPD-specific mortality. We examined 107 301 adults from the Copenhagen General Population Study. COPD outcomes were ascertained at baseline and prospectively through nationwide registries.

Results

In cross-sectional analysis, low LDL cholesterol was associated with increased risk of COPD (odds ratio for 1st versus 4th quartile: 1.07 (95% CI 1.01-1.14)). Prospectively, low LDL cholesterol was associated with increased risk of COPD exacerbations with hazard ratios of 1.43 (1.21-1.70) for 1st versus 4th quartile, 1.21 (1.03-1.43) for 2nd versus 4th quartile, and 1.01 (0.85-1.20) for 3rd versus 4th quartile of LDL cholesterol (p-value for trend=6×10^-6). Finally, low LDL cholesterol was likewise associated with increased risk of COPD-specific mortality (log-rank test: p=0.0009). Sensitivity analyses with death as competing risk provided similar results.

Conclusion

Low LDL cholesterol was associated with increased risks of severe COPD exacerbation and COPD-specific mortality in the Danish general population. As this is opposite of that observed in randomised controlled trials with statins, our findings might be a result of reverse causation indicating that individuals with severe phenotypes of COPD have lower plasma levels of LDL cholesterol due to wasting.

Possible association of high-density lipoprotein cholesterol levels with trunk muscle deficits and decrease in energy expenditure in patients with or at risk for COPD: A pilot study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated with low muscle mass and function caused by malnutrition and physical inactivity. We aimed to investigate possible associations between serum biomarkers and clinical traits including computed tomography-derived muscle measurements and energy expenditure indices in COPD.

METHODS

Total energy expenditure (TEE) was measured by the doubly labeled water method, while physical activity level (PAL) was calculated as TEE/basal metabolic rate. Cross-sections and densities of pectoralis, rectus abdominis, and erector spinae muscles were measured. Serum biomarkers included adiponectin, insulin-like growth factor-1, and high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol (C).

RESULTS

HDL-C levels were significantly correlated with all muscle areas, densities, and TEE. Only LDL-C levels were correlated with PAL.

CONCLUSIONS

HDL-C level was a potential biomarker for trunk muscle volumes and functions, as well as total energy expenditure in COPD.

A nationwide analysis on the effects of chronic obstructive pulmonary disease following primary total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND

Chronic obstructive pulmonary disease patients have been shown in orthopedic literature to have poorer outcomes and higher rates of complications from surgery. In this retrospective review, medical complications, length of stay, and costs were obtained to explore the effects of chronic obstructive pulmonary disease on patients undergoing primary total shoulder arthroplasty.

METHODS

Total shoulder arthroplasty cases from January 2005 to March 2014 were queried and analyzed from a nationwide database. Study patients were matched 1:5 to controls by age, sex, and medical comorbidities associated with chronic obstructive pulmonary disease. In-hospital length of stay, 90-day medical complications, day of surgery, and total global 90-day episode of care costs were obtained for comparison.

RESULTS

Chronic obstructive pulmonary disease patients were found to have higher incidence and odds (53.91 vs. 11.95%; OR: 3.58, 95%CI: 3.18-3.92, p < 0.0001) of 90-day medical complications, longer in-hospital length of stay (3 vs. 2 days, p < 0.0001), and significantly higher 90-day costs ($14,768.37 vs. $13,379.20, p < 0.0001) following primary total shoulder arthroplasty compared to matched controls.

DISCUSSION

Chronic obstructive pulmonary disease patients undergoing primary total shoulder arthroplasty have higher rates of medical complications, in-hospital length of stay, and costs of care. This represents an important factor that will allow orthopedic surgeons to adequately manage expectations and educate chronic obstructive pulmonary disease patients of the potential complications which may occur following total shoulder arthroplasty.

The HUNT study: Association of comorbidity clusters with long-term survival and incidence of exacerbation in a population-based Norwegian COPD cohort

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease often viewed as part of a multimorbidity complex. There is a need for better phenotyping of the disease, characterization of its interplay with other comorbidities and its association with long-term outcomes. This study aims to examine how clusters of comorbidities are associated with severe exacerbations and mortality in COPD.

METHODS

Participants with potential COPD were recruited from the second (1995-1997) and third (2006-2008) survey of the HUNT Study and followed up until April 2020. Ten objectively identified comorbidities were clustered using self-organizing maps. Severe COPD exacerbations requiring hospitalization were assessed using hospital data. All-cause mortality was collected from national registries. Multivariable Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for the association between comorbidity clusters and all-cause mortality. Poisson regression was used to calculate incidence rate ratios (IRRs) with 95% CI for the cumulative number of severe exacerbations for each cluster.

RESULTS

Five distinct clusters were identified, including 'less comorbidity', 'psychological', 'cardiovascular', 'metabolic' and 'cachectic' clusters. Using the less comorbidity cluster as reference, the psychological and cachectic clusters were associated with all-cause mortality (HR 1.23 [1.04-1.45] and HR 1.83 [1.52-2.20], adjusted for age and sex). The same clusters also had increased risk of exacerbations (unadjusted IRR of 1.24 [95% CI 1.04-1.48] and 1.50 [95% CI 1.23-1.83], respectively).

CONCLUSION

During 25 years of follow-up, individuals in the psychological and cachectic clusters had increased mortality. Furthermore, these clusters were associated with increased risk of severe COPD exacerbations.

Association of cardiovascular health with mortality among COPD patients: National Health and Nutrition Examination Survey III

BACKGROUND

All-cause and cardiovascular disease (CVD) mortality are higher among patients with chronic obstructive pulmonary disease (COPD). We examined the association between American Heart Association's Life's Simple 7 (LS7) metrics and all-cause as well as CVD mortality in patients with COPD.

METHODS

We examined 1513 US adults with COPD aged ≥ 40, without prior CVD, from the National Health and Nutrition Examination Survey III. COPD was defined as FEV₁/FVC<0.7 in absence of asthma. Adjusted Cox regression was used to assess the relation of LS7 metrics with all-cause and CVD mortality.

RESULTS

Overall, only 74 participants (4.9%) had ideal 5-7 LS7 metrics. Over a mean follow-up of 14.2±7.9 years, 1162 individuals died, of which 315 were due to CVD. Age, sex, and ethnicity-adjusted HRs (95% CI) for all-cause mortality were 0.53 (0.41-0.68), 0.45 (0.34-0.59), 0.66 (0.49-0.87) and 0.75 (0.56-1.00) among those with ideal vs poor control of smoking, diet, physical activity and fasting blood glucose, respectively. However, the ideal and intermediate LS7 metrics were not significantly associated with lower risk of CVD mortality, except for a BMI between 25-29.9 kg/m². Those with 5-7 vs 0-1 ideal metrics had adjusted HRs 0.50 (0.40-0.87) for all-cause and 0.53 (0.21-1.36) for CVD mortality.

CONCLUSION

Ideal levels of multiple behavioral and health factors are associated with substantially lower risks for all-cause mortality, with a trend for lower CVD mortality among US adults with COPD.

Hyperlipidaemia and mortality among patients hospitalised with pneumonia: retrospective cohort and propensity score matched study

OBJECTIVE

To characterise the potential association of hyperlipidaemia (HLP) versus no HLP with all-cause mortality among patients hospitalised for pneumonia.

DESIGN

Propensity score matched retrospective study.

PARTICIPANTS

The study cohort consisted of consecutive 8553 adults hospitalised at a large academic centre with a discharge diagnosis of pneumonia from 1996 through 2015, followed until death or end of the study period, 17 August 2017.

OUTCOMES

The outcome was HR for mortality at 28 days and in the long term in patients with pneumonia with concurrent HLP compared with those with no HLP. We first constructed multivariable Cox proportional regression models to estimate the association between concurrent HLP versus no HLP and mortality after pneumonia hospitalisation for the entire cohort. We then identified 1879 patients with pneumonia with concurrent HLP and propensity score matched in a 1:1 ratio to 1879 patients with no HLP to minimise the imbalance from measured covariates for further analysis.

RESULTS

Among 8553 unmatched patients with pneumonia, concurrent HLP versus no HLP was independently associated with lower mortality at 28 days (HR 0.52, 95% CI 0.41 to 0.66) and at a median follow-up of 3.9 years (HR 0.75, 95% CI 0.70 to 0.80). The risk difference in mortality was consistent between 1879 propensity score matched pairs both at 28 days (HR 0.65, 95% CI 0.49 to 0.86) and at a median follow-up of 4 years (HR 0.88, 95% CI 0.81 to 0.96). In the subgroup of patients with clinically measured low-density lipoprotein cholesterol (LDL-C), graded inverse associations between LDL-C levels and mortality were found in both unmatched and matched cohorts.

CONCLUSIONS

Among hospitalised patients with pneumonia, a diagnosis of HLP is protective against both short-term and long-term risk of death after adjustment for other major contributors to mortality in both unmatched and propensity score matched cohorts. These findings should be further investigated.

Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections

Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emergence of drug-resistant bacteria. On the other hand, treatment delay of the infection will likely result in a poor outcome. Therefore, it is necessary to determine the early predictors of post-stroke infection to screen patients with high infection risk for early clinical intervention, thereby promoting and improving survival rates. We assessed 257 patients with acute ischemic stroke from a consecutive retrospective cohort. Data of these patients were obtained from three hospitals (TongJi Hospital and its two branches) between August 2018 and June 2019. Of these patients, 59 (23.0%) developed SAI. SAI was defined according to the modified Centers for Disease Control and Prevention criteria. There were 38 patients (64.4%) who developed pneumonia, 11 with urinary tract infections (18.6%), and 10 with other infections (16.9%). We found that a higher neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] = 1.16; 95% confidence interval [CI], 1.01–1.33; P = 0.034), National Institutes of Health Stroke Scale score (aOR = 1.18; CI, 1.09–1.27; p < 0.001), and dysphagia (aOR = 2.95; CI, 1.40–6.22; P = 0.004) were risk factors for SAI. Of note, hypertriglyceridemia (aOR = 0.35; CI, 0.13–0.90; P = 0.029) was a protective factor, lowering the risk of SAI. To this end, a reliable nomogram was constructed for the prediction of SAI in our study (mean C-index value ± standard deviation = 0.821 ± 0.03). It has the potential to be widely used and may help identify patients at high risk for SAI and make timely clinical decisions. Given our study was based on relatively small dataset, the results should be interpreted with care and external validation in independent datasets is very necessary.

Karma of Cardiovascular Disease Risk Factors for Prevention and Management of Major Cardiovascular Events in the Context of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

There is compelling epidemiological evidence that airway exposure to cigarette smoke, air pollution particles, as well as bacterial and viral pathogens is strongly related to acute ischemic events. Over the years, there have been important animal and human studies that have provided experimental evidence to support a causal link. Studies show that patients with cardiovascular diseases (CVDs) or risk factors for CVD are more likely to have major adverse cardiovascular events (MACEs) after an acute exacerbation of chronic obstructive pulmonary disease (COPD), and patients with more severe COPD have higher cardiovascular mortality and morbidity than those with less severe COPD. The risk of MACEs in acute exacerbation of COPD is determined by the complex interactions between genetics, behavioral, metabolic, infectious, and environmental risk factors. To date, there are no guidelines regarding the prevention, screening, and management of the modifiable risk factors for MACEs in the context of COPD or COPD exacerbations, and there is insufficient CVD risk control in those with COPD. A deeper insight of the modifiable risk factors shared by CVD, COPD, and acute exacerbations of COPD may improve the strategies for reduction of MACEs in patients with COPD through vaccination, tight control of traditional CV risk factors and modifying lifestyle. This review summarizes the most recent studies regarding the pathophysiology and epidemiology of modifiable risk factors shared by CVD, COPD, and COPD exacerbations that could influence overall morbidity and mortality due to MACEs in patients with acute exacerbations of COPD.

Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population

AIMS

To evaluate the relationship between cardiovascular diseases (CVDs) and pneumonia in the general population.

METHODS

This retrospective observational study included two cohorts, namely CVD (n = 28,363) and non-CVD (n = 28,363) cohorts, which were matched by propensity score and examined for cases of pneumonia. Data were obtained from 2000 to 2011. In both cohorts, pneumonia risk was measured using multivariable Cox proportional hazard models.

RESULTS

With the non-CVD cohort as reference, the corresponding adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of pneumonia were 2.03 [1.77-2.31] for coronary artery disease, 4.11 [3.15-5.36] for heart failure, 3.21 [2.70-3.81] for cerebrovascular disease, 1.46 [1.07-1.98] for peripheral vascular disease, and 2.27 [2.01-2.56] for the CVD cohort. The cohort with comorbidities had a higher risk (all p < .05) of pneumonia compared with that without comorbidities, except for patients with the comorbidities of hypertension, hyperlipidemia, obesity, and liver disease. The aHR (95% CI) of pneumonia for antibiotic use was 1.26 (1.09-1.47). The aHRs of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) were 3.25 (95% CI = 1.04-10.1) and 2.95 (95% CI = 2.25-3.88), respectively. The aHRs (95% CI) were 1.78 (1.05-3.03) for intensive care unit (ICU) risk and 0.98 (0.96-0.99) for length of admission.

CONCLUSION

Pneumonia risk was associated with CVDs, especially heart failure, regardless of age, gender, comorbidities, and antibiotic use, particularly in elderly male patients. In addition, Patients with CVDs had a higher risk of CAP and HAP. The CVD cohort had a higher frequency of ICU admissions, but shorter admission lengths.

Additive effect of congenital heart disease and early developmental disorders on attention-deficit/hyperactivity disorder and autism spectrum disorder: a nationwide population-based longitudinal study

In this retrospective nationwide population-based case-control study, we investigated the impact of congenital heart disease (CHD) on the development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which remains unclear. Children aged <18 years that were diagnosed with CHD (n = 3552) between January 1, 1997 and December 31, 2009 were identified from the National Health Insurance Research Database in Taiwan. Non-CHD controls (n = 14,208) matched for age and sex (1:4) were selected from the same dataset. All subjects were observed until December 31, 2011 or their death. Comorbid perinatal conditions and early developmental disorders (EDD) that were diagnosed before ADHD and ASD diagnosis were also analyzed. The incidence rates of perinatal comorbidities, EDD, ADHD, and ASD were higher in the CHD group than in the control group. Multivariate Cox regression analysis revealed that the CHD group had an increased risk of developing ADHD (adjusted hazard ratio [aHR] 2.52, 95% confidence interval CI 1.96-3.25) and ASD (aHR 1.97, 95% CI 1.11-3.52) after adjusting for confounding comorbidities. EDD, but not perinatal comorbidities were also independent risk factors for ADHD and ASD after adjustment. Subgroup analysis indicated that the risk for ADHD (HR 16.59, 95% CI 12.17-22.60) and ASD (HR 80.68, 95% CI 39.96-176.12) was greatly increased in CHD subjects with EDD than in non-CHD subjects without EDD. These findings suggested that CHD at birth and EDD during early childhood were two independent risk factors for ADHD and ASD and that concurrent CHD and EDD might additively increase these risks.

Relationship of hyperlipidemia to comorbidities and lung function in COPD: Results of the COSYCONET cohort

Although hyperlipidemia is common in COPD, its relationship to comorbidities, risk factors and lung function in COPD has not been studied in detail. Using the baseline data of the COSYCONET cohort we addressed this question. Data from 1746 COPD patients (GOLD stage 1-4; mean age 64.6 y, mean FEV1%pred 57%) were evaluated, focusing on the comorbidities hyperlipidemia, diabetes and cardiovascular complex (CVC; including arterial hypertension, cardiac failure, ischemic heart disease). Risk factors comprised age, gender, BMI, and packyears of smoking. The results of linear and logistic regression analyses were implemented into a path analysis model describing the multiple relationships between parameters. Hyperlipidemia (prevalence 42.9%) was associated with lower intrathoracic gas volume (ITGV) and higher forced expiratory volume in 1 second (FEV1) when adjusting for its multiple relationships to risk factors and other comorbidities. These findings were robust in various statistical analyses. The associations between comorbidities and risk factors were in accordance with previous findings, thereby underlining the validity of our data. In conclusion, hyperlipidemia was associated with less hyperinflation and airway obstruction in patients with COPD. This surprising result might be due to different COPD phenotypes in these patients or related to effects of medication.

Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD

BACKGROUND

COPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients.

METHOD

Retrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions.

RESULTS

Fourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from ≥1 comorbidities, 3263 (22%) from ≥5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., ≥2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38-2.14), blindness & low vision (OR 1.46; 1.21-1.75), pulmonary cancer (OR 1.85; 1.28-2.67), depression 1.48; 1.14-1.91), prostate disorders (OR 1.50; 1.13-1.98), asthma (OR 1.36; 1.11-1.70), osteoporosis (OR 1.41; 1.11-1.80), diabetes (OR 0.80; 0.66-0.97), dyspepsia (OR 1.25; 1.03-1.50), and peripheral vascular disease (OR 1.20; 1.00-1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17-1.36).

CONCLUSION

Chronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk.