Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

Background

Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design.

Methods

A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement.

Results

Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event.

Conclusions

This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.

Association of Red Cell Index and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Purpose

This study aims to explore the association between red cell index (RCI) and hospital mortality in Chronic Obstructive Pulmonary Disease (COPD) patients in the intensive care unit.

Patients and Methods

This was a retrospective cohort research. The study included 821 COPD patients. Clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database was conducted. Multivariate logistic regression analysis was used to assess the correlation between RCI and in-hospital mortality. Age, SOFA score, diabetes mellitus, cerebrovascular disease, congestive heart failure and mechanical ventilation were considered for subgroup analysis.

Results

This study comprised 821 patients, of which 16.5% (124/821) suffered hospital mortality. In the multivariate logistic regression model, RCI was positively associated with hospital mortality, each unit increase in RCI was associated with a 3% increase in hospital mortality (odds ratio [OR] =1.03; 95% confidence interval [95CI%] =1.01-1.06). Meanwhile, compare with the lowest RCI group, the highest RCI groups tended to have higher risks of hospital mortality (OR [95% CI] 2.33 [1.27-4.27]). Additionally, subgroup analysis result was persistent among all the groups.

Conclusion

Higher RCI was positively associated with a higher risk of mortality in critically ill patients with COPD. Further investigation is necessary to confirm these findings.

Anemia in chronic obstructive pulmonary disease: A systematic review

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease that is characterized by poor airflow and airway inflammation. It is estimated that the global prevalence of COPD is about 13.1%. Anemia is associated with increased morbidity and hospitalization duration. In this systematic review, we investigate the association between all types of anemia and COPD progression.

METHODS

We systematically searched electronic databases, including Scopus, Medline/PubMed, EMBASE, Web of Sciences (WOS), and Cochrane Library, using the following mesh-standardized keywords: (((anemia∗ OR anaemia∗) OR "chronic anemia disease" [Mesh] OR "CAD" OR "iron deficiency anemia" OR" IDA" OR) AND ("COPD" [Mesh] OR "chronic obstructive pulmonary disease")) until February 2022.

RESULTS

Overall of 11,158 studies were included. Ultimately, 59 studies were included in the analysis. The most apparent findings from the analysis were that exacerbation of COPD, increased hospitalization, and increased long-term mortality were associated with anemia. Further analysis showed that iron deficiency (ID) is a common finding in COPD and is accompanied by an increase in the systolic pulmonary artery pressure.

CONCLUSION

Despite the comfortable control of anemia, the absence of treatment can be life-threatening in patients with COPD. Our systematic results showed significant homogeneity between studies on the increased mortality rate in anemic COPD, increased hospitalization, and decreased quality of life.

Betel Nut Chewing Was Associated with Obstructive Lung Disease in a Large Taiwanese Population Study

The prevalence of betel nut chewing in Taiwan is high at approximately 7%, however, few studies have evaluated the relationship between betel nut chewing and lung disease. Therefore, the aim of this study was to investigate associations between betel nut chewing and lung function in 80,877 participants in the Taiwan Biobank (TWB). We further investigated correlations between betel nut chewing characteristics such as years of use, frequency, daily amount, and accumulative dose, with obstructive lung disease. We used data from the TWB. Lung function was assessed using spirometry measurements of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). The participants were classified into normal lung function and obstructive lung function (FEV1/FVC < 70%) groups. The participants were asked questions about betel nut chewing, including years of use, frequency, and daily amount. After multivariable analysis, betel nut chewing (odds ratio [OR] = 1.159; p < 0.001) was significantly associated with FEV1/FVC < 70% in all participants (n = 80,877). Further, in the participants who chewed betel nut (n = 5135), a long duration of betel nut chewing (per 1 year; OR = 1.008; p = 0.012), betel nut use every day (vs. 1–3 days/month; OR = 1.793; p = 0.036), 10–20 quids a day (vs. <10 quids; OR = 1.404; p = 0.019), 21–30 quids a day (vs. <10 quids; OR = 1.662; p = 0.010), ≥31 quids a day (vs. <10 quids; OR = 1.717; p = 0.003), and high cumulative dose (per 1 year × frequency × daily score; OR = 1.001; p = 0.002) were significantly associated with FEV1/FVC < 70%. In this large population-based cohort study, chewing betel nut was associated with obstructive lung disease. Furthermore, a long duration of betel nut chewing, more frequent use, higher daily amount, and high cumulative dose were associated with obstructive lung disease. This suggests that preventing betel nut chewing should be considered to reduce obstructive lung disease in Taiwan.

Relationship of Red Cell Index with the Severity of Chronic Obstructive Pulmonary Disease

Background

We aimed to investigate the association between red cell index (RCI) and the severity of Chronic Obstructive Pulmonary Disease (COPD), and compare predictive value of RCI, neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) for the severity of COPD.

Methods

A total of 207 participants were recruited (100 COPD patients and 107 healthy controls). COPD patients were divided into two groups according to the optimal cut-off value of RCI determined by the receiver operating characteristic (ROC) curve. Pearson’s correlation test, logistic regression analysis and other tests were performed.

Results

Compared with low RCI group, the forced expiration volume in 1 second (FEV₁) and FEV₁ in percent of the predicted value (FEV₁%) in high RCI group were lower (p = 0.016, p = 0.001). There was a negative correlation between RCI and FEV₁% (r = −0.302, p = 0.004), while no correlation between FEV₁% and NLR as well as PLR were found. RCI showed higher predictive value than NLR and PLR for predicting Global Initiative for Chronic Obstructive Lung Disease classification (GOLD), with a cut-off value of 1.75 and area under the curve (AUC) of 0.729 (p = 0.001). Multivariate logistic regression analysis proved that RCI was an independent factor for lung function in COPD patients (odds ratio [OR] = 4.27, 95% CI: 1.57–11.63, p = 0.004).

Conclusion

RCI is a novel biomarker that can better assess pulmonary function and severity of COPD than NLR and PLR. Higher RCI is related to deterioration of pulmonary function.

Epidemiology and issues of NIV-treated AECOPD patients with hypercapnic respiratory failure in Shanghai: A multicentre retrospective survey

OBJECTIVE

To investigate the epidemiology, clinical features, treatment and outcome of Noninvasive ventilation (NIV)-treated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in secondary hospitals of Shanghai.

METHOD

Relying on Shanghai alliances for respiratory diseases, a retrospective observational study was performed in 34 secondary hospitals of Shanghai. The AECOPD patients treated with NIV and admitted to the respiratory department or respiratory intensive care unit were recruited between December 1, 2016, and November 30, 2017.

RESULTS

There were 555 patients finally recruited in this study. The age was 75.8 ± 9.6 years old and 380 patients (68.5%) were male. 70.5% of all patients had respiratory acidosis (pH <7.35). 55.3% of all patients received nebulised bronchodilator and 77.7% were treated with systemic or inhaled corticosteroids during hospitalisation. 525 patients (94.6%) recovered successfully and the mortality was 3.2%. The hospitalisation was 15.3 ± 6.7 days and hospital expenses were 22 911 ± 13 595 RMB. Inadequate and nonstandard drug treatments were the most important problems during management.

CONCLUSION

The NIV can be successfully used for AECOP patients in local hospitals of Shanghai, but accompanied by high costs and long hospital stays. However, the treatments for exacerbation and stable COPD patients are still insufficient.

Anemia at Intensive Care Unit Admission and Hospital Mortality Among Patients at a Referral Hospital in Malawi

BACKGROUND

Anemia is associated with intensive care unit (ICU) outcomes, but data describing this association in sub-Saharan Africa are scarce. Patients in this region are at risk for anemia due to endemic conditions like malaria and because transfusion services are limited.

METHODS

This was a prospective cohort study of ICU patients at Kamuzu Central Hospital (KCH) in Malawi. Exclusion criteria included age <5 years, pregnancy, ICU readmission, or admission for head injury. Cumulative incidence functions and Fine-Gray competing risk models were used to evaluate hemoglobin (Hgb) at ICU admission and hospital mortality.

RESULTS

Of 499 patients admitted to ICU, 359 were included. The median age was 28 years (interquartile ranges (IQRs) 20-40) and 37.5% were men. Median Hgb at ICU admission was 9.9 g/dL (IQR 7.5-11.4 g/dL; range 1.8-18.1 g/dL). There were 61 (19%) patients with Hgb < 7.0 g/dL, 59 (19%) with Hgb 7.0-8.9 g/dL, and 195 (62%) with Hgb ≥ 9.0 g/dL. Hospital mortality was 51%, 59%, and 54%, respectively. In adjusted analyses, anemia was associated with hospital mortality but was not statistically significant.

CONCLUSIONS

This study provides preliminary evidence that anemia at ICU admission may be an independent predictor of hospital mortality in Malawi. Larger studies are needed to confirm this association.

Effects of anemia on the survival of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

OBJECTIVES

Anemia is often seen in chronic obstructive pulmonary disease (COPD) patients. However, the implications of anemia on the outcomes of patients with COPD is not clearly known. Therefore, we conducted a systematic review and meta-analysis to evaluate the effects of anemia on the morbidity and mortality of patients with COPD.

METHODS

We followed PRISMA guidelines to perform a systematic identification of relevant publications in the literature on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL.

RESULTS

Out of 1845 records, we included data from 15 articles including 420 970 participants in this review. Our systematic review presents a 2b level of evidence suggesting a higher duration of hospital stay, Charlson comorbidity index score, and mortality rate for patients with COPD and anemia than for patients with COPD without anemia. The meta-analysis revealed a moderate effect increase in the mean duration of hospital stay (Hedge's g, 0.55), Charlson comorbidity index (0.68), and mortality rate (0.49) in patients with COPD and anemia as compared to those in patients with COPD without anemia.

CONCLUSION

The current systematic review and meta-analysis provide evidence regarding the detrimental consequences of anemia on the morbidity and mortality of patients with COPD.

How may we improve clinical outcomes for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease? A narrative review about possible therapeutic and preventive strategies

Introduction: In a subset of chronic obstructive pulmonary disease (COPD)patients the course of the disease is complicated by a severe acute exacerbations (AECOPD) that may require hospitalization, at which time negative outcomes may occur up to 30 days after discharge. Several predictors of negative outcomes have been documented.Areas covered: We considered five negative outcomes related to patients hospitalized with AECOPD: treatment failure, noninvasive mechanical ventilation (NIMV) failure, prolonged length of hospital stay (LHS), short-term mortality (≤ 90 days from admission and including the in-hospital mortality), and early readmission (≤30 days from discharge). Possible therapeutic and preventive strategies to improve these outcomes are outlined and discussed.Expert opinion: Several strategies have been proposed to improve outcomes. Among these, steroid or antibiotic use may reduce the risks of treatment failure or of prolonged hospital stay. We note that operator-related factors may influence the outcome of NIMV. However, little has been documented about the short-term mortality or early readmission rates. In general, few interventions consistently improve negative outcomes and prognosis of AECOPD.

The v-DECAF score can predict 90-day all-cause mortality in patients with COPD exacerbation requiring invasive mechanical ventilation

INTRODUCTION

The DECAF score is a simple and effective tool for predicting mortality in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, the DECAF score has not been validated in AECOPD patients requiring invasive mechanical ventilation (IMV). We devised the ventilator (v)-DECAF score, in which "anemia" replaces "acidaemia," for use in AECOPD patients requiring IMV. The objective of this study was to compare the predictive efficacy of the v-DECAF score and the DECAF score.

METHODS

This study prospectively recruited 112 consecutive AECOPD patients requiring IMV from a single center. The clinical endpoint was 90-day all-cause mortality. Demographic and clinical data were recorded, as well as APACHE II, GCS, CURB-65, BAP-65 and DECAF scores, and the newly devised v-DECAF score. The discriminatory value of the scoring systems in predicting 90-day all-cause mortality was determined using the area under the receiver operating characteristic (AUROC) curve.

RESULTS

In multivariate logistic regression analysis, the v-DECAF score was an independent predictor of 90-day all-cause mortality (odds ratio 3.004, 95% CI 1.658-5.445, P < 0.001). The AUROC of the v-DECAF and DECAF scores were 0.852 (95% CI 0.766-0.938) and 0.777 (95%CI: 0.676-0.878), respectively. The v-DECAF score had a better predictive value for 90-day all-cause mortality compared to the DECAF score (Z = 2.338, P = 0.019).

CONCLUSION

The v-DECAF score had good discriminatory power in predicting 90-day all-cause mortality in AECOPD patients requiring IMV.

Hemoglobin and mortality in patients with COPD: a nationwide population-based cohort study

Purpose

Previous studies have reported that anemia increased mortality in patients with COPD. However, it is unclear whether anemia is associated with increased COPD mortality in the general population. The purpose of our study is to identify whether anemia is related to long-term mortality in COPD using a large population-based database.

Patients and methods

Using the National Health Insurance Service-Health Screening Cohort, we identified COPD patients with available hemoglobin level. We analyzed mortality among patients with COPD from 2003 to 2013 according to hemoglobin level.

Results

A total of 7,114 patients with COPD were identified. Mean age was 65.0±9.3 years, and 62.9% were male. Anemia was present in 469 patients (6.6%). The overall mortality rate was 46.5% in anemia and 32.1% in non-anemia groups (p<0.001). The hazard ratio of anemia for mortality was 1.31 (95% CI, 1.11–1.54). Among patients with anemia, the hemoglobin level correlated well with mortality.

Conclusion

Anemia was associated with increased long-term mortality of COPD, and even mild anemia was related to a significantly increased risk.

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

Aim

To determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods

A retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years.

Results

Of 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit).

Conclusion

High in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.

Blood volume extracted from the critical patient in the first 24 hours after admission

OBJECTIVE

To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system.

METHOD

An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change.

RESULTS

The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001).

CONCLUSIONS

Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.