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Zhao X, Su R, Hu R, Chen Y, Xu X, Yuan Y, Zhang J, Zhang W, Yang Y, Chen M, Li D, Wu B, Huang D, Wu D. Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study. BMC Geriatr 2023; 23:89. [PMID: 36774462 PMCID: PMC9921248 DOI: 10.1186/s12877-023-03784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Sarcopenia is a geriatric syndrome with progressive loss of skeletal muscle mass and function and has a negative impact on clinical outcomes associated with chronic obstructive pulmonary disease (COPD). Recently, the sarcopenia index (SI) was developed as a surrogate marker of sarcopenia based upon the serum creatinine to cystatin C ratio. We aimed to assess the value of SI for predicting clinically important outcomes among elderly patients with acute exacerbation of COPD (AECOPD). METHODS This cross-sectional study included elderly patients with AECOPD in China from 2017 to 2021. Clinical data were collected from medical records, and serum creatinine and cystatin C were measured. Outcomes included respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality. Binary logistic regression was used to analyze the association between SI and clinical outcomes. RESULTS A total of 306 patients (260 men, 46 women, age range 60-88 years) were enrolled in this study. Among the total patients, the incidence of respiratory failure and severe pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was still independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13-0.56, P < 0.05). In subgroup analysis, the incidence of respiratory failure was negatively associated with SI values in groups with both frequent exacerbation and non-frequent exacerbation. After adjustment for potential confounders, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06-0.64 and OR: 0.31, 95% CI: 0.11-0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, invasive mechanical ventilation, and mortality in all groups. CONCLUSION The SI based on serum creatinine and cystatin C can predict respiratory failure in patients with AECOPD and either frequent or infrequent exacerbations. This indicator provides a convenient tool for clinicians when managing patients with AECOPD in daily clinical practice.
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Affiliation(s)
- Xuanna Zhao
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ruoxin Su
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Rongwei Hu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yujuan Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoyong Xu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yalian Yuan
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinhong Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wenchao Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yu Yang
- grid.410560.60000 0004 1760 3078Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Min Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongming Li
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Wu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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Incorvaia C, Scarpazza P, Riario-Sforza GG. Do not intubate order, is the misunderstanding finally over? Ann Thorac Med 2018; 13:195. [PMID: 30123341 PMCID: PMC6073790 DOI: 10.4103/atm.atm_113_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Paolo Scarpazza
- Division of Broncopneumotisiology, Civile Hospital, Vimercate, Italy
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Vargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, Alviggi I, Tizzano R, Salsano E, Di Grezia F, Vargas M. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res 2017; 29:833-845. [PMID: 27761759 DOI: 10.1007/s40520-016-0638-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
Abstract
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.
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Affiliation(s)
- Nicola Vargas
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy.
| | - Loredana Tibullo
- Medicine Ward, Medicine Department, "San Giuseppe Moscati" Hospital, via Gramsci, 81031, Aversa, CE, Italy
| | - Emanuela Landi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Giovanni Carifi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Alfonso Pirone
- Clinical Nutrition and Dietology Unit, Medicine Department, Azienda Ospedaliera di Rilievo Nazionale e di alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Antonio Pippo
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Immacolata Alviggi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Renato Tizzano
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Elisa Salsano
- Department of Clinical Disease and Internal Medicine, Federico II University of Naples, via Pansini, 80121, Naples, Italy
| | - Francesco Di Grezia
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Maria Vargas
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini, 89121, Naples, Italy
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Vilaça M, Aragão I, Cardoso T, Dias C, Cabral-Campello G. The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. PLoS One 2016; 11:e0149649. [PMID: 26901060 PMCID: PMC4763309 DOI: 10.1371/journal.pone.0149649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Noninvasive ventilation (NIV) is being used increasingly in patients who have a “do not intubate” (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symptoms in end-of-life care. Objective The aim of this prospective study was to determine the outcome and HRQOL impact of regular use of NIV outcomes on patients with a DNI order who were admitted to the emergency room department (ED). Methods: Eligible for participation were DNI-status patients who receive NIV for acute or acute-on-chronic respiratory failure when admitted to the ED of a tertiary care, university-affiliated, 600-bed hospital between January 2014 and December 2014. Patients were divided into 2 groups: (1) those whose DNI order related to a decision to withhold therapy and (2) those for whom any treatment, including NIV, was provided for symptom relief only. HRQOL was evaluated only in group 1, using the 12-item Short Form Health Survey (SF-12). Long-term outcome was evaluated 90 days after hospital discharge by means of a telephone interview. Results During the study period 1727 patients were admitted to the ED, 243 were submitted to NIV and 70 (29%) were included in the study. Twenty-nine (41%) of the 70 enrollees received NIV for symptom relief only (group2). Active cancer [7% vs 35%, p = 0,004] and neuromuscular diseases [0% vs. 17%] were more prevalent in this group. NIV was stopped in 59% of the patients in group 2 due to lake of clinical benefit. The in-hospital mortality rate was 37% for group 1 and 86% for group 2 0,001). Among patients who were discharged from hospital, 23% of the group 1 and all patients in group 2 died within 90 days. Relative to baseline, no significant decline in HRQOL occurred in group 1 by 90 days postdischarge. Conclusion The survival rate was 49% among DNI-status patients for whom NIV was used as a treatment in ED, and these patients did not experience a decline in HRQOL throughout the study. NIV did not provide significant relief of symptoms in more than half the patients who receive it for that purpose.
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Affiliation(s)
- Marta Vilaça
- Medicine Integrated Master (MIM), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto University (UP), Porto, Portugal
- * E-mail:
| | - Irene Aragão
- Intensive Care Unit (UCIP), Oporto Hospital Center, Porto, Portugal
| | - Teresa Cardoso
- Intensive Care Unit (UCIP), Oporto Hospital Center, Porto, Portugal
| | - Cláudia Dias
- Center for Health Technology and Services Research (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, Oporto University (UP), Porto, Portugal
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Stefan MS, Shieh MS, Pekow PS, Hill N, Rothberg MB, Lindenauer PK. Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 2015; 147:959-968. [PMID: 25375230 DOI: 10.1378/chest.14-1216] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The use of noninvasive ventilation (NIV) in acute exacerbation of COPD has increased over time. However, little is known about patient factors influencing its use in routine clinical practice. METHODS This was a retrospective cohort study of 723,560 hospitalizations for exacerbation of COPD at 475 hospitals between 2001 and 2011. The primary study outcome was the initial form of ventilation (NIV or invasive mechanical ventilation [IMV]). Hierarchical generalized linear models were used to examine the trends in ventilation and patient characteristics associated with receipt of NIV. RESULTS After adjusting for patient and hospital characteristics, initial NIV increased by 15.1% yearly (from 5.9% to 14.8%), and initial IMV declined by 3.2% yearly (from 8.7% to 5.9%); annual exposure to any form of mechanical ventilation increased by 4.4% (from 14.1% to 20.3%). Among case subjects treated with ventilation, those aged ≥ 85 years had a 22% higher odds of receiving NIV compared with those aged < 65 years, while blacks (OR, 0.86) and Hispanics (OR, 0.91) were less likely to be treated with NIV than were whites. Cases with a high burden of comorbidities and those with concomitant pneumonia had high rates of NIV failure and were more likely to receive initial IMV. Use of NIV increased at a faster rate among the admissions of the oldest patients relative to the youngest. CONCLUSIONS The use of NIV for COPD exacerbations has increased steadily, whereas IMV use has declined. Several patient factors, including age, race, and comorbidities, influenced the receipt of NIV. Further research is needed to identify the factors driving these patterns.
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Affiliation(s)
- Mihaela S Stefan
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA.
| | - Meng-Shiou Shieh
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA
| | - Penelope S Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Department of Biostatistics, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA
| | - Nicholas Hill
- Division of Pulmonary and Critical Care Medicine, Boston, MA
| | - Michael B Rothberg
- Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Peter K Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA
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Lopez-Campos JL, Jara-Palomares L, Muñoz X, Bustamante V, Barreiro E. Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD) exacerbations. Ann Thorac Med 2015; 10:87-93. [PMID: 25829958 PMCID: PMC4375747 DOI: 10.4103/1817-1737.151440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/30/2014] [Indexed: 01/01/2023] Open
Abstract
Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla ; Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Jara-Palomares
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla
| | - Xavier Muñoz
- Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain ; Department of Medicine, Pulmonology Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Bustamante
- Departamento de Medicina, Servicio de Neumología, Hospital Universitario Basurto, Osakidetza, EHU-University of the Basque Country, Biscay, Spain
| | - Esther Barreiro
- Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain ; Department of Pulmonology, Muscle Research and Respiratory System Unit Institut Hospital del Mar d'Investigacions Médiques Hospital del Mar, Barcelona, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
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Rodriguez AME, Scala R, Ambrosino N. Shrinking the room for invasive mechanical ventilation in acute chronic hypercapnic respiratory failure: yes, but must be sure to have opened windows for noninvasive ventilation. Int J Chron Obstruct Pulmon Dis 2013; 8:313-4. [PMID: 23882138 PMCID: PMC3709646 DOI: 10.2147/copd.s49015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Antonio M Esquinas Rodriguez
- International Fellow AARC, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
- Correspondence: Antonio M Esquinas Rodriguez, Avenida Marqués de Los Velez s/n, Murcia, 30008, Spain, Tel +34609321966, Fax +34968232484, Email
| | - Rafaelle Scala
- Respiratory Ward and Respiratory Intensive Care Unit, S, Donato Hospital, Arezzo, Italy
| | - Nicolino Ambrosino
- Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Department, University Hospital Pisa, Pisa, Italy
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