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Li B, Liu M, Wang Y, Zhang H, Xuan L, Huang K, An Z. Association of Severe Vitamin D Deficiency with Hospitalization in the Previous Year in Hospitalized Exacerbated COPD Patients. Int J Chron Obstruct Pulmon Dis 2024; 19:1471-1478. [PMID: 38948911 PMCID: PMC11214566 DOI: 10.2147/copd.s461029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/08/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Vitamin D deficiency (VDD, 25-hydroxyvitamin D < 20 ng/mL) has been reported associated with exacerbation of chronic obstructive pulmonary disease (COPD) but sometimes controversial. Research on severe vitamin D deficiency (SVDD, 25-hydroxyvitamin D < 10 ng/mL) in exacerbation of COPD is limited. Patients and Methods We performed a retrospective observational study in 134 hospitalized exacerbated COPD patients. 25-hydroxyvitamin D was modeled as a continuous or dichotomized (cutoff value: 10 or 20 ng/mL) variable to evaluate the association of SVDD with hospitalization in the previous year. Receiver operator characteristic (ROC) analysis was performed to find the optimal cut-off value of 25-hydroxyvitamin D. Results In total 23% of the patients had SVDD. SVDD was more prevalent in women, and SVDD group tended to have lower blood eosinophils counts. 25-hydroxyvitamin D level was significantly lower in patients who were hospitalized in the previous year (13.6 vs 16.7 ng/mL, P = 0.044), and the prevalence of SVDD was higher (38.0% vs 14.3%, P = 0.002). SVDD was independently associated with hospitalization in the previous year [odds ratio (OR) 4.34, 95% CI 1.61-11.72, P = 0.004] in hospitalized exacerbated COPD patients, whereas continuous 25-hydroxyvitamin D and VDD were not (P = 0.1, P = 0.9, separately). The ROC curve yielded an area under the curve of 0.60 (95% CI 0.50-0.71) with an optimal 25-hydroxyvitamin D cutoff of 10.4 ng/mL. Conclusion SVDD probably showed a more stable association with hospitalization in the previous year in hospitalized exacerbated COPD patients. Reasons for lower eosinophil counts in SVDD group needed further exploration.
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Affiliation(s)
- Boyu Li
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Meishan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lingling Xuan
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Kewu Huang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Ang BW, Fernandez L. A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center. BMC Pulm Med 2024; 24:184. [PMID: 38632584 PMCID: PMC11022336 DOI: 10.1186/s12890-024-03011-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (at peso-dollar rate of 56) for service patients was at $ 75.89 compared to private service patients at $ 285.71. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of ≥ $ 357. Accommodation cost and professional fees accounted for majority or 61.6% of the overall cost for private patients, while medications and diagnostic tests were the major or 76.01% contributor to the overall cost for charity patients. Despite existence of Phil-health, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the out-patient setting could potentially reduce total cost for this disease.
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Affiliation(s)
- Blake Warren Ang
- Division of Pulmonary Medicine, University of the Philippines? Philippine General Hospital, Manila, Philippines.
| | - Lenora Fernandez
- Division of Pulmonary Medicine, University of the Philippines? Philippine General Hospital, Manila, Philippines
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Crisafulli E, Sartori G, Huerta A, Gabarrús A, Fantin A, Soler N, Torres A. Association Between Rome Classification Among Hospitalized Patients With COPD Exacerbations and Short-Term and Intermediate-Term Outcomes. Chest 2023; 164:1422-1433. [PMID: 37516272 DOI: 10.1016/j.chest.2023.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Recently, the Rome proposal updated the definition of exacerbation of COPD (ECOPD). However, such severity grade has not yet demonstrated intermediate-term clinical relevance. RESEARCH QUESTION What is the association between the Rome severity classification and short-term and intermediate-term clinical outcomes? STUDY DESIGN AND METHODS We retrospectively grouped hospitalized patients with ECOPD according to the Rome severity classification (ie, mild, moderate, severe). Baseline, clinical, microbiologic, gas analysis, and laboratory variables were collected. In addition, data about the length of hospital stay and mortality (in-hospital and a follow-up time line from 6 months until 3 years) were assessed. RESULTS Of the 347 hospitalized patients, 39% were categorized as mild, 31% were categorized as moderate, and 30% were categorized as severe. Overall, patients with severe ECOPD had an extended length of hospital stay. Although in-hospital mortality was similar among groups, patients with severe ECOPD presented a worse prognosis in all follow-up time points. The Kaplan-Meier curves show the role of the severe classification in the cumulative survival at 1 and 3 years (Gehan-Breslow-Wilcoxon test, P = .032 and P = .004, respectively). The multivariable Cox regression analysis showed a higher risk of death at 1 year when patients presented a severe (hazard ratio, 1.99; 95% CI, 1.49-2.65) or moderate grade (hazard ratio, 1.47; 95% CI, 1.10-1.97) compared with a mild grade. Older patients (aged ≥ 80 years), patients requiring long-term oxygen therapy, or patients reporting previous ECOPD episodes had a higher mortality risk. A BMI between 25 and 29 kg/m2 was associated with a lower risk. INTERPRETATION The Rome classification makes it possible to discriminate patients with a worse prognosis (severe or moderate) until a 3-year follow-up.
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Affiliation(s)
- Ernesto Crisafulli
- Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giulia Sartori
- Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Clinica Sagrada Familia, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Gabarrús
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Alberto Fantin
- Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Néstor Soler
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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Quiroga TN, Bachar N, Voigt W, Danino N, Shafran I, Shtrichman R, Shuster G, Lambrecht N, Eisenmann S. Changes in tidal breathing biomarkers as indicators of treatment response in AECOPD patients in an acute care setting. Adv Med Sci 2023; 68:176-185. [PMID: 37146372 DOI: 10.1016/j.advms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a complication of COPD that typically necessitates intensified treatment and hospitalization. It is linked to higher morbidity, mortality and healthcare spending. Assessment of therapy response for AECOPD is difficult due to the variability of symptoms and limitations in current measures. Hence, there is a need for new biomarkers to aid in the management of AECOPD in acute care settings. MATERIALS AND METHODS Fifteen hospitalized AECOPD patients (GOLD 3-4) were enrolled in this study. Treatment response was assessed daily through clinical evaluations and by monitoring tidal breathing biomarkers (respiratory rate [RR], expiratory time [Tex], inspiratory time [Tin], expiratory pause [Trst], total breath time [Ttot]), using a novel, wearable nanosensor-based device (SenseGuard™). RESULTS Patients who showed significant clinical improvement had substantial changes in ΔTex/Ttot (+14%), ΔTrst/Ttot (-18%), and ΔTin/Tex (+0.09), whereas patients who showed mild or no clinical improvement had smaller changes (+5%, +3%, and -0.03, respectively). Linear regression between change in physician's assessment score and the median change in tidal breathing parameters was significant for Tin/Tex (R2 = 0.449, ∗p = 0.017), Tex/Ttot (R2 = 0.556, ∗p = 0.005) and Trst/Ttot (R2 = 0.446, ∗p = 0.018), while no significant regression was observed for RR, Tin/(Trst + Tex) and Tin/Ttot. CONCLUSIONS Our study demonstrates the potential of the SenseGuard™ to monitor treatment response in AECOPD patients by measuring changes in tidal breathing biomarkers, which were shown to be associated with significant changes in the patients' respiratory condition as evaluated by physicians. However, further large-scale clinical studies are needed to confirm these findings.
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Affiliation(s)
- Tess Nuñez Quiroga
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | | | - Wieland Voigt
- NanoVation-GS LTD, Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
| | | | | | | | | | - Nina Lambrecht
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
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Lüthi-Corridori G, Boesing M, Ottensarendt N, Leuppi-Taegtmeyer AB, Schuetz P, Leuppi JD. Predictors of Length of Stay, Mortality and Rehospitalization in COPD Patients: A Retrospective Cohort Study. J Clin Med 2023; 12:5322. [PMID: 37629364 PMCID: PMC10455093 DOI: 10.3390/jcm12165322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease that has a significant impact on individuals and healthcare systems worldwide. This study aimed to identify factors that predict the length of a hospital stay (LOHS), one-year mortality, and rehospitalization within 6 months in patients admitted for acute exacerbation of COPD (AECOPD). A retrospective cohort study was conducted using data from 170 patients admitted to a district general hospital in Switzerland between January 2019 and February 2020. Sociodemographic and health-related variables measured at admission were analyzed as potential predictors. Multivariable zero-truncated negative binomial and logistic regression analyses were performed to assess the risk factors for LOHS (primary endpoint), mortality, and rehospitalization. The results show that an indication for oxygen supplementation was the only significant predictor of LOHS. In the logistic regression analysis, older age, COPD severity stages GOLD III and IV, active cancer and arrhythmias were associated with higher mortality, whereas rehabilitation after discharge was associated with lower mortality. There were no significant associations regarding rehospitalization. This study identified routinely available predictors for LOHS and mortality, which may further advance our understanding of AECOPD and thereby improve patient management, discharge planning, and hospital costs. The protective effect of rehabilitation after hospitalization regarding lower mortality warrants further confirmation and may improve the comprehensive management of patients with AECOPD.
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Affiliation(s)
- Giorgia Lüthi-Corridori
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Maria Boesing
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Nicola Ottensarendt
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Anne Barbara Leuppi-Taegtmeyer
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4056 Basel, Switzerland
| | - Philipp Schuetz
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Cantonal Hospital Aarau, University Department of Medicine, 5001 Aarau, Switzerland
| | - Joerg Daniel Leuppi
- University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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Yuan FZ, Xing YL, Xie LJ, Yang DL, Shui W, Niu YY, Zhang X, Zhang CR. The Relationship Between Prognostic Nutritional Indexes and the Clinical Outcomes of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1155-1167. [PMID: 37332836 PMCID: PMC10275318 DOI: 10.2147/copd.s402717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Nutritional status is related to the clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of this study was to investigate the association between nutritional status, measured by the prognostic nutritional index (PNI), and adverse hospitalization outcomes in patients with AECOPD. Methods Consecutive AECOPD patients admitted to the First Affiliated Hospital of Sun Yat-sen University between January 1, 2015 to October 31, 2021 were enrolled. We collected the clinical characteristics and laboratory data of patients. Multivariable logistic regression models were developed to assess the relationship between the baseline PNI and adverse hospitalization outcomes. A generalized additive model (GAM) was used to identify any non-linear relationship. In addition, we performed a subgroup analysis to tested the robustness of the results. Results A total of 385 AECOPD patients were involved in this retrospective cohort study. Based on the tertiles of PNI, patients in the lower tertiles of PNI showed more worse outcome incidence (30 [23.6%] versus 17 [13.2%] versus 8 [6.2%]; p < 0.001). Multivariable logistic regression analysis revealed that the PNI were independently associated with adverse hospitalization outcomes after adjustment for confounding factors (Odds ratio [OR] = 0.94, 95% CI: 0.91 to 0.97, P < 0.0001). After adjusting for confounders, smooth curve fitting showed a saturation effect, suggesting that the relationship between the PNI and adverse hospitalization outcomes was nonlinear. Two-piecewise linear regression model suggested that the incidence of adverse hospitalization outcomes significantly decreased with PNI level up to the inflection point (PNI = 42), and PNI was not associated with adverse hospitalization outcome after that point. Conclusion Decreased PNI levels at admission were determined to be associated with adverse hospitalization outcomes in patients with AECOPD. The results obtained in this study may potentially assist clinicians optimize risk evaluations and clinical management processes.
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Affiliation(s)
- Fu-Zhen Yuan
- Department of General Practice Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Yan-Li Xing
- Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People’s Republic of China
| | - Liang-Jie Xie
- Department of General Practice Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Dong-Ling Yang
- Department of General Practice Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Wei Shui
- Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People’s Republic of China
| | - Yuan-Yuan Niu
- Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People’s Republic of China
| | - Xin Zhang
- Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People’s Republic of China
| | - Chang-Ran Zhang
- Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People’s Republic of China
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Wang M, Zhao F, Sun L, Liang Y, Yan W, Sun X, Zhou Q, He B. High-Flow Nasal Cannula versus Noninvasive Ventilation in AECOPD Patients with Respiratory Acidosis: A Retrospective Propensity Score-Matched Study. Can Respir J 2023; 2023:6377441. [PMID: 37096166 PMCID: PMC10122591 DOI: 10.1155/2023/6377441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/14/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Background Limited data are available about the clinical outcomes of AECOPD patients with respiratory acidosis treated with HFNC versus NIV. Methods We conducted a retrospective study to compare the efficacy of HFNC with NIV as initial ventilation support strategy in AECOPD patients with respiratory acidosis. Propensity score matching (PSM) was implemented to increase between-group comparability. Kaplan-Meier analysis was utilized to evaluate differences between the HFNC success, HFNC failure, and NIV groups. Univariate analysis was performed to identify the features that differed significantly between the HFNC success and HFNC failure groups. Results After screening 2219 hospitalization records, 44 patients from the HFNC group and 44 from the NIV group were successfully matched after PSM. The 30-day mortality (4.5% versus 6.8%, p = 0.645) and 90-day mortality (4.5% versus 11.4%, p = 0.237) did not differ between the HFNC and NIV groups. Length of ICU stay (median: 11 versus 18 days, p = 0.001), length of hospital stay (median: 14 versus 20 days, p = 0.001), and hospital cost (median: 4392 versus 8403 $USD, p = 0.001) were significantly lower in the HFNC group compared with NIV group. The treatment failure rate was much higher in the HFNC group than in the NIV group (38.6% versus 11.4%, p = 0.003). However, patients who experienced HFNC failure and switched to NIV showed similar clinical outcomes to those who first received NIV. Univariate analysis showed that log NT-proBNP was an important factor for HFNC failure (p = 0.007). Conclusions Compared with NIV, HFNC followed by NIV as rescue therapy may be a viable initial ventilation support strategy for AECOPD patients with respiratory acidosis. NT-proBNP may be an important factor for HFNC failure in these patients. Further well-designed randomized controlled trials are needed for more accurate and reliable results.
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Affiliation(s)
- Meng Wang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Feifan Zhao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Lina Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ying Liang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Wei Yan
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoyan Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qingtao Zhou
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Bei He
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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Liu T, Xuan H, Wang L, Li X, Lu Z, Tian Z, Chen J, Wang C, Li D, Xu T. The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database. PLoS One 2023; 18:e0282289. [PMID: 36827460 PMCID: PMC9956661 DOI: 10.1371/journal.pone.0282289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The purpose of this article is to assess the relationship between serum albumin level and long length of stay (LOS) of inpatients with acute heart failure (AHF) in the intensive care unit (ICU). METHODS We retrospectively analyzed data of 2280 patients with AHF from the medical information mart for intensive care IV (the MIMIC-IV) database. Multivariate logistic regression was performed to evaluate the association between serum albumin and long LOS, and the development of the predictive model was based on independent predictors of long LOS. RESULTS According to the statistical results, A negative linear relationship was presented between albumin and long LOS of AHF patients in the ICU (P for trend <0.001), and serum albumin could predict long LOS (AUC 0.649, 95%CI 0.616-0.683, P <0.001). Based on independent predictors, including respiratory failure (OR 1.672, 95%CI 1.289-2.169, P<0.001), WBC (OR 1.046, 95%CI 1.031-1.061, P<0.001), creatinine (OR 1.221, 95%CI 1.098-1.257, P<0.001), glucose (OR 1.010, 95%CI 1.007-1.012, P<0.001), lactic acid (OR 1.269, 95%CI 1.167-1.381, P<0.001), and albumin (OR 0.559, 95%CI 0.450-0.695, P<0.001), identified by multivariable logistic regression analysis, we developed the nomogram to predict the probability of long LOS of AHF patients in the ICU. The nomogram accurately predicted the probability of long LOS (AUC 0.740, 95%CI 0.712-0.768, P<0.001). The calibration suggested the predictive probability was highly consistent with the actual probability of long LOS. Decision curve analysis (DCA) also suggested that the nomogram was applicable in the clinic. CONCLUSION Serum albumin level was negatively associated with LOS among AHF patients. The predictive model based on serum albumin has predictive value for evaluating the length of stay in AHF patients.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People’s Hospital, Jinshan, Shanghai, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoqun Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhihao Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhaoxuan Tian
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- * E-mail: (TX); (DL)
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- * E-mail: (TX); (DL)
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Grosbois JM, Détrée A, Pierache A, Bautin N, Pérez T, Wallaert B, Chenivesse C, Le Rouzic O. Impact of Cardiovascular and Metabolic Comorbidities on Long-term Outcomes of Home-based Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:155-167. [PMID: 36860514 PMCID: PMC9969866 DOI: 10.2147/copd.s381744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results. Research Question This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients. Study Design and methods Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement. Results Patients (mean age 64.1±11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2±17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (-5.0±0.7 vs -2.9±0.8 and -2.6±0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14. Conclusion Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.
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Affiliation(s)
| | - Axelle Détrée
- Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France
| | - Adeline Pierache
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France,CHU Lille, Department of Biostatistics, Lille, F-59000, France
| | - Nathalie Bautin
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Thierry Pérez
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Benoit Wallaert
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Cécile Chenivesse
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Olivier Le Rouzic
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France,Correspondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email
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10
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Archontakis Barakakis P, Tran T, You JY, Hernandez Romero GJ, Gidwani V, Martinez FJ, Fortis S. High versus Medium Dose of Inhaled Corticosteroid in Chronic Obstructive Lung Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2023; 18:469-482. [PMID: 37056683 PMCID: PMC10086393 DOI: 10.2147/copd.s401736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
Background Inhaled corticosteroids (ICSs) combined with bronchodilators have been identified to improve outcomes in COPD but also to be associated with certain adverse effects. Objective We performed a systematic review and meta-analysis to compile and summarize data on the efficacy and safety of dosing levels (high versus medium/low) of ICS alongside ancillary bronchodilators following PRISMA guidelines. Data Sources Medline and Embase were systematically searched until December 2021. Randomized, clinical trials (RCTs) that met predefined inclusion criteria were included. Data Extraction Risk ratios (RRs) with 95% confidence intervals (CI) were extracted. Any acute exacerbation of COPD (AECOPD) risk was chosen as the primary efficacy outcome, mortality rate as the primary safety outcome, moderate/severe AECOPD risk as the secondary efficacy outcome and pneumonia risk as the secondary safety outcome. Subgroup analyses of individual ICS agents, of patients with baseline moderate/severe/very severe COPD and of patients with recent COPD exacerbation history were also performed. A random-effects model was used. Results We included 13 RCTs in our study. No data on low doses were included in the analysis. High dose ICS was not associated with a statistically significant difference in any AECOPD risk (RR: 0.98, 95% CI: 0.91-1.05, I2: 41.3%), mortality rate (RR: 0.99, 95% CI: 0.75-1.32, I2: 0.0%), moderate/severe AECOPD risk (RR: 1.01, 95% CI: 0.96-1.06, I2: 0.0%) or pneumonia risk (RR: 1.07, 95% CI: 0.86 -1.33, I2: 9.3%) compared to medium dose ICS. The same trend was identified with the several subgroup analyses. Conclusion Our study collected RCTs investigating the optimal dosing level of ICS prescribed alongside ancillary bronchodilators to patients with COPD. We identified that the high ICS dose neither reduces AECOPD risk and mortality rates nor increases pneumonia risk relative to the medium dose.
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Affiliation(s)
- Paraschos Archontakis Barakakis
- Northeast Internal Medicine Associates, LaGrange, IN, USA
- Correspondence: Paraschos Archontakis Barakakis, Northeast Internal Medicine Associates, 4344 Love Grass Lane, Fort Wayne, LaGrange, IN, 46845, USA, Tel +1 929-422-4589, Email
| | - Thuonghien Tran
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Jee Young You
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Vipul Gidwani
- Northeast Internal Medicine Associates, LaGrange, IN, USA
| | - Fernando J Martinez
- Departments of Medicine and Genetic Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Spyridon Fortis
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
- Veterans Rural Health Resource Center, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
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11
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Buhl R, Wilke T, Picker N, Schmidt O, Hechtner M, Kondla A, Maywald U, Vogelmeier CF. Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:2355-2367. [PMID: 36172035 PMCID: PMC9512029 DOI: 10.2147/copd.s375190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to describe the real-world treatment of German incident COPD patients, compare that treatment with clinical guidelines, and provide insight into disease development after incident diagnosis. In addition, the economic burden of the disease by assessing COPD-related healthcare costs was described. Patients and Methods Based on a German claims dataset, continuously insured individuals (04/2014-03/2019) aged 40 years or older with at least two incident pulmonologist's diagnoses or one inpatient diagnosis of COPD (ICD-10-GM code J44.-; no respective diagnosis in a 12-month baseline period) were selected. Treatment patterns after incident diagnosis considering inhaled maintenance therapies identified by ATC codes (outpatient prescriptions) were analyzed. Prescription patterns were compared with recommendations of German COPD treatment guidelines. Severe exacerbations were assessed as hospitalizations with main diagnosis ICD-10-GM code J44.1. COPD-associated costs from the perspective of the health insurance fund AOK PLUS were calculated per patient-year (PY). Results The sample comprised 17,464 incident COPD patients with a mean age of 71.5 years. 58.9% were male and the mean Charlson-Comorbidity-Index was 5.3. During follow-up (median: 2.0 years), 57.1% of the patients received at least one prescription of an inhaled maintenance therapy, whereas 42.9% did not. Among treated patients, 35.2% started their treatment with LABA/LAMA, 25.3% with LAMA monotherapy, 16.2% with LABA/ICS, and 7.8% with LABA/LAMA/ICS therapy. Within four weeks after initial diagnosis, ICS-containing therapies were prescribed in 14.1% of patients. Of all patients with a prescribed triple therapy, 68.9% had no corresponding exacerbation history documented. On average, 0.16 severe exacerbations and 0.19 COPD-related hospitalizations were observed per PY during available follow-up. Direct COPD-related costs were 3,693 €/PY, with COPD-related hospitalizations being responsible for about 79.2% of these costs. Conclusion Long-acting bronchodilators are the mainstay of pharmacological treatment of incident COPD patients in Germany, in line with guideline recommendations. Yet, a considerable proportion of incident COPD patients did not receive any inhaled maintenance therapy.
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Affiliation(s)
- Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | - Nils Picker
- Cytel Inc - Ingress-Health HWM GmbH, Wismar, Germany
| | | | | | - Anke Kondla
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
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12
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Pokharel P, Lamichhane P, Pant P, Shrestha AB. Factors affecting length of hospital stay in chronic obstructive pulmonary disease patients in a tertiary hospital of Nepal: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 80:104246. [PMID: 36045760 PMCID: PMC9422293 DOI: 10.1016/j.amsu.2022.104246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite the increasing burden of chronic obstructive pulmonary disease in Nepal, studies analyzing the factors associated with inpatient length of hospital stay are lacking. Methods This is a retrospective, cross-sectional hospital-based study conducted between July 2020 and July 2021 on patients admitted to the inpatient ward of Pulmonary and Critical Care Medicine of Tribhuvan University Teaching Hospital with a primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease. The sample size of our study was 90. Clinical and demographic factors, blood investigation parameters, and treatment received were analyzed via univariate and multivariate analysis to find the factors associated with length of stay. Results The mean age of chronic obstructive pulmonary disease patients was 68.84 ± 10.22 years, with 42.2% of males and 43.3% of current smokers. The length of hospital stay ranged from 2 to 25 days, with an average stay of 6.69 ± 4.02 days. Factors associated with length of stay are the number of comorbidities (p = 0.007), blood eosinophils at admission (p = 0.022), and use of mechanical ventilatory support (p < 0.001). Conclusions Proper management of comorbidities and eosinophilic exacerbations as well as careful use of mechanical ventilatory support are required to further reduce the duration of hospital stay in chronic obstructive pulmonary disease patients. This study is the first of its kind identifying the factors associated with the length of hospital stay in COPD patients in Nepal. COPD is the fifth most common cause of inpatient admission in Nepal and per our study the length of stay was 6.69 days. The culprits identified for the increase length of stay were the number of comorbidities, blood eosinophils at admission and use of mechanical ventilator support.
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13
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Karboub K, Tabaa M. A Machine Learning Based Discharge Prediction of Cardiovascular Diseases Patients in Intensive Care Units. Healthcare (Basel) 2022; 10:healthcare10060966. [PMID: 35742018 PMCID: PMC9222879 DOI: 10.3390/healthcare10060966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 01/12/2023] Open
Abstract
This paper targets a major challenge of how to effectively allocate medical resources in intensive care units (ICUs). We trained multiple regression models using the Medical Information Mart for Intensive Care III (MIMIC III) database recorded in the period between 2001 and 2012. The training and validation dataset included pneumonia, sepsis, congestive heart failure, hypotension, chest pain, coronary artery disease, fever, respiratory failure, acute coronary syndrome, shortness of breath, seizure and transient ischemic attack, and aortic stenosis patients’ recorded data. Then we tested the models on the unseen data of patients diagnosed with coronary artery disease, congestive heart failure or acute coronary syndrome. We included the admission characteristics, clinical prescriptions, physiological measurements, and discharge characteristics of those patients. We assessed the models’ performance using mean residuals and running times as metrics. We ran multiple experiments to study the data partition’s impact on the learning phase. The total running time of our best-evaluated model is 123,450.9 mS. The best model gives an average accuracy of 98%, highlighting the location of discharge, initial diagnosis, location of admission, drug therapy, length of stay and internal transfers as the most influencing patterns to decide a patient’s readiness for discharge.
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Affiliation(s)
- Kaouter Karboub
- FRDISI, Hassan II University Casablanca, Casablanca 20000, Morocco
- LRI-EAS, ENSEM, Hassan II University Casablanca, Casablanca 20000, Morocco
- LGIPM, Lorraine University, 57000 Metz, France
- Correspondence: (K.K.); (M.T.); Tel.: +212-661-943-174 (M.T.)
| | - Mohamed Tabaa
- LPRI, EMSI, Casablanca 23300, Morocco
- Correspondence: (K.K.); (M.T.); Tel.: +212-661-943-174 (M.T.)
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14
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The Impact of COPD on Hospitalized Patients with Diabetes: A Propensity Score Matched Analysis on Discharge Records. Healthcare (Basel) 2022; 10:healthcare10050885. [PMID: 35628022 PMCID: PMC9140845 DOI: 10.3390/healthcare10050885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Type 2 diabetes is a common comorbidity of chronic obstructive pulmonary disease. Despite the lack of knowledge of the pathophysiological link between diabetes and chronic obstructive pulmonary disease, the presence of diabetes among those with chronic obstructive pulmonary disease is associated with worse outcomes, such as mortality and hospitalization. The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease on in-hospital mortality and prolonged length of stay (PLOS) among patients with diabetes. (2) Methods: The study considered all hospital admissions of patients with diabetes aged over 65 years performed from 2006 to 2015 in Abruzzo, Italy. To compare outcomes between patients with and without chronic obstructive pulmonary disease, a propensity score matching procedure was performed. (3) Results: During the study period, 140,556 admissions of patients with diabetes were performed. After matching, 18,379 patients with chronic obstructive pulmonary disease and 18,379 controls were included in the analyses. Logistic regression analyses showed as chronic obstructive pulmonary disease was associated with in-hospital mortality (OR: 1.10; p = 0.036) and PLOS (OR: 1.18; p = 0.002). (4) Conclusions: In a cohort of Italian patients, diabetic patients with chronic obstructive pulmonary disease were associated with in-hospital mortality and PLOS. The definition of the causes of these differences aims to implement public health surveillance and policies.
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He G, Dong T, Yang Z, Branstad A, Huang L, Jiang Z. Point-of-care COPD diagnostics: biomarkers, sampling, paper-based analytical devices, and perspectives. Analyst 2022; 147:1273-1293. [PMID: 35113085 DOI: 10.1039/d1an01702k] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has become the third leading cause of global death. Insufficiency in early diagnosis and treatment of COPD, especially COPD exacerbations, leads to a tremendous economic burden and medical costs. A cost-effective and timely prevention requires decentralized point-of-care diagnostics at patients' residences at affordable prices. Advances in point-of-care (POC) diagnostics may offer new solutions to reduce medical expenditures by measuring salivary and blood biomarkers. Among them, paper-based analytical devices have been the most promising candidates due to their advantages of being affordable, biocompatible, disposable, scalable, and easy to modify. In this review, we present salivary and blood biomarkers related to COPD endotypes and exacerbations, summarize current technologies to collect human whole saliva and whole blood samples, evaluate state-of-the-art paper-based analytical devices that detect COPD biomarkers in saliva and blood, and discuss existing challenges with outlooks on future paper-based POC systems for COPD diagnosis and management.
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Affiliation(s)
- Guozhen He
- Chongqing Key Laboratory of Micro-Nano Systems and Smart Transduction, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Academician and Expert Workstation, Chongqing Technology and Business University, Nan'an District, Chongqing 400067, China.,Department of Microsystems (IMS), Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-Eastern Norway, Postboks 235, 3603 Kongsberg, Norway.
| | - Tao Dong
- Department of Microsystems (IMS), Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-Eastern Norway, Postboks 235, 3603 Kongsberg, Norway.
| | - Zhaochu Yang
- Chongqing Key Laboratory of Micro-Nano Systems and Smart Transduction, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Academician and Expert Workstation, Chongqing Technology and Business University, Nan'an District, Chongqing 400067, China
| | - Are Branstad
- University of Southeast Norway (USN), School of Business, Box 235, 3603 Kongsberg, Norway
| | - Lan Huang
- Chongqing Key Laboratory of Micro-Nano Systems and Smart Transduction, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Academician and Expert Workstation, Chongqing Technology and Business University, Nan'an District, Chongqing 400067, China
| | - Zhuangde Jiang
- Chongqing Key Laboratory of Micro-Nano Systems and Smart Transduction, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Academician and Expert Workstation, Chongqing Technology and Business University, Nan'an District, Chongqing 400067, China
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Wang H, Yang T, Yu X, Chen Z, Ran Y, Wang J, Dai G, Deng H, Li X, Zhu T. Risk Factors for Length of Hospital Stay in Acute Exacerbation Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study. Int J Gen Med 2022; 15:3447-3458. [PMID: 35378912 PMCID: PMC8976556 DOI: 10.2147/ijgm.s354748] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background/Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Hong Wang
- Respiratory Medicine, First People’s Hospital of Suining City, Suining, 629000, Sichuan, People’s Republic of China
| | - Tao Yang
- Thoracic Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Xiaodan Yu
- Respiratory Medicine, Fifth People’s Hospital of Chengdu, Chengdu, 610000, Sichuan, People’s Republic of China
| | - Zhihong Chen
- Respiratory Medicine, Zhongshan Hospital of Fudan University, Shanghai, 20032, People’s Republic of China
| | - Yajuan Ran
- Pharmacy Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Jiajia Wang
- Rheumatology Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Guangming Dai
- Respiratory Medicine, First People’s Hospital of Suining City, Suining, 629000, Sichuan, People’s Republic of China
| | - Huojin Deng
- Respiratory Medicine, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510280, People’s Republic of China
| | - Xinglong Li
- Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Tao Zhu
- Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
- Correspondence: Tao Zhu, Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China, Tel +86 23 63693094, Email
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Yang L, Li M, Shu J, Yang Y, Huang Q. A Risk Prediction Model for Prolonged Length of Stay in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective Study of 225 Patients in a Single Center in Kunming, China. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934392. [PMID: 35136009 PMCID: PMC8842644 DOI: 10.12659/msm.934392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background We aimed to develop an effective prediction model of prolonged length of stay (LOS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Material/Methods We systematically enrolled 225 patients admitted for AECOPD to our hospital and divided them into a normal LOS group (≤7 days) and prolonged LOS group (>7 days). To analyze differences in laboratory data at different times, 3 logistic regression models were established. To develop the prediction model, all variables with statistical significance were included in the model. The area under the curve (AUC) was used to evaluate discrimination, and the Hosmer-Lemeshow test was used to assess the calibration of the model. Results Factors found to be independently associated with the increased risk of prolonged LOS included the use of corticosteroids during hospitalization, elevated HCO3−, decreased pH, and reductions in platelets (PLTs) and procalcitonin (PCT) between the fourth and first day of hospitalization. The risk prediction model including these factors had an AUC of 0.795, suggesting the good discrimination of our model. The Hosmer-Lemeshow test also showed good calibration of the model, which confirmed its good predictive performance. Conclusions A clinical prediction model was developed with good predictive performance, which could help clinicians identify patients with a higher risk of prolonged LOS, help shorten hospital stay, reduce the disease burden of patients, and improve the outcomes of AECOPD.
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Affiliation(s)
- Lifen Yang
- Department of Respiratory and Critical Care Medicine, The First Hospital of Kunming, Kunming, Yunnan, China (mainland)
| | - Meihua Li
- Department of Respiratory and Critical Care Medicine, The First Hospital of Kunming, Kunming, Yunnan, China (mainland)
| | - Jingkui Shu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Yanxia Yang
- Department of Respiratory and Critical Care Medicine, The First Hospital of Kunming, Kunming, Yunnan, China (mainland)
| | - Qian Huang
- Kunming Medical University, Kunming, Yunnan, China (mainland)
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Chen D, Jiang L, Li J, Tan Y, Ma M, Cao C, Zhao J, Wan X. Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:3309-3316. [PMID: 34908833 PMCID: PMC8665827 DOI: 10.2147/copd.s334219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023] Open
Abstract
Purpose Both acute respiratory failure (ARF) and acute kidney injury (AKI) are two common complications in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Moreover, both ARF and AKI are reported as increasing the risk of mortality of patients with AECOPD. However, the interaction of ARF and AKI on the mortality of patients with AECOPD remains unknown. Therefore, the aim of this study is to investigate the joint effect of ARF and AKI on in-hospital mortality in AECOPD patients. Patients and Methods We performed a retrospective, observational cohort study of data from Nanjing First Hospital. The effect of AKI and ARF on in-hospital mortality was assessed using a multivariate logistic regression model. Additive interaction was assessed with the relative excess risk due to interaction. Results A total of 1647 participants were enrolled. ARF and AKI occurred in 515 (31.3%) and 357 (21.7%) patients, respectively. Overall, in-hospital mortality was 5.7%. The in-hospital mortality of the neither ARF nor AKI group, the ARF only group, the AKI only group, and both the ARF and AKI group were 0.8%, 7.0%, 7.5%, and 29.9%, respectively. After multivariate logistic regression analysis, the independent factors for in-hospital death included: albumin (OR 0.88, 95% CI 0.83–0.93, P < 0.001), ARF only (OR 8.53, 95% CI 3.64–19.99, P < 0.001), AKI only (OR 8.99, 95% CI 3.58–22.55, P < 0.001), and both ARF and AKI (OR 39.13, 95% CI 17.02–89.97, P < 0.001). The relative excess risk due to interaction was 22.62 (95% CI, 0.31 to 44.93), the attributable proportion due to interaction was 0.59 (95% CI, 0.36 to 0.79), and the synergy index was 2.46 (95% CI, 1.44 to 4.20), indicating ARF and AKI had a significant synergic effect on in-hospital mortality. Conclusion ARF and AKI had a synergistic effect on in-hospital mortality in AECOPD patients.
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Affiliation(s)
- Dawei Chen
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Linglin Jiang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jing Li
- Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Yan Tan
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Mengqing Ma
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Changchun Cao
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jing Zhao
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xin Wan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Fortis S, Gao Y, O'Shea AMJ, Beck B, Kaboli P, Vaughan Sarrazin M. Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2021; 16:3157-3166. [PMID: 34824529 PMCID: PMC8609200 DOI: 10.2147/copd.s321053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023] Open
Abstract
Background Non-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity. Methods We retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals. Results In 42,048 admissions for AECOPD over 6 years, the median risk-standardized initial NIV % was 57.3% (interquartile interval [IQI]=41.9–64.4%). Hospitals in the highest risk-standardized NIV % quartiles cared for more rural patients, used invasive ventilators less frequently, and had longer length of hospital stay, but had no difference in mortality relative to the hospitals in the lowest quartiles. The risk-standardized NIV % was 65.3% (IQI=34.2–84.2%) in rural and 55.1% (IQI=10.8–86.6%) in urban hospitals (p=0.047), but hospital mortality did not differ between the two groups. Conclusion NIV use varied significantly across hospitals, with rural hospitals having higher risk-standardized NIV % rates than urban hospitals. Further research should investigate the exact mechanism of variation in NIV use between rural and urban hospitals.
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Yubo Gao
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Amy M J O'Shea
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Brice Beck
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - Peter Kaboli
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Mary Vaughan Sarrazin
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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20
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Soetedjo NNM, Iryaningrum MR, Damara FA, Permadhi I, Sutanto LB, Hartono H, Rasyid H. Prognostic properties of hypoalbuminemia in COVID-19 patients: A systematic review and diagnostic meta-analysis. Clin Nutr ESPEN 2021; 45:120-126. [PMID: 34620307 PMCID: PMC8288213 DOI: 10.1016/j.clnesp.2021.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/20/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) elicits robust inflammatory reaction that may result in a declining albumin serum level. This meta-analysis aimed to evaluate the prognostic properties of hypoalbuminemia for poor prognosis and factors that may influence the relationship. Method A systematic literature search of PubMed was conducted from inception to April 22, 2021. The main exposure was albumin level below normal range–defined by the included studies. The outcome of interest was composite poor outcome that comprises of mortality, severity, and the requirement of mechanical ventilation or intensive care unit. Results There were 6200 patients from 19 studies. Meta-analysis showed that hypoalbuminemia was associated with composite poor outcome (OR 6.97 (95% CI 4.20–11.55), p < 0.001; I2 = 91.3%, p < 0.001). Meta-regression analysis showed that age (p = 0.44), gender (p = 0.76), HT (p = 0.97), DM (p = 0.40), CKD (p = 0.65), liver disease (p = 0.72), and malignancy (p = 0.84) did not affect the association. Subgroup analysis showed that hypoalbuminemia increased mortality (OR 6.26 (95% CI 3.26–12.04), p < 0.001; I2 = 69.6%, p < 0.01) and severity of the disease (OR 7.32 (95%CI 3.94–13.59), p < 0.001; I2 = 92.5%, p < 0.01). Pooled diagnostic analysis of hypoalbuminemia yielded a sensitivity of 0.63 (95% CI 0.52–0.72), specificity of 0.81 (95% CI 0.73–0.87), and AUC of 0.77. The probability of poor outcome was 70% in patients with hypoalbuminemia and 24% in patients with normal albumin level. Conclusion Hypoalbuminemia was associated with poor prognosis in COVID-19 patients.
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Affiliation(s)
- Nanny Natalia Mulyani Soetedjo
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Bandung, Indonesia.
| | - Maria Riastuti Iryaningrum
- Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Fachreza Aryo Damara
- Faculty of Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - Inge Permadhi
- Department of Nutrition, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Luciana B Sutanto
- Department of Nutrition, Faculty of Medicine, Krida Wacana Christian University, Indonesia
| | - Hartono Hartono
- Intensive Care Unit, Presidential Hospitals Central Army Gatot Soebroto, Jakarta, Indonesia
| | - Haerani Rasyid
- Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia
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21
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Li M, Cheng K, Ku K, Li J, Hu H, Ung COL. Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record. Int J Chron Obstruct Pulmon Dis 2021; 16:1677-1685. [PMID: 34135579 PMCID: PMC8200153 DOI: 10.2147/copd.s307164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao. Patients and Methods Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression. Results A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535–1.072), being female (B=−1.147, 95% CI:-0.138–0.056), being current (B=−0.086, 95% CI:-0.124–0.018) or previous smoker (B=0.072, 95% CI:0.004–0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034–0.147; B=0.125, 95% CI:0.031–0.144; B=0.116, 95% CI:0.028–0.146, B=0.090, 95% CI:0.021–0.166) and having low hemoglobin level (B=−0.118, 95% CI:-0.629- −0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022–0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212–0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003–0.166, B=0.255, 95% CI:0.083–0.237) were significantly associated with longer LOS (P<0.05). Conclusion NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Kun Cheng
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Keisun Ku
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Junlei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
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22
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Argano C, Scichilone N, Natoli G, Nobili A, Corazza GR, Mannucci PM, Perticone F, Corrao S. Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry. Intern Emerg Med 2021; 16:389-400. [PMID: 32720248 PMCID: PMC7384278 DOI: 10.1007/s11739-020-02412-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards.
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Affiliation(s)
- Christiano Argano
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy
| | - Nicola Scichilone
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Natoli
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, University of Pavia and San Matteo Hospital, Pavia, Italy
| | | | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Salvatore Corrao
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy.
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro, University of Palermo, Palermo, Italy.
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23
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Dong F, Huang K, Ren X, Qumu S, Niu H, Wang Y, Li Y, Lu M, Lin X, Yang T, Jiao J, Wang C. Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016-2017: a retrospective study. BMJ Open 2021; 11:e040560. [PMID: 33550232 PMCID: PMC7925858 DOI: 10.1136/bmjopen-2020-040560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To identify factors associated with length of stay (LOS) in chronic obstructive pulmonary disease (COPD) hospitalised patients, which may help shorten LOS and reduce economic burden accrued over hospital stay. DESIGN A retrospective cohort study. SETTING This study was performed in a tertiary hospital in China. PARTICIPANTS Patients with COPD who were aged ≥40 years and newly admitted between 2016 and 2017. PRIMARY AND SECONDARY OUTCOME MEASURES LOS at initial admission was the primary outcome and health expenditures were the secondary outcome. To identify factors associated with LOS, we collected information at index hospitalisation and constructed a conceptual model using directed acyclic graph. Potential factors were classified into five groups: demographic information, disease severity, comorbidities, hospital admission and environmental factors. Negative binomial regression model was fitted for each block of factors and a parsimonious analysis was performed. RESULTS In total, we analysed 565 patients with COPD. The mean age was 69±11 years old and 69.4% were men. The median LOS was 10 (interquartile range 8-14) days. LOS was significantly longer in patients with venous thromboembolism (VTE) (16 vs 10 days, p=0.0002) or with osteoporosis (15 vs 10 days, p=0.0228). VTE ((rate ratio) RR 1.38, 95% CI 1.07 to 1.76), hypoxic-hypercarbic encephalopathy (RR 1.53, 95% CI 1.06 to 2.20), respiratory infection (RR 1.12, 95% CI 1.01 to 1.24), osteoporosis (RR 1.45, 95% CI 1.07 to 1.96) and emergence admission (RR 1.08, 95% CI 1.01 to 1.16) were associated with longer LOS. In parsimonious analysis, all these factors remained significant except emergency admission, highlighting the important role of concomitant morbidities in patients' hospital stay. Total hospitalisation cost and patients' out-of-pocket cost increased monotonically with LOS (both ptrend <0.0001). CONCLUSION Patients' concomitant morbidities predicted excessive LOS in patients with COPD. Healthcare cost increased over the LOS. Quality improvement initiatives may need to identify patients at high risk for lengthy stay and implement early interventions to reduce COPD economic burden.
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Affiliation(s)
- Fen Dong
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoxia Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Shiwei Qumu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yanyan Wang
- Department of Medical Records, China-Japan Friendship Hospital, Beijing, China
| | - Yong Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Minya Lu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinshan Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Jianjun Jiao
- Department of Medical Administration, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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24
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Meeraus WH, Mullerova H, El Baou C, Fahey M, Hessel EM, Fahy WA. Predicting Re-Exacerbation Timing and Understanding Prolonged Exacerbations: An Analysis of Patients with COPD in the ECLIPSE Cohort. Int J Chron Obstruct Pulmon Dis 2021; 16:225-244. [PMID: 33574663 PMCID: PMC7872897 DOI: 10.2147/copd.s279315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Understanding risk factors for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is important for optimizing patient care. We re-analyzed data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study (NCT00292552) to identify factors predictive of re-exacerbations and associated with prolonged AECOPDs. Methods Patients with COPD from ECLIPSE with moderate/severe AECOPDs were included. The end of the first exacerbation was the index date. Timing of re-exacerbation risk was assessed in patients with 180 days’ post-index-date follow-up data. Factors predictive of early (1–90 days) vs late (91–180 days) vs no re-exacerbation were identified using a multivariable partial-proportional-odds-predictive model. Explanatory logistic-regression modeling identified factors associated with prolonged AECOPDs. Results Of the 1,554 eligible patients from ECLIPSE, 1,420 had 180 days’ follow-up data: more patients experienced early (30.9%) than late (18.7%) re-exacerbations; 50.4% had no re-exacerbation within 180 days. Lower post-bronchodilator FEV1 (P=0.0019), a higher number of moderate/severe exacerbations on/before index date (P<0.0001), higher St. George’s Respiratory Questionnaire total score (P=0.0036), and season of index exacerbation (autumn vs winter, P=0.00164) were identified as predictors of early (vs late/none) re-exacerbation risk within 180 days. Similarly, these were all predictors of any (vs none) re-exacerbation risk within 180 days. Median moderate/severe AECOPD duration was 12 days; 22.7% of patients experienced a prolonged AECOPD. The odds of experiencing a prolonged AECOPD were greater for severe vs moderate AECOPDs (adjusted odds ratio=1.917, P=0.002) and lower for spring vs winter AECOPDs (adjusted odds ratio=0.578, P=0.017). Conclusion Prior exacerbation history, reduced lung function, poorer respiratory-related quality-of-life (greater disease burden), and season may help identify patients who will re-exacerbate within 90 days of an AECOPD. Severe AECOPDs and winter AECOPDs are likely to be prolonged and may require close monitoring.
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Affiliation(s)
- Wilhelmine H Meeraus
- GlaxoSmithKline plc., Epidemiology - Value, Evidence and Outcomes, Middlesex, UK
| | - Hana Mullerova
- GlaxoSmithKline plc., Epidemiology - Value, Evidence and Outcomes, Middlesex, UK
| | - Céline El Baou
- GlaxoSmithKline plc., Research and Development, Middlesex, UK
| | - Marion Fahey
- GlaxoSmithKline plc., Epidemiology - Value, Evidence and Outcomes, Middlesex, UK
| | - Edith M Hessel
- GlaxoSmithKline plc., Research and Development, Middlesex, UK
| | - William A Fahy
- GlaxoSmithKline plc., Research and Development, Middlesex, UK
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25
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Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10020269. [PMID: 33450916 PMCID: PMC7828417 DOI: 10.3390/jcm10020269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/20/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airway inflammation and lung parenchyma damage. Systemic inflammation and oxidative stress also play a role in the pathogenesis of COPD. Serum albumin is a negative acute-phase protein with antioxidant effects and an important marker of malnutrition. The aim of this meta-analysis was to investigate differences in serum albumin concentrations between patients with stable COPD and non-COPD subjects. Methods: A systematic search was conducted, using the terms “albumin” and “chronic obstructive pulmonary disease” or “COPD”, in the electronic databases PubMed and Web of Science, from inception to May 2020. Results: Twenty-six studies were identified on a total of 2554 COPD patients and 2055 non-COPD controls. Pooled results showed that serum albumin concentrations were significantly lower in COPD patients (standard mean difference, SMD = −0.50, 95% CI −0.67 to −0.32; p < 0.001). No significant differences were observed in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) < 50% and those with FEV1 > 50%. Conclusions: Our systematic review and meta-analysis showed that serum albumin concentrations are significantly lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.
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26
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Horne BD, Ali R, Midwinter D, Scott-Wilson C, Crim C, Miller BE, Rubin DB. Validation of the Summit Lab Score in Predicting Exacerbations of Chronic Obstructive Pulmonary Disease Among Individuals with High Arterial Stiffness. Int J Chron Obstruct Pulmon Dis 2021; 16:41-51. [PMID: 33447025 PMCID: PMC7802087 DOI: 10.2147/copd.s279645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction The presence of cardiovascular (CV) risk factors and CV disease in patients with chronic obstructive pulmonary disease (COPD) leads to worse outcomes. A number of tools are currently available to stratify the risk of adverse outcomes in these patients with COPD. This post hoc analysis evaluated the Summit Lab Score for validation as a predictor of the first episode of moderate-to-severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and other outcomes, in patients with COPD and high arterial pulse wave velocity (aPWV). Methods Data from a multicenter, randomized, placebo-controlled, double-blind study were retrospectively analyzed to evaluate treatment effects of once-daily fluticasone furoate/vilanterol 100/25 μg in patients with COPD and an elevated CV risk (aPWV≥11m/s) over 24 weeks. The previously derived Summit Lab Score and, secondarily, the Intermountain Risk Score (IMRS) were computed for each patient, with patients then stratified into tertiles for each score. Risk of moderate-to-severe AECOPD was analyzed across tertiles using Kaplan–Meier survival curve and Cox regression analyses. Results In 430 patients with COPD, Kaplan–Meier probabilities of no moderate-to-severe AECOPD for Summit Lab Score tertiles 1, 2, and 3 were 92.3%, 95.5%, and 85.1%, respectively (P trend = 0.015), over 24 weeks. Grouped by IMRS tertiles, the respective probabilities were 92.9%, 91.2%, and 88.3%, respectively (P trend = 0.141). Length of stay in the hospital (P = 0.034) and the hospital ward (P = 0.042) were also significantly different between Summit Lab Score tertiles but not for intensive care (P = 0.191). Conclusion The Summit Lab Score was associated with the 24-week risk of moderate-to-severe AECOPD in COPD patients with elevated CV risk. Secondarily, IMRS showed a trend towards differences in the risk of AECOPD, which was not statistically significant.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | | | - Courtney Crim
- GlaxoSmithKline Plc., Research Triangle Park, Raleigh, NC, USA
| | | | - David B Rubin
- GlaxoSmithKline Plc., Research Triangle Park, Raleigh, NC, USA
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27
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Mao X, Liang C, Niu H, Dong F, Huang K, Chen Y, Huang K, Zhan Q, Zhang Y, Huang Y, Yang T, Wang C. Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry. Respir Res 2021; 22:7. [PMID: 33407433 PMCID: PMC7789818 DOI: 10.1186/s12931-020-01607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background Diabetes is a common comorbidity among patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Diabetes has been reported to be associated with length of stay (LOS), death, and cost among AECOPD patients. However, most studies are retrospective or have small sample sizes. The association for cost has not been researched using diabetes as a main analytic factor. This study aimed to fill gaps mentioned above, to compare basic characteristics between the diabetic and non-diabetic group, and to detect associations between diabetes and clinical outcomes among patients hospitalized with AECOPD. Methods A total of 5334 AECOPD patients, classified into diabetic and non-diabetic group, were included from a prospective multicenter patient registry study. Generalized linear regression and logistic regression were separately used for the association between diabetes and direct hospitalization cost and the association between diabetes and LOS. Results Generally, diabetic patients had a more severe profile, including being older, more overweight or obese, having more former smokers, more emergency room visits in the past 12 months, and more comorbidities occurrence. Diabetic patients also had worse clinical outcomes, including higher cost and longer LOS. Additionally, the generalized linear regression indicated that the marginal mean cost difference between diabetic and non-diabetic patients was RMB (¥) 775.7. Conclusions AECOPD patients with comorbid diabetes had a more severe profile and higher direct hospitalization cost. Diabetes screening and integrated care programs might help reduce the heavy comorbidity and economic burden. Moreover, corticosteroids and metformin could be considered in the treatment of these patients. Trial registration Clinicaltrials.gov with the identifier NCT0265752.
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Affiliation(s)
- Xihua Mao
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Chen Liang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fen Dong
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yaowen Zhang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Yin Huang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China. .,Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, 100730, China.
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Gunasekaran K, Ahmad M, Rehman S, Thilagar B, Gopalratnam K, Ramalingam S, Paramasivam V, Arora A, Chandran A. Impact of a Positive Viral Polymerase Chain Reaction on Outcomes of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218072. [PMID: 33147795 PMCID: PMC7662648 DOI: 10.3390/ijerph17218072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
Introduction: More than 15 million adults in the USA have chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) places a high burden on the healthcare system. Many hospital admissions are due to an exacerbation, which is suspected to be from a viral cause. The purpose of this analysis was to compare the outcomes of patients with a positive and negative respiratory virus panel who were admitted to the hospital with COPD exacerbations. Methods: This retrospective cohort study was conducted in the Geisinger Healthcare System. The dataset included 2729 patient encounters between 1 January 2006 and 30 November 2017. Hospital length of stay was calculated as the discrete number of calendar days a patient was in the hospital. Patient encounters with a positive and negative respiratory virus panel were compared using Pearson’s chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum tests for continuous variables. Results: There were 1626 patients with a total of 2729 chronic obstructive pulmonary disease exacerbation encounters. Nineteen percent of those encounters (n = 524) had a respiratory virus panel performed during their admission. Among these encounters, 161 (30.7%) had positive results, and 363 (69.3%) had negative results. For encounters with the respiratory virus panel, the mean age was 64.5, 59.5% were female, 98.9% were white, and the mean body mass index was 26.6. Those with a negative respiratory virus panel had a higher median white blood cell count (11.1 vs. 9.9, p = 0.0076). There were no other statistically significant differences in characteristics between the two groups. Respiratory virus panel positive patients had a statistically significant longer hospital length of stay. There were no significant differences with respect to being on mechanical ventilation or ventilation-free days. Conclusion: This study shows that a positive respiratory virus panel is associated with increased length of hospital stay. Early diagnosis of chronic obstructive pulmonary disease exacerbation patients with positive viral panel would help identify patients with a longer length of stay.
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Affiliation(s)
- Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
- Correspondence: ; Tel.: +1-203-384-5009; Fax: +1-203-330-7498
| | - Mudassar Ahmad
- Division of Pulmonary Diseases and Critical Care, St. Peter’s University Hospital, New Brunswick, NJ 08901, USA;
| | - Sana Rehman
- Department of Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore 53720, Pakistan;
| | - Bright Thilagar
- Division of Hospital Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA;
| | - Kavitha Gopalratnam
- Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Sathish Ramalingam
- Division of Hospital Medicine, Lovelace Medical Center, 601 Dr. Martin Luther King Jr. Ave NE, Albuquerque, NM 87102, USA;
| | - Vijayakumar Paramasivam
- Division of Nephrology, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA;
| | - Ashish Arora
- Division of Pulmonary Diseases and Critical Care, Saint Mary’s Hospital, 56 Franklin St, Waterbury, CT 06610, USA;
| | - Arul Chandran
- Division of Pulmonary Diseases and Critical Care, Hurley Medical Center, G-3252 Beecher Road, Flint, MI 48532, USA;
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29
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Yu X, Zhu GP, Cai TF, Zheng JY. Establishment of risk prediction model and risk score for in-hospital mortality in patients with AECOPD. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:1090-1098. [PMID: 32757441 DOI: 10.1111/crj.13246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/18/2020] [Accepted: 07/31/2020] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Risk stratification for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may help clinicians choose appropriate treatments and improve the quality of care. METHODS A total of 695 patients hospitalized with AECOPD from January 2015 to December 2017 were considered. They were assigned to a death and a survival cohort. The independent prognostic factors were determined by multivariate logistic regression analysis. Meanwhile, we also compared the new scale with three other scores and tested the new scale internally and externally. RESULTS A new risk score was created, made up of six independent variables: age, D-dimer, albumin, cardiac troponin I, partial pressure of carbon dioxide and oxygenation index. The area under the receiver operator characteristic curve (AUROC) for the model was 0.929, and the other three CURB-65, DECAF and BAP-65 models were 0.718, 0.922 and 0.708. The Cohen's kappa coefficient between the new scale and DECAF was calculated to be 0.648, suggesting that there is a substantial consistency between the two. In the internal and external validation cohorts, 490 and 500 patients were recruited with a total mortality rate of 5.15%. The AUROC for in-hospital mortality was 0.937 in the internal cohort and 0.914 in external cohort, which was significantly better than the scores for CURB-65 and BAP-65, but it was not significantly different from the DECAF. CONCLUSIONS The new scale may help to stratify the risk of in-hospital mortality of AECOPD. The DECAF performed as well as the new instrument, and it appears to be valid in Chinese patients.
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Affiliation(s)
- Xing Yu
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Gui-Ping Zhu
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Teng-Fei Cai
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Jian-Yi Zheng
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
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30
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Weissinger GM, Carthon JMB, Brawner BM. Non-psychiatric hospitalization length-of-stay for patients with psychotic disorders: A mixed methods study. Gen Hosp Psychiatry 2020; 67:1-9. [PMID: 32866772 PMCID: PMC7722147 DOI: 10.1016/j.genhosppsych.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with psychotic disorders experience higher rates of chronic and acute non-psychotic diseases and have frequent non-psychiatric hospitalizations which result in both longer and more varied length-of-stay (LoS) than other patients. This study seeks to use a patient-centered perspective to examine LoS. METHODS This article reports Phase Two of a mixed methods, exploratory sequential study on non-psychiatric hospitalizations for individuals with psychotic disorders. Patients' experiences were used to guide a quantitative analysis of LoS using a general linear model. RESULTS Medical comorbidities were the patient characteristics which had the largest effect on LoS. Certain processes of care highlighted by patients from Phase One were also associated with longer LoS, including: physical restraints (105%), psychiatric consults (20%) and continuous observation (133%). Only recent in-system outpatient appointments were associated with shorter LoS. Data integration highlighted that factors which were important to patients such as partner support, were not always quantitatively significant, while others like medical comorbidities and use of physical restraints were points of congruence. CONCLUSIONS Medical comorbidities were highly associated with LoS but processes relating to longer LoS are those that are used to manage symptoms of acute psychosis. Clinicians should develop policies and procedures that address psychosis symptoms effectively during non-psychiatric hospitalizations. Further research is needed to understand which patients with psychotic disorders are at highest risk of extended length-of-stay.
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Affiliation(s)
- Guy M Weissinger
- Drexel University, College of Nursing and Health Professions, 3020 Market Street, Suite 510, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America.
| | - J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
| | - Bridgette M Brawner
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
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31
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Kim JH, Fine DR, Li L, Kimmel SD, Ngo LH, Suzuki J, Price CN, Ronan MV, Herzig SJ. Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study. PLoS Med 2020; 17:e1003247. [PMID: 32764761 PMCID: PMC7413412 DOI: 10.1371/journal.pmed.1003247] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. METHODS AND FINDINGS We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59-0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33-0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57-2.17; p < 0.001) or patient-directed discharge (also referred to as "discharge against medical advice") (aOR 3.47; 95% CI 2.80-4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts. CONCLUSIONS Our findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.
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Affiliation(s)
- June-Ho Kim
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle R. Fine
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lily Li
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Simeon D. Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Joji Suzuki
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Christin N. Price
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Physicians Organization, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Matthew V. Ronan
- Department of Medicine, West Roxbury VA Medical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Shoshana J. Herzig
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Viglino D, Maignan M. Aspects extrapulmonaires des exacerbations de bronchopneumopathie chronique obstructive. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La bronchopneumopathie chronique obstructive (BPCO) est une maladie systémique aux multiples atteintes, émaillée d’exacerbations. L’inflammation, l’hypoxémie, les troubles de la coagulation et les perturbations des interactions coeur–poumon expliquent en partie les atteintes non pulmonaires observées notamment lors d’exacerbations aiguës. Les événements cardiovasculaires sont la première cause de mortalité des patients BPCO, et leur recrudescence est observée pendant plusieurs semaines après une exacerbation. Aux urgences, la prise en charge des patients en exacerbation de BPCO repose donc en plus du support ventilatoire sur une bonne évaluation des potentielles pathologies associées telles que l’insuffisance cardiaque, l’ischémie myocardique, l’insuffisance rénale ou encore la maladie thromboembolique. Cette évaluation globale permet d’adapter les thérapeutiques parfois délétères sur la fonction cardiaque ou l’équilibre acide−base et de prendre en compte le risque extrapulmonaire dans le choix du parcours de soins du patient. Dans cette mise au point, nous abordons quelques explications physiologiques des multiples perturbations observées au cours de l’exacerbation de BPCO, et proposons une vision globale de l’évaluation de ces patients admis pour une dyspnée ou un autre motif pouvant être en rapport avec la BPCO.
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33
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Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Symum H, Zayas-Castro JL. Prediction of Chronic Disease-Related Inpatient Prolonged Length of Stay Using Machine Learning Algorithms. Healthc Inform Res 2020; 26:20-33. [PMID: 32082697 PMCID: PMC7010949 DOI: 10.4258/hir.2020.26.1.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The study aimed to develop and compare predictive models based on supervised machine learning algorithms for predicting the prolonged length of stay (LOS) of hospitalized patients diagnosed with five different chronic conditions. Methods An administrative claim dataset (2008-2012) of a regional network of nine hospitals in the Tampa Bay area, Florida, USA, was used to develop the prediction models. Features were extracted from the dataset using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Five learning algorithms, namely, decision tree C5.0, linear support vector machine (LSVM), k-nearest neighbors, random forest, and multi-layered artificial neural networks, were used to build the model with semi-supervised anomaly detection and two feature selection methods. Issues with the unbalanced nature of the dataset were resolved using the Synthetic Minority Over-sampling Technique (SMOTE). Results LSVM with wrapper feature selection performed moderately well for all patient cohorts. Using SMOTE to counter data imbalances triggered a tradeoff between the model's sensitivity and specificity, which can be masked under a similar area under the curve. The proposed aggregate rank selection approach resulted in a balanced performing model compared to other criteria. Finally, factors such as comorbidity conditions, source of admission, and payer types were associated with the increased risk of a prolonged LOS. Conclusions Prolonged LOS is mostly associated with pre-intraoperative clinical and patient socioeconomic factors. Accurate patient identification with the risk of prolonged LOS using the selected model can provide hospitals a better tool for planning early discharge and resource allocation, thus reducing avoidable hospitalization costs.
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Affiliation(s)
- Hasan Symum
- Department of Industrial and Management System Engineering, University of South Florida, Tampa, FL, USA
| | - José L Zayas-Castro
- Department of Industrial and Management System Engineering, University of South Florida, Tampa, FL, USA.,College of Engineering, University of South Florida, Tampa, FL, USA
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35
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Crisafulli E, Manco A, Torres A. 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. Expert Rev Respir Med 2020; 14:493-500. [PMID: 32077337 DOI: 10.1080/17476348.2020.1732823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandra Manco
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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36
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Data analytics for the sustainable use of resources in hospitals: Predicting the length of stay for patients with chronic diseases. INFORMATION & MANAGEMENT 2020. [DOI: 10.1016/j.im.2020.103282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Castañ-Abad MT, Montserrat-Capdevila J, Godoy P, Marsal JR, Ortega M, Alsedà M, Barbé F. Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study. Eur J Public Health 2020; 30:822-827. [DOI: 10.1093/eurpub/ckz219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Type 2 diabetes comorbidity is common in patients with COPD. One of the most frequent causes of hospital admission in patients with COPD are exacerbations.
Methods
Prospective cohort study, which included 512 patients with COPD recruited in a primary care centre in Mollerussa (Lleida, Spain). Inclusion criteria were: patients >40 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease. Variables collected were as follows: age, gender, civil status, education level, smoking habit, severity (Global Initiative for Chronic Obstructive Lung Disease), comorbidities (Charlson), history of severe exacerbations, dyspnoea (mMRC), BODEx, EuroQol 5 D and depression (HAD). Logistic regression was used to determine the association of diabetes with risk of hospital admission and death.
Results
Prevalence of diabetes was 25.8%. During the second year of follow up, 18.2% of patients with COPD and diabetes were admitted for exacerbation, in comparison with 8.9% non-diabetic COPD patients. The variables associated with hospital admission were diabetes (ORa=1.54); gender (men, ORa=1.93); age (ORa=1.02); number of hospital admissions during the previous year: 1 (ORa=2.83) or more than one admission (ORa=4.08); EuroQol 5 D (ORa=0.76) and BODEx (ORa=1.24). With the exclusion of BODEx, all these variables were associated with a higher risk of death.
Conclusion
Prevalence of diabetes is high in patients suffering from COPD. COPD patients with diabetes are at higher risk of severe exacerbation and death. The suggested predictive model could identify patients at higher risk so that adequate preventive and therapeutic measures can be implemented.
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Affiliation(s)
- Maria T Castañ-Abad
- Institut Catala De La Salut, Centre d'Atenció Primària Eixample Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
| | - Josep Montserrat-Capdevila
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
- Institut Catala De La Salut, UGA Terres de l'Urgell (Consultori Local de Bellvís-Els Arcs), Lleida, Spain
- University of Lleida, Lleida, Spain
| | - Pere Godoy
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
- University of Lleida, Lleida, Spain
- Agencia de Salut Publica de Catalunya Lleida, Catalunya, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Madrid, Spain
| | - Josep R Marsal
- University Hospital Vall d'Hebron, Cardiovascular Epidemiology Unit, CIBERESP Barcelona, Catalunya, Spain
| | - Marta Ortega
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
- Institut Catala De La Salut, Barcelona, Spain
| | - Miquel Alsedà
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
- Agencia de Salut Publica de Catalunya Lleida, Catalunya, Spain
| | - Ferran Barbé
- Biomedical Research Institute of Lleida (IRBLLeida), Lleida, Spain
- Arnau de Vilanova University Hospital, Lleida, Spain
- Respiratory Diseases, Biomedical Research Institute of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Samaranayake CB, Neill J, Bint M. Respiratory acute discharge service: a hospital in the home programme for chronic obstructive pulmonary disease exacerbations (RADS study). Intern Med J 2019; 50:1253-1258. [PMID: 31589356 DOI: 10.1111/imj.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Respiratory Acute Discharge Service (RADS) is a novel early discharge service with nurse-led community based recovery in selected patients with acute exacerbations of chronic obstructive pulmonary disease. AIM This pilot study aimed to determine the efficacy and safety of the programme in an Australian tertiary hospital. METHODS All patients who were recruited to RADS at Sunshine Coast University Hospital over a 6 months period from June to November 2018 were included. The co-primary outcomes were length of hospital days saved and rate of readmission within 30 days from discharge. RESULTS A total of 166 patients (median age 74 years (interquartile range 70-80 years)) was recruited to the programme over the study period. The mean forced expiratory volume in one second (FEV1%) of the patients was 42% (standard deviation 19). The median length-of-stay prior to discharge on the RADS programme was 1 day (range 0-5), compared to a previous average of 5.8 days in our health service. Patients were on the programme for a median of 4 days (range 1-6). A total of 613 hospital bed days was saved over the study period, with significant cost savings. Forty-one (24.7%) patients represented to hospital within 30 days, the majority (64%) were due to recurrent symptoms. The rate of 30-day all-cause mortality for the study population was 1 (0.6%). CONCLUSION Early supported discharge care model with nurse-led community based recovery after an acute exacerbation of chronic obstructive pulmonary disease in selected patients is safe, and has the potential to provide greater flow through the hospital systems with cost effective care.
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Affiliation(s)
- Chinthaka B Samaranayake
- Department of Respiratory Medicine, Sunshine Coast University Hospital, Queensland, Australia.,Department of Respiratory Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Neill
- Department of Respiratory Medicine, Sunshine Coast University Hospital, Queensland, Australia
| | - Michael Bint
- Department of Respiratory Medicine, Sunshine Coast University Hospital, Queensland, Australia.,Department of Respiratory Medicine, Griffith University, Queensland, Australia
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Ailey SH, Johnson TJ, Cabrera A. Evaluation of Factors Related to Prolonged Lengths of Stay for Patients With Autism With or Without Intellectual Disability. J Psychosoc Nurs Ment Health Serv 2019; 57:17-22. [PMID: 30753733 DOI: 10.3928/02793695-20190205-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Patients with autism spectrum disorder and/or intellectual disability (ASD/ID) face unique health care challenges. In addition to hospital experiences characterized by fear and insufficient staff training, these patients have 1.5-times longer lengths of stay (LOS) than patients without ASD/ID, and 3.4% of patients with ASD/ID have prolonged LOS (i.e., ≥30 days). Little research exists on factors related to prolonged LOS of patients with ASD/ID, hindering efforts to develop and implement evidence-based practices to improve care and reduce prolonged LOS. The purpose of the current study was to describe factors related to prolonged LOS of adult patients with ASD/ID in acute care settings using a retrospective chart review of 10 patients discharged from one academic medical center. Findings indicate that health care institutions should evaluate performance with this patient population and identify evidence-based strategies to provide a safe environment for care and reduce LOS that is due to non-health care needs. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 17-22.].
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Botana-Rial M, Mouronte-Roibas C, Ramos-Hernández C, Fernández Villar A. Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease. Rev Clin Esp 2019; 220:79-85. [PMID: 31208703 DOI: 10.1016/j.rce.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. METHODOLOGY We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. RESULTS The study included 253 patients, with a mean age of 68.9±9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). CONCLUSIONS Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation.
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Affiliation(s)
- S Fernández-García
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Represas-Represas
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Ruano-Raviña
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela; Servicio de Medicina Preventiva, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - M Botana-Rial
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Mouronte-Roibas
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Ramos-Hernández
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Fernández Villar
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España.
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Zhang J, Yao W, You X, Liu T, Liu Y. Comparative analysis of medical expenditure with nebulized budesonide versus systemic corticosteroids in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease in China. Int J Chron Obstruct Pulmon Dis 2019; 14:1195-1207. [PMID: 31213797 PMCID: PMC6549719 DOI: 10.2147/copd.s182015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. Patients and methods: A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. Results: The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (P=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (P<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (P=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (P=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; P=0.2299). Conclusion: AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.
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Affiliation(s)
- Jing Zhang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wanzhen Yao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xuedan You
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Tianyi Liu
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Yuantao Liu
- Medical Affairs, AstraZeneca, Shanghai, People's Republic of China
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Feng CX. Zero-augmented accelerated spatial failure model for modeling hospital length of stay data. Spat Spatiotemporal Epidemiol 2019; 29:121-137. [PMID: 31128621 DOI: 10.1016/j.sste.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/02/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
Hospital length of stay (LOS) is often used as an indicator for hospital efficiency and resource utilization. LOS is nonnegative with presence of zeros and typically positively skewed with a long right tail, which may not be adequately modelled by traditional distributions, such as lognormal. We developed a zero-augmented accelerated frailty model for modeling the extreme skewness with the presence of zeros. Levels of utilization of health services may vary geographically, so conditional autoregressive priors were used to provide spatial smoothing across neighboring hospital health districts. The random effect terms are further linked to investigate if the capacity for longer LOS are consistently higher or lower at the health district level. Modeling and inference used the Bayesian approach via Markov Chain Monte Carlo simulation techniques. We demonstrated the proposed model for modeling the LOS of patients admitted due to chronic lower respiratory disease in Saskatchewan, Canada.
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Affiliation(s)
- Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N2Z4, Canada.
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Crisafulli E, Ielpo A, Barbeta E, Ceccato A, Huerta A, Gabarrús A, Soler N, Chetta A, Torres A. Clinical variables predicting the risk of a hospital stay for longer than 7 days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study. Respir Res 2018; 19:261. [PMID: 30591055 PMCID: PMC6307152 DOI: 10.1186/s12931-018-0951-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients may experience an acute exacerbation (AECOPD) that requires hospitalisation. The length of hospital stay (LHS) has a great economic impact on the health-care system. Knowing the predictors of prolonged LHS could help to identify possible interventions. METHODS We performed a prospective study to identify the clinical predictors of prolonged LHS in patients hospitalised for AECOPD. We divided the study sample by LHS into normal (≤7 days) and prolonged LHS (> 7 days) groups. Outcomes were the need for non-invasive and invasive mechanical ventilation (NIMV and IMV), intensive care unit (ICU) admission, and the 3-year mortality. RESULTS We enrolled 437 patients, of which 213 and 224 had normal LHS and prolonged LHS, respectively. Patients with a prolonged LHS had more prior hospitalisations for AECOPD, a worse mMRC (modified Medical Research Council) dyspnoea score, a higher prevalence of long-term oxygen therapy and a higher rate of congestive heart disease. During the current admission, this group also tended to require NIMV, IMV and ICU admission and the mortality risks at 6 months, 1 year and 3 years were higher. In the multivariate regression analysis, an mMRC dyspnoea score ≥ 2 (odds ratio-OR 2.24; 95% confidence interval-CI 1.34 to 3.74; p = 0.002) and the presence of acute respiratory acidosis (OR 2.75; 95% CI 1.49 to 5.05; p = 0.001) predicted a prolonged LHS at admission. CONCLUSIONS The presence of an mMRC ≥2 and acute respiratory acidosis at admission independently increased the risk of a prolonged LHS for AECOPD.
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Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antonella Ielpo
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enric Barbeta
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain
| | - Adrian Ceccato
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain
| | - Arturo Huerta
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain
| | - Albert Gabarrús
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain
| | - Néstor Soler
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Villarroel 170, 08036, Barcelona, Spain. .,Icrea Academia, Barcelona, Spain.
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Orea-Tejeda A, Navarrete-Peñaloza AG, Verdeja-Vendrell L, Jiménez-Cepeda A, González-Islas DG, Hernández-Zenteno R, Keirns-Davis C, Sánchez-Santillán R, Velazquez-Montero A, Puentes Rodríguez G. Right heart failure as a risk factor for severe exacerbation in patients with chronic obstructive pulmonary disease: Prospective cohort study. CLINICAL RESPIRATORY JOURNAL 2018; 12:2635-2641. [PMID: 30307708 DOI: 10.1111/crj.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/11/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prognosis in patients with Chronic Obstructive Pulmonary Disease (COPD) depends, in large part, on the frequency of exacerbations. Cardiovascular diseases, including heart failure (HF), are the risk factors for exacerbations. However, the importance of HF type over the exacerbations in COPD patients is unknown. OBJECTIVE To determine whether right heart failure (RHF) is an independent risk factor for severe exacerbations in patients with COPD. METHODS A prospective cohort study of 133 patients diagnosed with COPD with a follow-up period from 2010 to 2016. Patients with bronchial hyperreactivity, asthma, or pulmonary embolism were excluded. RESULTS The mean age was 74.7 ± 8.2 years and 43.6% were men, 69.9% had severe exacerbations during follow-up. Subjects with RHF had lower FEV1 (50.2 ± 19.9 vs 57.4 ± 16.9, P = .006) and greater incidence of stroke (15.4% vs 1.8%, P = .009) compared to those without RHF. Subjects with RHF were at higher risk of severe exacerbations (HR, 2.46; CI 95%, 1.32-4.58, P = .005) compared to those without RHF after adjusting for confounding variables. CONCLUSION In patients with COPD, RHF is an independent risk factor for suffering severe exacerbations.
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Affiliation(s)
- Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Ana Grecia Navarrete-Peñaloza
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Leslie Verdeja-Vendrell
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Abril Jiménez-Cepeda
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Dulce Gabriela González-Islas
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Rafael Hernández-Zenteno
- Tabaquism and COPD Investigation Department, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Candace Keirns-Davis
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Rocío Sánchez-Santillán
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Alejandra Velazquez-Montero
- Tabaquism and COPD Investigation Department, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
| | - Gerardo Puentes Rodríguez
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico
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Inabnit LS, Blanchette C, Ruban C. Comorbidities and length of stay in chronic obstructive pulmonary disease patients. COPD 2018; 15:355-360. [PMID: 30273058 DOI: 10.1080/15412555.2018.1513470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) has a significant burden on patients and the healthcare system. There is a link between COPD and comorbidities such as congestive heart failure (CHF), fluid and electrolyte disorders, and renal failure. This adds to the complexity of healthcare in these patients. The objective of this study is to determine if certain comorbidities affect length of stay. A sample of 3,399 patients with COPD were assessed from the Premier© healthcare database. The cohort had a mean (standard deviation (SD)) age of 68.41 (10.85) years. The average number of comorbidities was 24.83 (10.46) with a mean length of stay (SD) of 11.64 (9.40) days. A negative binomial regression model was used to evaluate the impact that comorbidities have on the length of hospital stay. The authors found that the number of comorbidities was associated with an increased length of stay (r = .4596, p < .0001). Having at least one comorbidity was associated with a 13% greater length of stay (IRR = 1.13, 95% CI 1.11-1.15, p < 0.0001). CHF was associated with a 28% greater length of stay (IRR = 1.28, 95% CI 1.24-1.31, p < 0.0001). Fluid and electrolyte disorders were associated with a 2-fold greater length of stay (IRR = 2.57, 95% CI 2.52-2.62, p < 0.0001). Renal failure was associated with a 50% greater length of stay (IRR = 1.50, 95% CI 1.45-1.55, p < 0.0001). However, uncomplicated diabetes was associated with 13% shorter length of stay than not having uncomplicated diabetes (IRR = .87, 95% CI .82-.91, p < .0001). This study demonstrated that specific comorbidities have an impact on length of stay.
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Affiliation(s)
- Lanny S Inabnit
- a BSRT , University of North Carolina-Charlotte , Charlotte , North Carolina , USA
| | - Christopher Blanchette
- b Public Health Sciences , University of North Carolina-Charlotte , Charlotte , North Carolina , USA
| | - Cynthiya Ruban
- c University of North Carolina-Charlotte , Charlotte , North Carolina , USA
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García-Sanz MT, González-Barcala FJ, Cánive-Gómez JC, García-Couceiro N, Alonso-Acuña S, Carreira JM. Prolonged stay predictors in patients admitted with chronic obstructive pulmonary disease acute exacerbation. Lung India 2018; 35:316-320. [PMID: 29970771 PMCID: PMC6034377 DOI: 10.4103/lungindia.lungindia_469_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The study aimed to identify the factors related to prolonged stay in those patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) to our hospital. Methods: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD to the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with length of stay, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. Results: Six hundred and sixty-one patients were assessed; 76.6% were male and the mean age was 74.5 years (standard deviation [SD]: 11.48). The mean stay was 11.9 days (SD: 8) and 24% of all patients required prolonged stay. Factors associated with prolonged mean stay in multivariate analysis were admission to the Intensive Care Unit (odds ratio [OR], 14.7), hospitalization by internal medicine (OR, 2.1), and use of noninvasive mechanical ventilation (OR, 1.75). Conclusions: Prolonged stay in AECOPD is primarily related to the unit patients are admitted to, and to the need for more intensive care.
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Affiliation(s)
| | - Francisco-Javier González-Barcala
- Department of Medicine, University of Santiago de Compostela; Spanish Biomedical Research Networking Centre-CIBERES, Barcelona; Department of Respiratory Medicine, University Hospital Complex of Santiago de Compostela; Health Research Institute of Santiago de Compostela, Spain
| | | | | | - Sara Alonso-Acuña
- Nursing Staff, University Hospital Complex of Santiago de Compostela, Spain
| | - José-Martín Carreira
- Department of Radiology, University Hospital Complex of Santiago de Compostela, Spain
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Adwani SH, Yuan C, Alsaleh L, Pepe J, Abusaada K. Variations in practice patterns and resource utilization in patients treated for chronic obstructive pulmonary disease. J Eval Clin Pract 2018. [PMID: 29532567 DOI: 10.1111/jep.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Several studies have looked at patient-related variables influencing hospital length of stay (LOS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, there has been increasing recognition that physician-related factors also play a significant role. This study aims to evaluate differences in practice patterns between teaching and nonteaching services and their effect on LOS in a large community hospital. METHODS A retrospective study of 354 patients admitted to Florida Hospital, Orlando, with AECOPD between January 2009 and December 2011. Patients who presented with acute respiratory failure requiring mechanical ventilation were excluded. Practice patterns of interest were use of oral versus intravenous systemic steroids, use of oral versus intravenous antibiotics, and utilization of consultations. RESULTS Length of stay was significantly lower in the teaching compared with the nonteaching group (2.80 vs. 5.04 days, P < .001). There was significantly greater use of oral steroids (85% vs. 8.9%, P < .001), greater use of oral antibiotics (72% vs. 33%, P < .001), and lower utilization of consults (0.3 vs. 1.4 consults per patient, P < .001) in the teaching compared with the nonteaching group. The teaching service was independently associated with decreased LOS in a multivariable regression model. However, after adjustment for the difference in practice patterns between the 2 groups, the teaching service was no longer associated with decreased LOS. Of the practice patterns, only utilization of consults was independently associated with increased LOS. CONCLUSIONS The teaching service had decreased LOS compared with the nonteaching service in patients hospitalized for AECOPD. The observed difference was completely explained by differences in practice patterns between the 2 groups. The study identifies an opportunity for more efficient and cost-effective care of AECOPD patients through streamlining of consultations, use of oral steroids in lieu of IV steroids, and antibiotic stewardship.
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Affiliation(s)
- Sunil H Adwani
- Florida Hospital Internal Medicine Residency Program, Orlando, FL, USA
| | - Cai Yuan
- Florida Hospital Internal Medicine Residency Program, Orlando, FL, USA
| | - Leen Alsaleh
- Florida Hospital Internal Medicine Residency Program, Orlando, FL, USA
| | | | - Khalid Abusaada
- Florida Hospital Internal Medicine Residency Program, Orlando, FL, USA
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Pendharkar SR, Ospina MB, Southern DA, Hirani N, Graham J, Faris P, Bhutani M, Leigh R, Mody CH, Stickland MK. Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2018; 18:93. [PMID: 29843772 PMCID: PMC5975274 DOI: 10.1186/s12890-018-0657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. Methods The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits. Results There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions. Conclusions Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care. Electronic supplementary material The online version of this article (10.1186/s12890-018-0657-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,University of Calgary, TRW Building, Rm 3E23, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Maria B Ospina
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Danielle A Southern
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naushad Hirani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jim Graham
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Peter Faris
- Research Priorities and Implementation, Alberta Health Services, Calgary, AB, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Richard Leigh
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher H Mody
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Pavliša G, Labor M, Puretić H, Hećimović A, Jakopović M, Samaržija M. 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. Croat Med J 2018; 58:395-405. [PMID: 29308831 PMCID: PMC5778679 DOI: 10.3325/cmj.2017.58.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - Marina Labor
- Marina Labor, Department of Pulmonology, University Hospital Center Osijek, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia,
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Madani Y, Saigal A, Sunny J, Morris L, Johns RH. Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study. Turk Thorac J 2018; 18:119-124. [PMID: 29404175 DOI: 10.5152/turkthoracj.2017.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation. MATERIAL AND METHODS From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS. RESULTS Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care. CONCLUSION Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals.
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Affiliation(s)
- Yasser Madani
- Department of Respiratory Medicine, Queen's Hospital, Romford, United Kingdom
| | - Anita Saigal
- Department of Respiratory Medicine, Queen's Hospital, Romford, United Kingdom
| | - Juno Sunny
- Department of Respiratory Medicine, Queen's Hospital, Romford, United Kingdom
| | - Leila Morris
- Department of Respiratory Medicine, Queen's Hospital, Romford, United Kingdom
| | - Robin H Johns
- Department of Respiratory Medicine, Queen's Hospital, Romford, United Kingdom
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