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Koblizek V, Milenkovic B, Svoboda M, Kocianova J, Holub S, Zindr V, Ilic M, Jankovic J, Cupurdija V, Jarkovsky J, Popov B, Valipour A. RETRO-POPE: A Retrospective, Multicenter, Real-World Study of All-Cause Mortality in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:2661-2672. [PMID: 38022829 PMCID: PMC10661906 DOI: 10.2147/copd.s426919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The Phenotypes of COPD in Central and Eastern Europe (POPE) study assessed the prevalence and clinical characteristics of four clinical COPD phenotypes, but not mortality. This retrospective analysis of the POPE study (RETRO-POPE) investigated the relationship between all-cause mortality and patient characteristics using two grouping methods: clinical phenotyping (as in POPE) and Burgel clustering, to better identify high-risk patients. Patients and Methods The two largest POPE study patient cohorts (Czech Republic and Serbia) were categorized into one of four clinical phenotypes (acute exacerbators [with/without chronic bronchitis], non-exacerbators, asthma-COPD overlap), and one of five Burgel clusters based on comorbidities, lung function, age, body mass index (BMI) and dyspnea (very severe comorbid, very severe respiratory, moderate-to-severe respiratory, moderate-to-severe comorbid/obese, and mild respiratory). Patients were followed-up for approximately 7 years for survival status. Results Overall, 801 of 1,003 screened patients had sufficient data for analysis. Of these, 440 patients (54.9%) were alive and 361 (45.1%) had died at the end of follow-up. Analysis of survival by clinical phenotype showed no significant differences between the phenotypes (P=0.211). However, Burgel clustering demonstrated significant differences in survival between clusters (P<0.001), with patients in the "very severe comorbid" and "very severe respiratory" clusters most likely to die. Overall survival was not significantly different between Serbia and the Czech Republic after adjustment for age, BMI, comorbidities and forced expiratory volume in 1 second (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.65-0.99; P=0.036 [unadjusted]; HR 0.88, 95% CI 0.7-1.1; P=0.257 [adjusted]). The most common causes of death were respiratory-related (36.8%), followed by cardiovascular (25.2%) then neoplasm (15.2%). Conclusion Patient clusters based on comorbidities, lung function, age, BMI and dyspnea were more likely to show differences in COPD mortality risk than phenotypes defined by exacerbation history and presence/absence of chronic bronchitis and/or asthmatic features.
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Affiliation(s)
- Vladimir Koblizek
- Department of Pneumology, University Hospital, Hradec Kralove, Czech Republic
- Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michal Svoboda
- Institute of Biostatistics and Analyses Ltd., Brno, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Kocianova
- Outpatient Department of Pneumology Alveolus, APRO MED, Ostrava, Czech Republic
| | - Stanislav Holub
- Outpatient Chest Clinic, Plicni Stredisko Teplice Ltd., Teplice, Czech Republic
| | - Vladimir Zindr
- Outpatient Chest Clinic, PNEUMO KV Ltd., Karlovy Vary, Czech Republic
| | - Miroslav Ilic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Tuberculosis and Interstitial Lung Diseases, PolyClinic Department, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Jelena Jankovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Cupurdija
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Boris Popov
- Medicine Department, Boehringer Ingelheim Serbia d.o.o. Beograd, Belgrade, Serbia
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, Vienna, Austria
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Zivancevic-Simonovic S, Minic R, Cupurdija V, Stanojevic-Pirkovic M, Milosevic-Djordjevic O, Jakovljevic V, Mihaljevic O. Transforming growth factor beta 1 (TGF-β1) in COVID-19 patients: relation to platelets and association with the disease outcome. Mol Cell Biochem 2023; 478:2461-2471. [PMID: 36869188 PMCID: PMC9984293 DOI: 10.1007/s11010-023-04674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
Transforming growth factor beta (TGF-β) is a ubiquitously distributed cytokine known to contribute to the pathogenesis of numerous pathological processes. The aim of this study was to measure serum concentrations of TGF-β1 in severely ill COVID-19 patients and to analyze its relationship with selected hematological and biochemical parameters and with the disease outcome. The study population included 53 COVID-19 patients with severe clinical expression of the disease and 15 control subjects. TGF-β1 was determined in serum samples and supernatants from PHA-stimulated whole blood cultures using ELISA assay. Biochemical and hematological parameters were analyzed using standard accepted methods. Our results showed that serum levels of TGF-β1 in COVID-19 patients and controls correlate with the platelet counts. Also, positive correlations of TGF-β1 with white blood cell and lymphocyte counts, platelet-to-lymphocyte (PLR) ratio, and fibrinogen level were shown, while negative correlations of this cytokine with platelet distribution width (PDW), D-dimer and activated partial thromboplastin time (a-PTT) values in COVID-19 patients were observed. The lower serum values of TGF-β1 were associated with the unfavorable outcome of COVID-19. In conclusion, TGF-β1 levels were strongly associated with platelet counts and unfavorable disease outcome of severely ill COVID-19 patients.
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Affiliation(s)
| | - Rajna Minic
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Vojislav Cupurdija
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marijana Stanojevic-Pirkovic
- University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Biochemistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Mihaljevic O, Zivancevic-Simonovic S, Cupurdija V, Marinkovic M, Tubic Vukajlovic J, Markovic A, Stanojevic-Pirkovic M, Milosevic-Djordjevic O. OUP accepted manuscript. Mutagenesis 2022; 37:203-212. [PMID: 35524945 PMCID: PMC9129204 DOI: 10.1093/mutage/geac011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/11/2022] [Indexed: 01/08/2023] Open
Affiliation(s)
- Olgica Mihaljevic
- Corresponding author. Department of Pathophysiology, University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovica 69, 34000 Kragujevac, Serbia. E-mail:
| | | | - Vojislav Cupurdija
- Department of Internal Medicine Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Internal medicine, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Milos Marinkovic
- Department of Internal medicine, University Clinical Center Kragujevac, Kragujevac, Serbia
| | | | - Aleksandra Markovic
- Department of Biology, Faculty of Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Olivera Milosevic-Djordjevic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Biology, Faculty of Sciences, University of Kragujevac, Kragujevac, Serbia
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Djokovic D, Nikolic M, Muric N, Nedeljkovic I, Simovic S, Novkovic L, Cupurdija V, Savovic Z, Vuckovic-Filipovic J, Susa R, Cekerevac I. Cardiopulmonary Exercise Test in the Detection of Unexplained Post-COVID-19 Dyspnea. Int Heart J 2021; 62:1164-1170. [PMID: 34544975 DOI: 10.1536/ihj.21-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is emerging evidence of prolonged recovery in survivors of coronavirus disease 2019 (COVID-19), even in those with mild COVID-19. In this paper, we report a case of a 39-year-old male with excessive body weight and a history of borderline values of arterial hypertension without therapy, who was mainly complaining of progressive dyspnea after being diagnosed with mild COVID-19. According to the recent guidelines on the holistic assessment and management of patients who had COVID-19, all preferred diagnostic procedures, including multidetector computed tomography (CT), CT pulmonary angiogram, and echocardiography, should be conducted. However, in our patient, no underlying cardiopulmonary disorder has been established. Therefore, considering all additional symptoms our patient had beyond dyspnea, our initial differential diagnosis included anxiety-related dysfunctional breathing. However, psychiatric evaluation revealed that our patient had only a mild anxiety level, which was unlikely to provoke somatic complaints. We decided to perform further investigations considering that cardiopulmonary exercise test (CPET) represents a reliable diagnostic tool for patients with unexplained dyspnea. Finally, the CPET elucidated the diastolic dysfunction of the left ventricle, which was the most probable cause of progressive dyspnea in our patient. We suggested that, based on uncontrolled cardiovascular risk factors our patient had, COVID-19 triggered a subclinical form of heart failure (HF) with preserved ejection fraction (HFpEF) to become clinically manifest. Recently, the new onset, exacerbation, or transition from subclinical to clinical HFpEF has been associated with COVID-19. Therefore, in addition to the present literature, our case should warn physicians on HFpEF among survivors of COVID-19.
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Affiliation(s)
- Danijela Djokovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Psychiatry, Clinical Center Kragujevac
| | - Maja Nikolic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac
| | - Nemanja Muric
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Psychiatry, Clinical Center Kragujevac
| | - Ivana Nedeljkovic
- Department of Internal Medicine, School of Medicine, University of Belgrade.,Clinic for Cardiology, Clinical Center Serbia
| | - Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Cardiology, Clinical Center Kragujevac
| | - Ljiljana Novkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Pulmology, Clinical Center Kragujevac
| | - Vojislav Cupurdija
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Pulmology, Clinical Center Kragujevac
| | | | | | - Romana Susa
- Clinic for Pulmology, Clinical Center Kragujevac
| | - Ivan Cekerevac
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac.,Clinic for Pulmology, Clinical Center Kragujevac
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Lazic Z, Stankovic I, Milenkovic B, Zvezdin B, Hromis S, Jankovic S, Cupurdija V. Characteristics of COPD Phenotypes in Serbia. Int J Chron Obstruct Pulmon Dis 2021; 16:643-654. [PMID: 33758501 PMCID: PMC7981162 DOI: 10.2147/copd.s300693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Establishing a regional/national/international registry of patients suffering from chronic obstructive pulmonary disease (COPD) is essential for both research and healthcare, because it enables collection of comprehensive real-life data from a large number of individuals. Objective The aim of this study was to describe characteristics of COPD patients from the Serbian patient registry, and to investigate actual differences of those characteristics among the COPD phenotypes. Methods The Serbian registry of patients with COPD was established in 2018 at University of Kragujevac, Faculty of Medical Sciences, based on an online platform. Entry in the Registry was allowed for patients who were diagnosed with COPD according to the following criteria: symptoms of dyspnea, chronic cough or sputum production, history of risk factors for COPD and any degree of persistent airflow limitation diagnosed at spirometry. Results In the Serbian COPD registry B and D GOLD group were dominant, while among the COPD phenotypes, the most prevalent were non-exacerbators (49.4%) and then frequent exacerbators without chronic bronchitis (29.6%). The frequent exacerbator with chronic bronchitis phenotype was associated with low levels of bronchopulmonary function and absolute predominance of GOLD D group. Anxiety, depression, insomnia, hypertension and chronic heart failure were the most prevalent in the frequent exacerbator with chronic bronchitis phenotype; patients with this phenotype were also treated more frequently than other patients with a triple combination of the most effective inhaled anti-obstructive drugs: long-acting muscarinic antagonists, long-acting beta 2 agonists and corticosteroids. Conclusion In conclusion, the data from the Serbian registry are in line with those from other national registries, showing that frequent exacerbators with chronic bronchitis have worse bronchopulmonary function, more severe signs and symptoms, and more comorbidities (especially anxiety and depression) than other phenotypes. Other studies also confirmed worse quality of life and worse prognosis of the AE-CB phenotype, stressing importance of both preventive and appropriate therapeutic measures against chronic bronchitis.
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Affiliation(s)
- Zorica Lazic
- Faculty of Medical Sciences, University of Kragujevac, and Clinic for Pulmonology, Clinical Centre, Kragujevac, Serbia
| | - Ivana Stankovic
- Faculty of Medicine, University of Niš, and Clinic for Lung Diseases, Clinical Centre, Niš, Serbia
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, and Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Biljana Zvezdin
- Faculty of Medicine, University of Novi Sad, and the Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Sanja Hromis
- Faculty of Medicine, University of Novi Sad, and the Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, and Clinical Pharmacology Department, Clinical Centre, Kragujevac, Serbia
| | - Vojislav Cupurdija
- Faculty of Medical Sciences, University of Kragujevac, and Clinic for Pulmonology, Clinical Centre, Kragujevac, Serbia
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Novkovic L, Cekerevac I, Lazic Z, Petrovic M, Cupurdija V, Djokic B, Novkovic I. The prevalence and clinical characteristics of asthma–COPD overlap syndrome (ACOS) in patients with COPD. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cekerevac I, Cupurdija V, Novkovic L, Lazic Z, Petrovic M, Gajovic O, Susa R. Unusual Respiratory Manifestations of Ankylosing Spondylitis – A Case Report. Serbian Journal of Experimental and Clinical Research 2016. [DOI: 10.1515/sjecr-2016-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. The diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verified the existence of severe obstructive sleep apnoea (AHI =73). This was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. Thee patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night.
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Affiliation(s)
- Ivan Cekerevac
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vojislav Cupurdija
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ljiljana Novkovic
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorica Lazic
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Petrovic
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olgica Gajovic
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Romana Susa
- Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia
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Dudvarski Ilic A, Zugic V, Zvezdin B, Kopitovic I, Cekerevac I, Cupurdija V, Perhoc N, Veljkovic V, Barac A. Influence of inhaler technique on asthma and COPD control: a multicenter experience. Int J Chron Obstruct Pulmon Dis 2016; 11:2509-2517. [PMID: 27785007 PMCID: PMC5063589 DOI: 10.2147/copd.s114576] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The successful management of asthma and chronic obstructive pulmonary disease (COPD) mostly depends on adherence to inhalation drug therapy, the usage of which is commonly associated with many difficulties in real life. Improvement of patients' adherence to inhalation technique could lead to a better outcome in the treatment of asthma and COPD. OBJECTIVE The aim of this study was to assess the utility of inhalation technique in clinical and functional control of asthma and COPD during a 3-month follow-up. METHODS A total of 312 patients with asthma or COPD who used dry powder Turbuhaler were enrolled in this observational study. During three visits (once a month), training in seven-step inhalation technique was given and it was practically demonstrated. Correctness of patients' usage of inhaler was assessed in three visits by scoring each of the seven steps during administration of inhaler dose. Assessment of disease control was done at each visit and evaluated as: fully controlled, partially controlled, or uncontrolled. Patients' subjective perception of the simplicity of inhalation technique, disease control, and quality of life were assessed by using specially designed questionnaires. RESULTS Significant improvement in inhalation technique was achieved after the third visit compared to the first one, as measured by the seven-step inhaler usage score (5.94 and 6.82, respectively; P<0.001). Improvement of disease control significantly increased from visit 1 to visit 2 (53.9% and 74.5%, respectively; P<0.001) and from visit 2 to visit 3 (74.5% and 77%, respectively; P<0.001). Patients' subjective assessment of symptoms and quality of life significantly improved from visit 1 to visit 3 (P<0.001). CONCLUSION Adherence to inhalation therapy is one of the key factors of successful respiratory disease treatment. Therefore, health care professionals should insist on educational programs aimed at improving patients' inhalation technique with different devices, resulting in better long-term disease control and improved quality of life.
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Affiliation(s)
- Aleksandra Dudvarski Ilic
- Faculty of Medicine, University of Belgrade
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade
| | - Vladimir Zugic
- Faculty of Medicine, University of Belgrade
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade
| | - Biljana Zvezdin
- Faculty of Medicine, University of Novi Sad, Novi Sad
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica
| | - Ivan Kopitovic
- Faculty of Medicine, University of Novi Sad, Novi Sad
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica
| | - Ivan Cekerevac
- Faculty of Medicine, University of Kragujevac
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac
| | - Vojislav Cupurdija
- Faculty of Medicine, University of Kragujevac
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac
| | - Nela Perhoc
- Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis
| | - Vesna Veljkovic
- Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis
| | - Aleksandra Barac
- Faculty of Stomatology, University Academy of Business Novi Sad, Novi Sad, Serbia
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Cupurdija V, Lazic Z, Petrovic M, Mojsilovic S, Cekerevac I, Rancic N, Jakovljevic M. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity. J Bras Pneumol 2015; 41:48-57. [PMID: 25750674 PMCID: PMC4350825 DOI: 10.1590/s1806-37132015000100007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/05/2014] [Indexed: 12/26/2022] Open
Abstract
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.
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Affiliation(s)
- Vojislav Cupurdija
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Zorica Lazic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Head. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Marina Petrovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Internist. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Slavica Mojsilovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Center for Clinical Medicine, Kragujevac, Serbia. Intensive Care Unit, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Nemanja Rancic
- University of Defence, Military Medical Academy, Medical Faculty, Belgrade, Serbia. Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. Graduate Program in Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Affiliation(s)
- Vojislav Cupurdija
- Faculty of Medical Sciences, University in Kragujevac , Kragujevac , Serbia ; Clinical Center Kragujevac, Clinic for Pulmonary Diseases , Kragujevac , Serbia
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Vucic R, Andrejic O, Zdravkovic V, Petrovic M, Simic I, Iric Cupic V, Vulovic D, Cupurdija V. P241Prognostic value of heart rate in patients with acute myocardial infarction. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cupurdija V, Lazic Z, Jankovic S, Gajovic O, Cekerevac I, Novkovic L, Petrovic M, Djonovic N. Adverse events induced by anti-infectives in hospitalized patients. Ser J Exp Clin Res 2011. [DOI: 10.5937/sjecr1103097c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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