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Cheng ZX, Hua JL, Jie ZJ, Li XJ, Zhang J. Genetic Insights into the Gut-Lung Axis: Mendelian Randomization Analysis on Gut Microbiota, Lung Function, and COPD. Int J Chron Obstruct Pulmon Dis 2024; 19:643-653. [PMID: 38464560 PMCID: PMC10921945 DOI: 10.2147/copd.s441242] [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: 10/15/2023] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a respiratory disorder with a complex etiology involving genetic and environmental factors. The dysbiosis of gut microbiota has been implicated in COPD. Mendelian Randomization (MR) provides a tool to investigate causal links using genetic variants as instrumental variables. This study aims to employ MR analysis to explore the causal relationship between gut microbiota, lung function, and COPD. Methods We utilized genome-wide association study (GWAS) data from MiBioGen, UK Biobank and FinnGen, which were related to gut microbial taxa, lung function parameters including forced vital capacity in one second (FEV1), forced vital capacity (FVC), and percentage of predicted FEV1 (FEV1%pred), as well as GWAS data for COPD. MR analysis was conducted to assess the causal effects of gut microbiota on lung function and the risk of COPD. Sensitivity analysis was utilized to examine the stability of the causal relationships. Multiple testing and reverse analysis were employed to evaluate the robustness of these relationships. Results Using the IVW method, 64 causal correlations were identified. Through conducting sensitivity analysis, multiple testing, and reverse analysis, we identified 14 robust and stable causal relationships. The bacterial taxa that showed a positive association with lung function included Desulfovibrionaceae, Erysipelotrichales, Desulfovibrionales, Clostridiales, Clostridia, Deltaproteobacteria and Erysipelotrichia, while Selenomonadales and Negativicutes showed a negative association with lung function. The abundance of Holdemanella were positively correlated with the risk of COPD, while FamilyXIII exhibited a negative correlation with the risk of COPD. Conclusion Several microbial taxa were discovered to have a positive causal correlation with lung function, offering potential insights into the development of probiotics. The presence of microbial taxa negatively correlated with lung function and positively correlated with COPD emphasized the potential impact of gut microbiota dysbiosis on respiratory health.
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Affiliation(s)
- Zi-Xuan Cheng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Jian-Lan Hua
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, the Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China
| | - Xing-Jing Li
- Department of Respiratory Medicine, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, People’s Republic of China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Cheng ZX, Wu YX, Jie ZJ, Li XJ, Zhang J. Genetic evidence on the causality between gut microbiota and various asthma phenotypes: a two-sample Mendelian randomization study. Front Cell Infect Microbiol 2024; 13:1270067. [PMID: 38274730 PMCID: PMC10808785 DOI: 10.3389/fcimb.2023.1270067] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Asthma is a multifarious disease that manifests in various phenotypes. Among the various factors that contribute to the development of asthma, the gut microbiota has recently emerged as a compelling area of investigation. This study aims to investigate the causal relationships between gut microbiota and distinct asthma phenotypes. Methods The genome-wide association study (GWAS) summary statistics for 211 gut microbial taxa were used as study exposure. Five traits pertaining to various asthma phenotypes (asthma, allergic asthma, childhood asthma, suggestive for eosinophilic asthma and obesity-related asthma) were included as study outcome. We conducted Mendelian randomization (MR) analysis and sensitivity analysis for each bacterial taxa and asthma phenotypes. Result We discovered a total of 58 associations that exhibited evidence of causality. Out of these, 4 associations remained significant even after applying multiple correction. An increased risk of asthma was causally associated with higher abundance of genus Holdemanella (OR = 1.11; CI: 1.05-1.17; p = 0.027), genus Oxalobacter (OR = 1.09; CI: 1.04-1.15; p = 0.025) and genus Butyricimonas (OR = 1.14; CI: 1.06-1.22; p = 0.027). Order NB1n was causally linked with an increased risk of obesity-related asthma (OR = 1.17; CI: 1.07-1.29; p = 0.015). There was limited overlap among the taxa that exhibited potential causal relationships with distinct asthma phenotypes. Conclusion Our research has provided genetic evidence that establishes multiple causal relationships between the gut microbiota and distinct asthma phenotypes, supporting the role of the gut microbiota in various asthma phenotypes. It is possible that different taxa play a role in the development of distinct asthma phenotypes. The causal relationships identified in this study require further investigation.
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Affiliation(s)
- Zi-Xuan Cheng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Xing Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, the Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xing-Jing Li
- Department of Respiratory Medicine, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Gao YH, Lu HW, Zheng HZ, Cao C, Chu DJ, Fan H, Fan XY, Gu HY, Guan WJ, Jie ZJ, Jin Y, Li W, Li YP, Li YY, Liu L, Liu XD, Luo H, Lv XD, Mo WQ, Song YL, Wang DX, Wang LW, Wang CZ, Xie M, Zhang M, Zheng CX, Mao B, Chotirmall SH, Chalmers JD, Qu JM, Xu JF. A phase 4 multicentre, 2×2 factorial randomised, double-blind, placebo-controlled trial to investigate the efficacy and safety of tobramycin inhalation solution for Pseudomonas aeruginosa eradication in bronchiectasis: ERASE. ERJ Open Res 2024; 10:00938-2023. [PMID: 38410702 PMCID: PMC10895435 DOI: 10.1183/23120541.00938-2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024] Open
Abstract
Chronic Pseudomonas aeruginosa (PA) infection significantly contributes to morbidity and mortality in bronchiectasis patients. Initiating antibiotics early may lead to the eradication of PA. Here we outline the design of a trial (ERASE; NCT06093191) assessing the efficacy and safety of inhaled tobramycin, alone or with oral ciprofloxacin, in bronchiectasis patients with a new isolation of PA. This multicentre, 2×2 factorial randomised, double-blind, placebo-controlled, parallel-group trial includes a 2-week screening period, a 12-week treatment phase (with a combination of ciprofloxacin or a placebo at initial 2 weeks) and a 24-week follow-up. 364 adults with bronchiectasis and a new PA isolation will be randomly assigned to one of four groups: placebo (inhaled saline and ciprofloxacin placebo twice daily), ciprofloxacin alone (750 mg ciprofloxacin and inhaled saline twice daily), inhaled tobramycin alone (inhaled 300 mg tobramycin and ciprofloxacin placebo twice daily) or a combination of both drugs (inhaled 300 mg tobramycin and 750 mg ciprofloxacin twice daily). The primary objective of this study is to assess the proportion of patients successfully eradicating PA in each group by the end of the study. Efficacy will be evaluated based on the eradication rate of PA at other time points (12, 24 and 36 weeks), the occurrence of exacerbations and hospitalisations, time to first pulmonary exacerbations, patient-reported outcomes, symptom measures, pulmonary function tests and the cost of hospitalisations. To date no randomised trial has evaluated the benefit of different PA eradication strategies in bronchiectasis patients. The ERASE trial will therefore generate crucial data to inform future clinical guidelines.
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Affiliation(s)
- Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China
- These authors contributed equally as first authors
| | - Hai-Wen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China
- These authors contributed equally as first authors
| | - Hui-Zhen Zheng
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China
- These authors contributed equally as first authors
| | - Chao Cao
- Department of Respiratory Medicine, The Affiliated Hospital of School of Medicine, Ningbo University, Ningbo, China
| | - De-Jie Chu
- Department of Respiratory Medicine, The Eighth People's Hospital of Shanghai, Shanghai, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yun Fan
- Department of Geriatric Respiratory and Critical Care, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hong-Yan Gu
- Department of Pulmonary and Critical Care Medicine, The Sixth People's Hospital of Nantong, Nantong, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Ping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuan-Yuan Li
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Liu
- Department of Respiratory Medicine, Guizhou Provincial People Hospital, Guiyang City, China
| | | | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Dong Lv
- Department of Respiration, The First Hospital of Jiaxing, Jiaxing, China
| | - Wei-Qiang Mo
- Department of Respiration, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yuan-Lin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dao-Xin Wang
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Wei Wang
- Pulmonary and Critical Care Department, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China
| | - Chang-Zheng Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui-Xia Zheng
- Department of Respiratory Medicine, Shanghai Yangpu District Central Hospital, Tongji University, Shanghai, China
| | - Bei Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- These authors contributed equally as senior authors
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- These authors contributed equally as senior authors
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China
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Mei ZF, Yan J, Qian L, He YC, Feng JJ, Wang J, Jie ZJ, Zou H. Enrichment of Circulating Tumor Cells of Lung Cancer and Correlation With Serum Leukomonocyte and Tumor Biomarkers: A Retrospective Study. Technol Cancer Res Treat 2023; 22:15330338231167827. [PMID: 37078167 PMCID: PMC10126612 DOI: 10.1177/15330338231167827] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
STUDY DESIGN Circulating tumor cells is important in the clinical diagnosis of cancer and there are a number of circulating tumor cell detection systems associated with different isolation strategies being validated. There is a novel platform, the CytoBot 2000, which utilizes a combination of physical and immunological technologies to isolate and capture circulating tumor cells. METHODS In this retrospective study, 39 lung cancer patients and 11 normal healthy individuals were enrolled and performed circulating tumor cell tests and immunofluorescence staining with CytoBot 2000. The performance of this device was assessed by receiver operating characteristic curve. The clinical relevance of circulating tumor cells was assessed by Chi-square. The correlations between circulating tumor cell number and blood lymphocytes and tumor biomarkers were analyzed by Pearson correlation coefficient. RESULTS The number of circulating tumor cell is significantly increased in lung cancer patients (3.74 > 0.45, P < .0001). The CytoBot 2000 presented a 100% (39/39) circulating tumor cell detection rate in lung cancer patients and 36% (4/11) in healthy individual blood samples, the sensitivity and specificity were 89.7% and 90.9%, respectively, and with the area under curve of 0.966. Further, there was a positive correlation between circulating tumor cell count and carcinoembryonic antigen 211 (R2 = 0.125, P = .027), but not blood lymphocytes (P = .089). CONCLUSIONS This automatic platform showed excellent performance of circulating tumor cell detection by clinical sample. The tumor biomarkers increased with the number of circulating tumor cell in the lung cancer patients.
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Affiliation(s)
- Zhou-Fang Mei
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Community Health Research Center of Fudan University, Shanghai, China
| | - Jing Yan
- Holosensor Medical Ltd, Suzhou, China
| | - Ling Qian
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Community Health Research Center of Fudan University, Shanghai, China
| | - Yan-Chao He
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Community Health Research Center of Fudan University, Shanghai, China
| | - Jing-Jing Feng
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Community Health Research Center of Fudan University, Shanghai, China
| | - Jie Wang
- Holosensor Medical Ltd, Suzhou, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Community Health Research Center of Fudan University, Shanghai, China
| | - Hua Zou
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
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Gao YH, Lu HW, Mao B, Guan WJ, Song YL, Li YY, Wang DX, Wang B, Gu HY, Li W, Luo H, Wang LW, Li F, Guo FX, Zhang M, Jie ZJ, Hang JQ, Yang C, Ren T, Yuan Z, Meng QW, Jia Q, Chen Y, Chen RC, Qu JM, Xu JF. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China): Protocol of a prospective multicenter observational study. Respir Res 2022; 23:328. [PMID: 36463140 PMCID: PMC9719665 DOI: 10.1186/s12931-022-02254-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Bronchiectasis is a highly heterogeneous chronic airway disease with marked geographic and ethnic variations. Most influential cohort studies to date have been performed in Europe and USA, which serve as the examples for developing a cohort study in China where there is a high burden of bronchiectasis. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China) is designed to: (1) describe the clinical characteristics and natural history of bronchiectasis in China and identify the differences of bronchiectasis between the western countries and China; (2) identify the risk factors associated with disease progression in Chinese population; (3) elucidate the phenotype and endotype of bronchiectasis by integrating the genome, microbiome, proteome, and transcriptome with detailed clinical data; (4) facilitate large randomized controlled trials in China. METHODS The BE-China is an ongoing prospective, longitudinal, multi-center, observational cohort study aiming to recruit a minimum of 10,000 patients, which was initiated in January 2020 in China. Comprehensive data, including medical history, aetiological testing, lung function, microbiological profiles, radiological scores, comorbidities, mental status, and quality of life (QoL), will be collected at baseline. Patients will be followed up annually for up to 10 years to record longitudinal data on outcomes, treatment patterns and QoL. Biospecimens, if possible, will be collected and stored at - 80 °C for further research. Up to October 2021, the BE-China has enrolled 3758 patients, and collected 666 blood samples and 196 sputum samples from 91 medical centers. The study protocol has been approved by the Shanghai Pulmonary Hospital ethics committee, and all collaborating centers have received approvals from their local ethics committee. All patients will be required to provide written informed consent to their participation. CONCLUSIONS Findings of the BE-China will be crucial to reveal the clinical characteristics and natural history of bronchiectasis and facilitate evidence-based clinical practice in China. Trial registration Registration Number in ClinicalTrials.gov: NCT03643653.
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Affiliation(s)
- Yong-Hua Gao
- grid.24516.340000000123704535Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433 China
| | - Hai-Wen Lu
- grid.24516.340000000123704535Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433 China
| | - Bei Mao
- grid.24516.340000000123704535Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433 China
| | - Wei-Jie Guan
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuan-Lin Song
- grid.8547.e0000 0001 0125 2443Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan-Yuan Li
- grid.216417.70000 0001 0379 7164Department of Pulmonary and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Dao-Xin Wang
- grid.412461.40000 0004 9334 6536Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wang
- grid.413679.e0000 0004 0517 0981Department of Pulmonary and Critical Care Medicine, Huzhou Central Hospital, Huzhou, Zhejiang China
| | - Hong-Yan Gu
- Department of Pulmonary and Critical Care Medicine, The Sixth People’s Hospital of Nantong, Nantong, Jiangsu, China
| | - Wen Li
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Hong Luo
- grid.216417.70000 0001 0379 7164Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Ling-Wei Wang
- grid.440218.b0000 0004 1759 7210Pulmonary and Critical Care Department, Shenzhen People’s Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, 518020 Guangdong China
| | - Fan Li
- grid.452742.2Department of Respiratory and Critical Care Medicine, Songjiang District Central Hospital, Shanghai, China
| | - Feng-Xia Guo
- grid.459495.0Department of Respiratory and Critical Care Medicine, The Eighth People’s Hospital of Shanghai, Shanghai, China
| | - Min Zhang
- grid.16821.3c0000 0004 0368 8293Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Jun Jie
- grid.8547.e0000 0001 0125 2443Department of Respiratory and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Jing-Qing Hang
- Department of Respiratory and Critical Care Medicine, Shanghai Putuo District People’s Hospital, Shanghai, China
| | - Chao Yang
- Department of Respiratory and Critical Care Medicine, Suzhou Science and Technology Town Hospital, Suzhou, China
| | - Tao Ren
- grid.412528.80000 0004 1798 5117Department of Respiratory and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhi Yuan
- Department of Respiratory and Critical Care Medicine, Fenghua District People’s Hospital, Ningbo, Zhejiang China
| | - Qing-Wei Meng
- Department of Respiratory and Critical Care Medicine, Shangrao People’s Hospital, Shangrao, Jiangxi China
| | - Qin Jia
- Department of Respiratory and Critical Care Medicine, Shidong Hospital of Yangpu District, Shanghai, China
| | - Yu Chen
- grid.412449.e0000 0000 9678 1884Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rong-Chang Chen
- grid.440218.b0000 0004 1759 7210Pulmonary and Critical Care Department, Shenzhen People’s Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, 518020 Guangdong China
| | - Jie-Ming Qu
- grid.16821.3c0000 0004 0368 8293Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025 China
| | - Jin-Fu Xu
- grid.24516.340000000123704535Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433 China
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Liu Y, Lu HW, Gu SY, Wang WW, Ge J, Jie ZJ, Jia JG, Gao ZT, Li J, Shi JY, Liang S, Cheng KB, Bai JW, Qu JM, Xu JF. Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis. EBioMedicine 2021; 72:103587. [PMID: 34537448 PMCID: PMC8452777 DOI: 10.1016/j.ebiom.2021.103587] [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: 12/27/2020] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbation. Methods A randomised controlled trial was conducted to explore the efficacy and safety of B-ACT among 189 bronchiectasis inpatients from February 1, 2018 to February 28, 2019. The primary outcome was the time to first acute exacerbation. Secondary outcomes included changes of health-related scores, length of hospital stay, hospitalization expenses and incidences of adverse events. Findings B-ACT therapy significantly prolonged the median days to first acute exacerbation when compared with control group (198 vs 168 days, HR 0·555 (0·322-0·958), p=0·012; effect size(r)= 0·94). Further analysis showed that B-ACT therapy was more beneficial for these patients with severe disease and greater symptoms. COPD Assessment Test (CAT) scores improved significantly on the third day (5·45 vs 4·85, 0·60 (0·09-1·11), p=0·023), and Leicester Cough Questionnaire (LCQ) scores improved obviously on the third and seventh days (1·53 vs 1·23, 0·30 (0·05-0·55), p=0·044; 1·66 vs 1·32, 0·34 (0·08-0·60), p=0·022; respectively) after B-ACT therapy. Adverse events associated with B-ACT were mostly transient and mild. Differences of the lengths of hospital stay and hospitalization expenses in both group was not significant. Interpretation B-ACT therapy significantly prolonged the time to first acute exacerbation after discharge, highlighting the importance of B-ACT therapy focused on symptom improvements in preventing exacerbation. Funding National Natural Science Foundation of China. Trial registry ClinicalTrials.gov; No.:NCT03643302; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Yang Liu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Hai-Wen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Shu-Yi Gu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Wen-Wen Wang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Juan Ge
- Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Shanghai University, Jiangsu 226001, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Jin-Guang Jia
- Department of Respiratory and Critical Care Medicine, People's Hospital of Zhengzhou, Henan University of Chinese Medicine, Henan 450014, China
| | - Zhi-Ting Gao
- Department of Respiratory and Critical Care Medicine, People's Hospital of Putuo District, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jun Li
- Center of Clinical Research, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jing-Yun Shi
- Department of Radiology Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shuo Liang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Ke-Bing Cheng
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Jiu-Wu Bai
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China.
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Zheng ZG, Sun WZ, Hu JY, Jie ZJ, Xu JF, Cao J, Song YL, Wang CH, Wang J, Zhao H, Guo ZL, Zhong NS. Hydrogen/oxygen therapy for the treatment of an acute exacerbation of chronic obstructive pulmonary disease: results of a multicenter, randomized, double-blind, parallel-group controlled trial. Respir Res 2021; 22:149. [PMID: 33985501 PMCID: PMC8120708 DOI: 10.1186/s12931-021-01740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/06/2021] [Indexed: 12/08/2022] Open
Abstract
Background To investigate whether the administration of hydrogen/oxygen mixture was superior to oxygen in improving symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This prospective, randomized, double-blind, controlled clinical trial in 10 centres enrolled patient with AECOPD and a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 6 points. Eligible patients were randomly assigned (in a 1:1 ratio) to receive either hydrogen/oxygen mixture or oxygen therapy. Primary endpoint was the change from baseline in BCSS score at day 7. Adverse events (AEs) were recorded to evaluate safety. Results Change of BCSS score in Hydrogen/oxygen group was larger than that in Oxygen group (− 5.3 vs. − 2.4 point; difference: − 2.75 [95% CI − 3.27 to − 2.22], meeting criteria for superiority). Similar results were observed in other time points from day 2 through day 6. There was a significant reduction of Cough Assessment Test score in Hydrogen/oxygen group compared to control (− 11.00 vs. − 6.00, p < 0.001). Changes in pulmonary function, arterial blood gas and noninvasive oxygen saturation did not differ significantly between groups as well as other endpoints. AEs were reported in 34 (63.0%) patients in Hydrogen/oxygen group and 42 (77.8%) in Oxygen group. No death and equipment defects were reported during study period. Conclusions The trial demonstrated that hydrogen/oxygen therapy is superior to oxygen therapy in patient with AECOPD with acceptable safety and tolerability profile. Trial registration: Name of the registry: U.S National Library of Medicine Clinical Trials; Trial registration number: NCT04000451; Date of registration: June 27, 2019-Retrospectively registered; URL of trial registry record: https://www.clinicaltrials.gov/ct2/show/study/NCT04000451?term=04000451&draw=2&rank=1. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01740-w.
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Affiliation(s)
- Ze-Guang Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangdong, China.
| | - Wu-Zhuang Sun
- Department of Respiratory and Critical Care Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie-Ying Hu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangdong, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, The Fifth People's Hospital of Shanghai, Shanghai, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jie Cao
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan-Lin Song
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chang-Hui Wang
- Department of Respiratory and Critical Care Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Zhao
- Department of Respiratory and Critical Care Medicine, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhong-Liang Guo
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital of Tongji University, Shanghai, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangdong, China.
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8
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Wang SM, Zhang FY, Du CL, Wang XB, Li F, Hang JQ, Chen YJ, Cheng KW, Zhao L, Jin XY, Shi JD, Jie ZJ, Qu JM. Epidemiology and issues of NIV-treated AECOPD patients with hypercapnic respiratory failure in Shanghai: A multicentre retrospective survey. Clin Respir J 2021; 15:550-557. [PMID: 33217227 DOI: 10.1111/crj.13311] [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] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/16/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the epidemiology, clinical features, treatment and outcome of Noninvasive ventilation (NIV)-treated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in secondary hospitals of Shanghai. METHOD Relying on Shanghai alliances for respiratory diseases, a retrospective observational study was performed in 34 secondary hospitals of Shanghai. The AECOPD patients treated with NIV and admitted to the respiratory department or respiratory intensive care unit were recruited between December 1, 2016, and November 30, 2017. RESULTS There were 555 patients finally recruited in this study. The age was 75.8 ± 9.6 years old and 380 patients (68.5%) were male. 70.5% of all patients had respiratory acidosis (pH <7.35). 55.3% of all patients received nebulised bronchodilator and 77.7% were treated with systemic or inhaled corticosteroids during hospitalisation. 525 patients (94.6%) recovered successfully and the mortality was 3.2%. The hospitalisation was 15.3 ± 6.7 days and hospital expenses were 22 911 ± 13 595 RMB. Inadequate and nonstandard drug treatments were the most important problems during management. CONCLUSION The NIV can be successfully used for AECOP patients in local hospitals of Shanghai, but accompanied by high costs and long hospital stays. However, the treatments for exacerbation and stable COPD patients are still insufficient.
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Affiliation(s)
- Sheng-Mei Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Feng-Ying Zhang
- Department of Respiratory Medicine, Putuo District People's Hospital, Shanghai, China
| | - Chun-Ling Du
- Department of Respiratory Medicine, Zhongshan Hospital Subordinating Qingpu Hospital, Shanghai, China
| | - Xiong-Biao Wang
- Department of Respiratory Medicine, Putuo District Central Hospital, Shanghai, China
| | - Fan Li
- Department of Respiratory Medicine, Songjiang District Central Hospital, Shanghai, China
| | - Jing-Qing Hang
- Department of Respiratory Medicine, Putuo District People's Hospital, Shanghai, China
| | - Yuan-Jing Chen
- Department of Respiratory Medicine, Yangpu District Kongjiang Hospital, Shanghai, China
| | - Ke-Wen Cheng
- Department of Respiratory Medicine, Renhe Hospital, Shanghai, China
| | - Lei Zhao
- Department of Respiratory Medicine, Gongli Hospital, Shanghai, China
| | - Xiao-Yan Jin
- Department of Respiratory Medicine, Tong Ren Hospital, Shanghai, China
| | - Jin-Dong Shi
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Zhi-Jun Jie
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jie-Ming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai, China.,Institute of Respiratory Diseases, Shanghai Jiao-Tong University School of Medicine, China
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9
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Zuo YH, Wang WQ, Chen QJ, Liu B, Zhang FY, Jin XY, Hang JQ, Li HY, Bao ZY, Jie ZJ, Wang GF, Gao XW, Sun H, Xu JF, Zhang J, Qu JM. Candida in Lower Respiratory Tract Increases the Frequency of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Case-Control Study. Front Cell Infect Microbiol 2020; 10:538005. [PMID: 33117725 PMCID: PMC7561360 DOI: 10.3389/fcimb.2020.538005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore impact of Candida on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) outcome. Methods: A retrospective, multi-center, case-control study was performed. Patients hospitalized for AECOPD in 25 centers during Jan 2011-Dec 2016 were enrolled. Data were collected, including demographic information, conditions during the stable phase of COPD, clinical characteristics of AECOPD, and follow-up information within 1 year after discharge. Univariate analysis and binary logistic regression were applied, and p < 0.05 was regarded as significant. Results: Totally 1,103 patients were analyzed, with 644 lower respiratory airway (LTR) Candida positive cases and 459 Candida negative controls. Long-term prognosis was significantly different between Candida positive and negative group, including the recurrent AECOPD within 180 days (75.5 vs. 6.6%, p < 0.001) and mortality within 1 year (6.9 vs. 0.4%, p < 0.001). Univariate logistic analysis showed that LTR Candida isolation was related to higher recurrence rate of AECOPD within 180 days and mortality within 1 year. Binary logistic regression analysis demonstrated that LTR Candida isolation was independently associated with recurrence of AECOPD within 180 days. Conclusions: LTR Candida isolation was associated with worse long-term prognosis of AECOPD and independently related to higher risks of recurrent AECOPD within 180 days.
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Affiliation(s)
- Yi-Hui Zuo
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Qin Wang
- Department of Respiratory Medicine, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qi-Jian Chen
- Department of Respiratory Medicine, School of Medicine, Ruijin North Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Liu
- Department of Respiratory Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng-Ying Zhang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Xiao-Yan Jin
- Department of Respiratory Medicine, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Qing Hang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Hua-Yin Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi-Yao Bao
- Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Jun Jie
- Department of Respiratory Medicine, Shanghai Fifth' Peoples Hospital, Fudan University, Shanghai, China
| | - Gui-Fang Wang
- Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi-Wen Gao
- Department of Respiratory Medicine, Central Hospital of Minhang District, Shanghai, Fudan University, Shanghai, China
| | - He Sun
- Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Fu Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie-Ming Qu
- Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
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10
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Liu Y, Mao B, Liang S, Yang JW, Lu HW, Chai YH, Wang L, Zhang L, Li QH, Zhao L, He Y, Gu XL, Ji XB, Li L, Jie ZJ, Li Q, Li XY, Lu HZ, Zhang WH, Song YL, Qu JM, Xu JF. Association between age and clinical characteristics and outcomes of COVID-19. Eur Respir J 2020; 55:13993003.01112-2020. [PMID: 32312864 PMCID: PMC7173682 DOI: 10.1183/13993003.01112-2020] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/11/2020] [Indexed: 02/07/2023]
Abstract
The rapid outbreak of coronavirus disease 2019 (COVID-19) has been a matter of international concern as the disease is spreading fast [1, 2]. Considering that the contagious disease has led to an enormous impact globally, there is an urgent need to identify the risk populations with poor prognosis. Ageing is associated with certain changes in pulmonary physiology, pathology and function, during the period of lung infection. Therefore, age-related differences in responsiveness and tolerance become obvious and lead to worse clinical outcomes in elderly individuals [3]. Previous studies have mentioned that older COVID-19 patients are at an increased risk of death [4–7]. However, the age-related clinical characteristics, disease courses and outcomes other than death in COVID-19 patients remain unclear. Age significantly determined the clinical features and prognosis of COVID-19. The prognosis was worse in patients older than 60 years, calling for clinicians to pay more attention to patients of this age.https://bit.ly/34DTI05
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Affiliation(s)
- Yang Liu
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Bei Mao
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Shuo Liang
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Jia-Wei Yang
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Hai-Wen Lu
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Yan-Hua Chai
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Lan Wang
- Dept of Pulmonary Circulation Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li Zhang
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiu-Hong Li
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Zhao
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan He
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Gu
- Dept of Respiratory Medicine, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Xiao-Bin Ji
- Dept of Respiratory Medicine, Zhoupu Hospital of Pudong New District, Shanghai, China
| | - Li Li
- Dept of Respiratory Medicine, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Zhi-Jun Jie
- Dept of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Qiang Li
- Dept of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xiang-Yang Li
- Dept of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, China
| | - Hong-Zhou Lu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Wen-Hong Zhang
- Dept of Infectious Disease, Huashan Hospital Fudan University, Shanghai, China
| | - Yuan-Lin Song
- Dept of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jie-Ming Qu
- Dept of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,These authors contributed equally
| | - Jin-Fu Xu
- Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,These authors contributed equally
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11
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Mao B, Liu Y, Chai YH, Jin XY, Lu HW, Yang JW, Gao XW, Song XL, Bao H, Wang A, Gu WC, Zhao L, Pan JP, Li F, Zhang TF, Qian YC, Du CL, Ding W, Tu CL, Chu DJ, Li C, Ye L, Luo Y, Zheng CX, Yu RH, Qiu ZM, Cao HF, Ren JW, Zhao JY, Wang CH, Lu HZ, Li J, Hu Y, Liang S, Jie ZJ, Qu JM, Xu JF. Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study. Lancet Digit Health 2020; 2:e323-e330. [PMID: 32501440 PMCID: PMC7255260 DOI: 10.1016/s2589-7500(20)30109-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The outbreak of COVID-19 has led to international concern. We aimed to establish an effective screening strategy in Shanghai, China, to aid early identification of patients with COVID-19. Methods We did a multicentre, observational cohort study in fever clinics of 25 hospitals in 16 districts of Shanghai. All patients visiting the clinics within the study period were included. A strategy for COVID-19 screening was presented and then suspected cases were monitored and analysed until they were confirmed as cases or excluded. Logistic regression was used to determine the risk factors of COVID-19. Findings We enrolled patients visiting fever clinics from Jan 17 to Feb 16, 2020. Among 53 617 patients visiting fever clinics, 1004 (1·9%) were considered as suspected cases, with 188 (0·4% of all patients, 18·7% of suspected cases) eventually diagnosed as confirmed cases. 154 patients with missing data were excluded from the analysis. Exposure history (odds ratio [OR] 4·16, 95% CI 2·74-6·33; p<0·0001), fatigue (OR 1·56, 1·01-2·41; p=0·043), white blood cell count less than 4 × 109 per L (OR 2·44, 1·28-4·64; p=0·0066), lymphocyte count less than 0·8 × 109 per L (OR 1·82, 1·00-3·31; p=0·049), ground glass opacity (OR 1·95, 1·32-2·89; p=0·0009), and having both lungs affected (OR 1·54, 1·04-2·28; p=0·032) were independent risk factors for confirmed COVID-19. Interpretation The screening strategy was effective for confirming or excluding COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified in this study might be helpful for early recognition of the disease. Funding National Natural Science Foundation of China.
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Affiliation(s)
- Bei Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Hua Chai
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Yan Jin
- Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Wen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia-Wei Yang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi-Wen Gao
- Department of Respiratory and Critical Care Medicine, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiao-Lian Song
- Department of Respiratory and Critical Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Hong Bao
- Department of Respiratory Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - An Wang
- Department of Medical Management, Zhoupu Hospital of Pudong New District, Shanghai, China
| | - Wen-Chao Gu
- Department of Respiratory Medicine, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Lei Zhao
- Department of Pulmonary and Critical Care Medicine, Gongli Hospital, Shanghai, China
| | - Jie-Ping Pan
- Department of Infectious Disease, Shanghai Nanhua Hospital of Pudong New District, Shanghai, China
| | - Fan Li
- Department of Respiratory and Critical Care Medicine, Songjiang Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tie-Feng Zhang
- Department of Respiratory Medicine, Baoshan Branch of Renji Hospital, Shanghai, China
| | - Ye-Chang Qian
- Department of Respiratory Medicine, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Chun-Ling Du
- Department of Respiratory Medicine Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Ding
- Department of Respiratory Medicine, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Chun-Lin Tu
- Department of Respiratory and Critical Care Medicine, Jiading Center Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - De-Jie Chu
- Department of Respiratory and Critical Care Medicine, Shanghai Eighth People's Hospital, Shanghai, China
| | - Chun Li
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ling Ye
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yong Luo
- Department of Respiratory Medicine, Chongming Branch of Xin Hua Hospital Affiliated to School of Medicine, Jiaotong University, Shanghai, China
| | - Cui-Xia Zheng
- Department of Respiratory and Critical Care Medicine, Yangpu Hospital, Tongji University, Shanghai, China
| | - Rong-Huan Yu
- Department of Respiratory Medicine, Xuhui District Central Hospital, Shanghai, China
| | - Zhong-Min Qiu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Fang Cao
- Department of Respiratory Medicine, Jing'an District Centre Hospital of Shanghai, Shanghai, China
| | - Jia-Wei Ren
- Department of Respiratory Medicine, Shanghai Fourth People's Hospital, Shanghai, China
| | - Jing-Ya Zhao
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Hui Wang
- Department of Respiratory and Critical Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Hong-Zhou Lu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Jun Li
- Clinical Research Unit, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Hu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Liang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi-Jun Jie
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Hu WP, Zhang FY, Zhang J, Hang JQ, Zeng YY, Du CL, Jie ZJ, Jin XY, Zheng CX, Luo XM, Huang Y, Cheng QJ, Qu JM. Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai. J Thorac Dis 2020; 12:1417-1426. [PMID: 32395279 PMCID: PMC7212141 DOI: 10.21037/jtd.2020.03.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/06/2022]
Abstract
Background Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy making. Methods A short-period, 5-day prospective cross-sectional study was performed with sampled pulmonologists from 36 hospitals, encompassing all the administrative districts of Shanghai, during January 8–12, 2018. The medical information was recorded and analyzed for the patients with the diagnosis of CAP who were cared for by 46 pulmonologists during the study period. Results Overall, 435 patients were included in the final analysis, and 94.3% had a low risk of death in terms of CRB-65 criteria (C: disturbance of consciousness, R: respiratory rate, B: blood pressure, 65: age). When diagnosed with CAP, 70.1% of patients were not evaluated using the CURB-65 score (CRB-65 + U: urea nitrogen), but most patients (95.4%) were evaluated using CRB-65. Time to achieve clinical stability was longer in patients with hypoxemia than in those without hypoxemia (8.42±6.36 vs. 5.53±4.12 days, P=0.004). Overall, 84.4% of patients with a CRB-65 score of 0 were administered antibiotics intravenously, and 19.4% were still hospitalized after excluding hypoxemia and comorbidities. The average duration of antibiotic treatment was 10.4±4.9 days. Overall, 72.6% of patients received antibiotics covering atypical pathogens whose time to clinical stability was significantly shortened compared with those without coverage, but the antibiotic duration was similar and not correspondingly shortened. Conclusions CRB-65 seems to be more practical than CURB-65 for the initial evaluation of CAP in the context of local practice, and oxygenation assessment should be included in the evaluation of severity. Overtreatment may be relatively common in patients at low risk of death, including unreasonable hospitalization, intravenous administration, and antibiotic duration.
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Affiliation(s)
- Wei-Ping Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Feng-Ying Zhang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai 200060, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jing-Qing Hang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai 200060, China
| | - Ying-Ying Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Chun-Ling Du
- Department of Respiratory Medicine, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
| | - Zhi-Jun Jie
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China
| | - Xiao-Yan Jin
- Department of Respiratory Medicine, Tong Ren Hospital, Shanghai Jiao Tong University, Shanghai 200050, China
| | - Cui-Xia Zheng
- Department of Respiratory Medicine, Shanghai Yangpu District Central Hospital, Tongji University, Shanghai 200090, China
| | - Xu-Ming Luo
- Department of Respiratory Medicine, Shanghai Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Changhai Hospital of Shanghai, Navy Medical University, Shanghai 200433, China
| | - Qi-Jian Cheng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Jie-Ming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
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