Chronic obstructive pulmonary disease is associated with increased recurrent peptic ulcer bleeding risk

Effectiveness, Safety, and Costs of Thromboprophylaxis with Enoxaparin or Unfractionated Heparin Among Medical Inpatients With Chronic Obstructive Pulmonary Disease or Heart Failure

Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are risk factors for venous thromboembolism (VTE). Enoxaparin and unfractionated heparin (UFH) help prevent hospital-associated VTE, but few studies have compared them in COPD or HF. Objectives: To compare effectiveness, safety, and costs of enoxaparin vs UFH thromboprophylaxis in medical inpatients with COPD or HF. Methods: This retrospective cohort study included adults with COPD or HF from the Premier PINC AI Healthcare Database. Included patients received prophylactic-dose enoxaparin or UFH during a >6-day index hospitalization (the first visit/admission that met selection criteria during the study period) between January 1, 2010, and September 30, 2016. Multivariable regression models assessed independent associations between exposures and outcomes. Hospital costs were adjusted to 2017 US dollars. Patients were followed 90 days postdischarge (readmission period). Results: In the COPD cohort, 114 174 (69%) patients received enoxaparin and 51 011 (31%) received UFH. Among patients with COPD, enoxaparin recipients had 21%, 37%, and 10% lower odds of VTE, major bleeding, and in-hospital mortality during index admission, and 17% and 50% lower odds of major bleeding and heparin-induced thrombocytopenia (HIT) during the readmission period, compared with UFH recipients (all P <.006). In the HF cohort, 58 488 (58%) patients received enoxaparin and 42 726 (42%) received UFH. Enoxaparin recipients had 24% and 10% lower odds of major bleeding and in-hospital mortality during index admission, and 13%, 11%, and 51% lower odds of VTE, major bleeding, and HIT during readmission (all P <.04) compared with UFH recipients. Enoxaparin recipients also had significantly lower total hospital costs during index admission (mean reduction per patient: COPD, 1280 ; H F , 2677) and readmission (COPD, 379 ; H F , 1024). Among inpatients with COPD or HF, thromboprophylaxis with enoxaparin vs UFH was associated with significantly lower odds of bleeding, mortality, and HIT, and with lower hospital costs. Conclusions: This study suggests that thromboprophylaxis with enoxaparin is associated with better outcomes and lower costs among medical inpatients with COPD or HF based on real-world evidence. Our findings underscore the importance of assessing clinical outcomes and side effects when evaluating cost-effectiveness.

Common gastrointestinal diseases and chronic obstructive pulmonary disease risk: a bidirectional Mendelian randomization analysis

Background: Observational studies suggest an association between gastrointestinal diseases and chronic obstructive pulmonary disease (COPD), but the causal relationship remains unclear. Methods: We conducted bidirectional Mendelian randomization (MR) analysis using summary data from genome-wide association study (GWAS) to explore the causal relationship between common gastrointestinal diseases and COPD. Gastrointestinal diseases included gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS), Crohn's disease (CD), ulcerative colitis (UC), functional dyspepsia (FD), non-infectious gastroenteritis (NGE), and constipation (CP). Significant MR analysis results were replicated in the COPD validation cohort. Results: Bidirectional MR analysis supported a bidirectional causal relationship between GERD and COPD, and COPD was also found to increase the risk of IBS and CP. Our study also provided evidence for a bidirectional causal relationship between PUD and COPD, although the strength of evidence may be insufficient. Furthermore, we provided evidence that there is no causal association between CD, UC, FD, NGE, and COPD. Conclusion: This study offers some evidence to clarify the causal relationship between common gastrointestinal diseases and COPD. Further research is needed to understand the underlying mechanisms of these associations.

Prevalence and risk factors of upper gastrointestinal bleeding in chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) can cause upper gastrointestinal bleeding. In this study we identified the risk factors for upper gastrointestinal bleeding in patients with COPD by logistic regression analysis and established a logistic regression equation to predict the probability of upper gastrointestinal bleeding in COPD patients.

AIM

To investigate the prevalence and risk factors of upper gastrointestinal bleeding in patients with COPD.

METHODS

A total of 400 COPD patients treated at our hospital from October 2016 to October 2021 were selected, of which 240 were used for modeling. The prevalence of upper gastrointestinal bleeding in the modeling group was counted, the clinical data of patients with and without upper gastrointestinal bleeding were compared, and the factors influencing the occurrence of upper gastrointestinal bleeding were identified by logistic regression analysis. The rest 160 cases were included in a validation group to verify the performance of the logistic regression model developed.

RESULTS

Among the 240 COPD patients in the modeling group, the prevalence of upper gastrointestinal bleeding was 19.58% (47/240). The proportions of patients with coronary heart disease, severe infection, pulmonary encephalopathy, low ALB, and Helicobacter pylori infection were significantly higher in patients with upper gastrointestinal bleeding than in those without (P < 0.05). Age ≥ 60 years, COPD grade III, disease duration ≥ 4.3 years, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, and Helicobacter pylori infection were identified to be independent risk factors for upper gastrointestinal bleeding in COPD patients, while ALB elevation was a protective factor (P < 0.05). The area under the curve (AUC) of the logistic regression prediction model for predicting upper gastrointestinal bleeding in COPD patients was 0.867 (95% confidence interval [CI]: 0.818-0.907), with a sensitivity of 85.11% and specificity of 75.13%. When the logistic regression prediction model was applied to the validation group (160 COPD patients), the Hosmer-Lemeshow χ² value was 3.142 (P = 0.514) and the AUC was 0.900 (95%CI: 0.855-0.935), suggesting good discriminant validity and calibration of the model.

CONCLUSION

The prevalence of upper gastrointestinal bleeding in COPD patients is relatively high, and its occurrence is related to many factors such as patient age, COPD severity and course, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, Helicobacter pylori infection, and elevated ALB. The logistic regression prediction model developed has good discriminant validity and calibration for predicting the risk of upper gastrointestinal bleeding in COPD patients.

Prevalence and risk factors of upper gastrointestinal bleeding in chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) can cause upper gastrointestinal bleeding. In this study we identified the risk factors for upper gastrointestinal bleeding in patients with COPD by logistic regression analysis and established a logistic regression equation to predict the probability of upper gastrointestinal bleeding in COPD patients.

AIM

To investigate the prevalence and risk factors of upper gastrointestinal bleeding in patients with COPD.

METHODS

A total of 400 COPD patients treated at our hospital from October 2016 to October 2021 were selected, of which 240 were used for modeling. The prevalence of upper gastrointestinal bleeding in the modeling group was counted, the clinical data of patients with and without upper gastrointestinal bleeding were compared, and the factors influencing the occurrence of upper gastrointestinal bleeding were identified by logistic regression analysis. The rest 160 cases were included in a validation group to verify the performance of the logistic regression model developed.

RESULTS

Among the 240 COPD patients in the modeling group, the prevalence of upper gastrointestinal bleeding was 19.58% (47/240). The proportions of patients with coronary heart disease, severe infection, pulmonary encephalopathy, low ALB, and Helicobacter pylori infection were significantly higher in patients with upper gastrointestinal bleeding than in those without (P < 0.05). Age ≥ 60 years, COPD grade III, disease duration ≥ 4.3 years, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, and Helicobacter pylori infection were identified to be independent risk factors for upper gastrointestinal bleeding in COPD patients, while ALB elevation was a protective factor (P < 0.05). The area under the curve (AUC) of the logistic regression prediction model for predicting upper gastrointestinal bleeding in COPD patients was 0.867 (95% confidence interval [CI]: 0.818-0.907), with a sensitivity of 85.11% and specificity of 75.13%. When the logistic regression prediction model was applied to the validation group (160 COPD patients), the Hosmer-Lemeshow χ² value was 3.142 (P = 0.514) and the AUC was 0.900 (95%CI: 0.855-0.935), suggesting good discriminant validity and calibration of the model.

CONCLUSION

The prevalence of upper gastrointestinal bleeding in COPD patients is relatively high, and its occurrence is related to many factors such as patient age, COPD severity and course, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, Helicobacter pylori infection, and elevated ALB. The logistic regression prediction model developed has good discriminant validity and calibration for predicting the risk of upper gastrointestinal bleeding in COPD patients.

Factors Associated with Differential Readmission Diagnoses Following Acute Exacerbations of Chronic Obstructive Pulmonary Disease

BACKGROUND

Readmissions after exacerbations of chronic obstructive pulmonary disease (COPD) are penalized under the Hospital Readmissions Reduction Program (HRRP). Understanding attributable diagnoses at readmission would improve readmission reduction strategies.

OBJECTIVES

Determine factors that portend 30-day readmissions attributable to COPD versus non-COPD diagnoses among patients discharged following COPD exacerbations.

DESIGN, SETTING, AND PARTICIPANTS

We analyzed COPD discharges in the Nationwide Readmissions Database from 2010 to 2016 using inclusion and readmission definitions in HRRP.

MAIN OUTCOMES AND MEASURES

We evaluated readmission odds for COPD versus non-COPD returns using a multilevel, multinomial logistic regression model. Patient-level covariates included age, sex, community characteristics, payer, discharge disposition, and Elixhauser Comorbidity Index. Hospital-level covariates included hospital ownership, teaching status, volume of annual discharges, and proportion of Medicaid patients.

RESULTS

Of 1,622,983 (a weighted effective sample of 3,743,164) eligible COPD hospitalizations, 17.25% were readmitted within 30 days (7.69% for COPD and 9.56% for other diagnoses). Sepsis, heart failure, and respiratory infections were the most common non-COPD return diagnoses. Patients readmitted for COPD were younger with fewer comorbidities than patients readmitted for non-COPD. COPD returns were more prevalent the first two days after discharge than non-COPD returns. Comorbidity was a stronger driver for non-COPD (odds ratio [OR] 1.19) than COPD (OR 1.04) readmissions.

CONCLUSION

Thirty-day readmissions following COPD exacerbations are common, and 55% of them are attributable to non-COPD diagnoses at the time of return. Higher burden of comorbidity is observed among non-COPD than COPD rehospitalizations. Readmission reduction efforts should focus intensively on factors beyond COPD disease management to reduce readmissions considerably by aggressively attempting to mitigate comorbid conditions.

Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population

Background

Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis.

Methods

Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the “data warehouse of the Galician Healthcare Service” using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0.

Results

A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA₂DS₂-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality.

Conclusion

AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.

Impact of Various Types of Comorbidities on the Outcomes of Laparoscopic Total Gastrectomy in Patients with Gastric Carcinoma

Purpose

With increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma.

Materials and Methods

We retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses.

Results

A total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03-4.64), along with old age and intraoperative bleeding.

Conclusions

Among the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.