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Fanaridis M, Bouloukaki I, Stathakis G, Steiropoulos P, Tzanakis N, Moniaki V, Mavroudi E, Tsiligianni I, Schiza S. Prevalence and Characteristics of Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: Overlap Syndrome. Life (Basel) 2024; 14:547. [PMID: 38792569 PMCID: PMC11122385 DOI: 10.3390/life14050547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Overlap syndrome (OVS) is a distinct clinical entity that seems to result in potential cardiovascular consequences. We aimed to estimate the prevalence and risk factors for OVS in OSA patients and analyze clinical and PSG characteristics associated with OVS. In this cross-sectional study, 2616 patients evaluated for OSA underwent type-1 polysomnography (PSG). They were grouped as pure OSA (AHI > 15/h) and OVS patients. Demographics, PSG data, pulmonary function tests and arterial blood gases (ABGs) were compared between groups after adjustments for confounders. OSA was diagnosed in 2108 out of 2616 patients. Of those, 398 (19%) had OVS. Independent predictors of OVS were older age [OR: 5.386 (4.153-6.987)], current/former smoking [OR: 11.577 (7.232-18.532)], BMI [OR: 2.901 (2.082-4.044)] and ABG measurements [PaCO2 ≥ 45 OR: 4.648 (3.078-7.019), PO2 [OR: 0.934 (0.920-0.949)], HCO3- [OR: 1.196 (1.133-1.263), all p < 0.001]. OVS was also associated with prevalent hypertension [OR: 1.345 (1.030-1.758), p = 0.03] and cardiovascular disease [OR: 1.617 (1.229-2.126), p < 0.001], depressive symptoms [OR: 1.741 (1.230-2.465), p = 0.002] and nocturia [OR: 1.944 (1.378-2.742), p < 0.001], as well as with indices of OSA severity. Disturbances in sleep architecture were more prominent in OVS expressed by lower %N3 and REM% and higher arousal index. Our data suggest that OVS is prevalent among OSA patients, with distinct clinical and PSG characteristics. These characteristics could be utilized as predictive factors for early identification and further evaluation of these patients towards desirable patient-reported outcomes.
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Affiliation(s)
- Michail Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
- Department of Social Medicine, School of Medicine, University of Crete, 71410 Heraklion, Greece;
| | - Georgios Stathakis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece;
| | - Nikos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Eleni Mavroudi
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, 71410 Heraklion, Greece;
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
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Orlowski A, Ettinger J, Bottle A, Snow S, Ashton R, Quint JK. Modifiable risk factors that may be addressed in routine care to prevent progression to and extension of multimorbidity in people with COPD: a systematic literature review. BMJ Open Respir Res 2024; 11:e002272. [PMID: 38653506 PMCID: PMC11043725 DOI: 10.1136/bmjresp-2023-002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a multisystem disease, and many patients have multiple conditions. We explored multimorbidity patterns that might inform intervention planning to reduce health-care costs while preserving quality of life for patients. Literature searches up to February 2022 revealed 4419 clinical observational and comparative studies of risk factors for multimorbidity in people with COPD, pulmonary emphysema, or chronic bronchitis at baseline. Of these, 29 met the inclusion criteria for this review. Eight studies were cluster and network analyses, five were regression analyses, and 17 (in 16 papers) were other studies of specific conditions, physical activity and treatment. People with COPD more frequently had multimorbidity and had up to ten times the number of disorders of those without COPD. Disease combinations prominently featured cardiovascular and metabolic diseases, asthma, musculoskeletal and psychiatric disorders. An important risk factor for multimorbidity was low socioeconomic status. One study showed that many patients were receiving multiple drugs and had increased risk of adverse events, and that 10% of medications prescribed were inappropriate. Many patients with COPD have mainly preventable or modifiable multimorbidity. A proactive multidisciplinary approach to prevention and management could reduce the burden of care.
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Affiliation(s)
- Andi Orlowski
- Health Economics Unit, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | | | - Jennifer K Quint
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Schiza S, Schwarz EI, Bonsignore MR, McNicholas WT, Pataka A, Bouloukaki I. Co-existence of OSA and respiratory diseases and the influence of gender. Expert Rev Respir Med 2023; 17:1221-1235. [PMID: 38198636 DOI: 10.1080/17476348.2024.2304065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease. AREAS COVERED This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations. EXPERT OPINION Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich and University of Zurich, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Department, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Medical School, Aristoteleio Panepistemio Thessalonikes Schole Epistemon Ygeias, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
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Spicuzza L, Sambataro G, Schisano M, Ielo G, Mancuso S, Vancheri C. Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea. Sleep Breath 2023; 27:1049-1055. [PMID: 36057738 PMCID: PMC10227143 DOI: 10.1007/s11325-022-02702-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/23/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is known as "overlap syndrome" (OS). Patients with OS are usually older than patients with OSA alone, suffer from more profound oxygen desaturation during the obstructive events often accompanied by sustained nocturnal hypoventilation. Although oxygen-enriched positive airway pressure (PAP) is the treatment of choice in these patients, this therapy is often poorly tolerated particularly by the elderly. The aim of this study was to assess the usefulness of nocturnal oxygen therapy via nasal high flow (NHF-OT) as a possible alternative to PAP in patients with OS. METHODS Patients > 65 years old with OS and nocturnal respiratory failure (time spent below SaO2 90% (T90) > 30%) had cardio-respiratory monitoring performed at baseline, during NHF-OT, or during conventional oxygen therapy (COT). RESULTS A total of 40 patients were enrolled in the study. NHF-OT significantly reduced the apnea-hypopnea index (AHI) in all patients compared to baseline and COT. The mean basal AHI was 25.4 ± 8.6. During COT and NHF-OT, the AHI was 19.4 ± 7 and 5.4 ± 4.6, respectively (P < 0.001) and 19 patients reached an AHI < 5 during NHF-OT. The mean nocturnal SaO2% was 86.2 ± 2.6 at baseline and at equivalent FiO2 it significantly increased to 91.8 ± 2.4 during COT and to 93.9 ± 2.5 during NHF-OT (P < 0.001). The T90% was 48.7 ± 20.1 at baseline, 16.8 ± 11.7 during COT, and 8.8 ± 8.0 during NHF-OT (P < 0.001). CONCLUSIONS In elderly patients with OS, nocturnal treatment with NHF-OT significantly reduces obstructive episodes and improves oxygenation. As the treatment is generally well tolerated compared to PAP, NHF-OT may be a possible alternative therapy in this subgroup of patients.
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Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- UO Pneumologia, Azienda Policlinico-San Marco, Via S. Sofia, 95123, Catania, Italy.
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Matteo Schisano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Ielo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Mancuso
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Czerwaty K, Dżaman K, Sobczyk KM, Sikorska KI. The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review. Biomedicines 2022; 11:biomedicines11010016. [PMID: 36672523 PMCID: PMC9856172 DOI: 10.3390/biomedicines11010016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases that strongly impact the quality and length of life. Their coexistence is determined by overlap syndrome (OS). This systematic review aims to define the significance of these comorbidities according to the current state of knowledge. For this systematic review, we searched PubMed, Scopus, and Cochrane for studies published between 2018 and 26 October 2022, to find original, observational, human studies published in English, where the diagnosis of COPD was according to the Global Initiative for Obstructive Lung Disease guidelines and the diagnosis of OSA was based on polysomnography. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool for cohort and case-control studies, as well as its modification for cross-sectional studies. Of the 1548 records identified, 38 were eligible and included in this systematic review. The included studies covered a total population of 27,064 participants. This paper summarizes the most important, up-to-date information regarding OS, including the prevalence, meaning of age/gender/body mass index, polysomnography findings, pulmonary function, comorbidities, predicting OSA among COPD patients, and treatment of this syndrome.
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Clímaco DCS, Lustosa TC, de F P MV, Lins-Filho OL, Rodrigues VK, de Oliveira Neto LDAP, Feitosa ADM, Queiroga Júnior FJP, Cabral MM, Pedrosa RP. Is obstructive sleep apnea associated with increased arterial stiffness in patients with COPD? Sleep Breath 2022; 27:765-770. [PMID: 35538181 DOI: 10.1007/s11325-022-02635-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate arterial stiffness, a predictor of vascular damage was assessed by means of pulse wave velocity (PWV) in patients with chronic obstructive pulmonary disease (COPD) and comorbid obstructive sleep apnea (OSA), namely overlap syndrome (OS). METHODS Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography in the laboratory. A clinical assessment was performed according to a strict protocol, including two COPD questionnaires: the COPD assessment test and the modified Medical Research Council scale. COPD severity was graded according to the guidelines of the Global Initiative for Chronic Obstructive Lung Disease. Arterial stiffness was assessed by means of PWV, using a standard technique. RESULTS Of 102 patients with COPD, 51 had associated OSA. The OS group had more men than the COPD group (73% vs. 47%, respectively; p < 0.01). Both groups had similar ages (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Hypertension was found in 22% of COPD patients, as opposed to 17% patients in the OS group (p = 0.29). High PWV values were present in 42% of the patients. Patients with COPD and OS had the same PWV values (9.8 vs. 10.5 m/s, p = 0.34). There were no differences in central blood pressure, peripheral blood pressure, and augmentation index between the two groups (p > 0.05). CONCLUSION High PWV values were frequently observed in patients with COPD. However, there was no difference in PWV between patients with OS and those with COPD alone.
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Affiliation(s)
- Danielle Cristina Silva Clímaco
- Pulmonology Clinic, Hospital Otávio de Freitas, Rua Aprígio Guimarães s/n, Pernambuco, Tejipió, Recife, Brazil.
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil.
| | - Thais C Lustosa
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Marcus Vinícius de F P
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Ozeas L Lins-Filho
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Valesca Kehrle Rodrigues
- Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, s/n, Pernambuco, Santo Amaro, Recife, Brazil
| | | | - Audes Diógenes Magalhães Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | | | - Marília Montenegro Cabral
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Rodrigo P Pedrosa
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
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Clímaco DCS, Lustosa TC, Silva MVDFP, Lins-Filho OL, Rodrigues VK, Oliveira-Neto LDAPD, Feitosa ADM, Queiroga FJP, Cabral MM, Pedrosa RP. Sleep quality in COPD patients: correlation with disease severity and health status. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210340. [PMID: 35508063 PMCID: PMC9064624 DOI: 10.36416/1806-3756/e20210340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
Objective: To evaluate clinical predictors of poor sleep quality in COPD patients with and without obstructive sleep apnea (OSA). Methods: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography; for sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI); and for disease impact by means of the COPD Assessment Test. COPD severity was graded in accordance with the 2020 GOLD guidelines. Predictors of poor sleep quality were evaluated by multivariate logistic regression analysis. Results: We studied 51 patients with COPD alone and 51 patients with COPD and OSA. Both groups had similar age (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Poor sleep quality was present in 74.8% of the study participants, with no significant difference between COPD patients with and without OSA regarding PSQI scores (p = 0.73). Polysomnography showed increased stage 1 non-rapid eye movement sleep and arousal index, as well as reduced sleep efficiency and stage 3 non-rapid eye movement sleep, in the group of patients with COPD and OSA (p < 0.05). Independent predictors of poor sleep quality were GOLD grade C/D COPD (OR = 6.4; 95% CI, 1.79-23.3; p < 0.01), a COPD Assessment Test score ≥ 10 (OR = 12.3; 95% CI, 4.1-36.5; p < 0.01), and lowest SaO2 < 80% (p < 0.0001). Conclusions: Poor sleep quality is quite common in patients with COPD and is associated with severe COPD and poor health status, having a negative impact on overall quality of life. Despite changes in polysomnography, OSA appears to have no impact on subjective sleep quality in COPD patients.
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Affiliation(s)
- Danielle Cristina Silva Clímaco
- . Clínica de Pneumologia, Hospital Otávio de Freitas, Recife (PE) Brasil.,. Laboratório do Sono e Coração, Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil
| | - Thais C Lustosa
- . Laboratório do Sono e Coração, Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil
| | | | - Ozeas L Lins-Filho
- . Laboratório do Sono e Coração, Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil
| | | | | | | | | | - Marília Montenegro Cabral
- . Laboratório do Sono e Coração, Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil
| | - Rodrigo P Pedrosa
- . Laboratório do Sono e Coração, Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil.,. Pronto-Socorro Cardiológico Universitário de Pernambuco - PROCAPE - Universidade de Pernambuco, Recife (PE) Brasil
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Liu W, Zhou L, Zhao D, Wu X, Yue F, Yang H, Jin M, Xiong M, Hu K. Development and Validation of a Prognostic Nomogram in Lung Cancer With Obstructive Sleep Apnea Syndrome. Front Med (Lausanne) 2022; 9:810907. [PMID: 35372417 PMCID: PMC8971712 DOI: 10.3389/fmed.2022.810907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
To analyze the prognostic factors and survival rate of lung cancer patients with obstructive sleep apnea (OSA) by nomogram. The nomogram was established by a development cohort (n = 90), and the validation cohort included 38 patients. Factors in the nomogram were identified by Cox hazard analysis. We tested the accuracy of the nomograms by discrimination and calibration, and plotted decision curves to assess the benefits of nomogram-assisted decisions. There were significant difference in sex, apnea hypopnea index (AHI), Tumor Node Metastasis (TNM), coronary heart disease, lowest arterial oxygen saturation [LSpO2 (%)], oxygen below 90% of the time [T90% (min)], the percentage of the total recorded time spend below 90% oxygen saturation (TS90%) and oxygen desaturation index (ODI4) between lung cancer subgroup and lung cancer with OSA subgroup (P < 0.05). Lung cancer patients with OSA age, AHI, TNM, cancer types, BMI and ODI4 were independent prognostic factor. Based on these six factors, a nomogram model was established. The c-index of internal verification was 0.802 (95% CI 0.767–0.885). The ROC curve analysis for the nomogram show 1-year survival (AUC = 0.827), 3-year survival (AUC = 0.867), 5-year survival (AUC = 0.801) in the development cohort were good accuracy. The calibration curve shows that this prediction model is in good agreement. Decision curve analysis (DCA) suggests that the net benefit of decision-making with this nomogram is higher, especially in the probability interval of <20% threshold. The nomogram can predict the prognosis of patients and guide individualized treatment.
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Affiliation(s)
- Wei Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haizhen Yang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Meng Jin
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Ke Hu
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