Evaluation of ghrelin level and appetite regulation in patients with acute exacerbations of chronic obstructive pulmonary disease

Symptom Network and Subgroup Analysis in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Purpose

This study aims to construct a contemporaneous symptom network of inpatients with Exacerbation of Chronic Obstructive Pulmonary Disease (ECOPD) based on the symptom cluster, identify core and bridge symptoms, and patient subgroups with different symptom clusters based on individual differences in the intensity of patient symptom experiences.

Patients and Methods

This study used convenience sampling to collect demographic, symptom, auxiliary examination, and prognosis information of 208 inpatients with ECOPD from April 2022 to October 2023. The data underwent exploratory factor analysis (EFA), symptom network analysis, latent class analysis (LCA), Spearman correlation analysis, Wilcoxon signed-rank test, single-factor regression and multiple-factor stepwise regression.

Results

In hospitalized patients with ECOPD, symptom network analysis revealed that loss of appetite was the core symptom, while chest distress was the bridge symptom. Through LCA analysis, two symptom subgroups were identified: a high-symptom group (53.8%) and a low-symptom group (46.2%). This suggests that there is significant heterogeneity in symptom experience among ECOPD individuals. Patients in the high-symptom group had a higher probability of experiencing symptom clusters related to nutrition-sleep.

Conclusion

The combination of symptom network analysis and LCA comprehensively captures the symptom/symptom cluster characteristics and accounts for the heterogeneity of ECOPD patients from both individual and group perspectives. This study identifies core symptoms, bridge symptoms, and symptom subgroups, offering valuable insights for precision symptom management in ECOPD.

Effect of cardiopulmonary rehabilitation nursing on exercise endurance and quality of life of stable COPD patients

OBJECTIVE

To investigate the effect of cardiopulmonary rehabilitation nursing on exercise endurance and quality of life (QOL) of patients with stable chronic obstructive pulmonary disease (COPD).

METHODS

This randomized trial was conducted on 84 subjects with stable COPD recruited in our hospital from March 2018 to December 2019 and they were divied into the observation group (n=42) and the control group (n=42) based on nursing methods. The control group adopted conventional nursing, and the observation group received cardiopulmonary rehabilitation nursing in addition to conventional method. The exercise endurance, cardiopulmonary function, psychological state, QOL and nursing satisfaction were compared at pre- and post-nursing care.

RESULTS

Before nursing, no notable difference was observed in 6 min walking distance (6MWD), deep inspiratory volume (IC), left ventricular ejection fraction (LVEF), forced vital capacity (FVC), Forced expiratory volume in one second (FEV1), FEV1/FVC, Self-Rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) score, QOL, scores of symptoms, activities and impact in these two groups (P>0.05). After nursing, 6MWD and IC of observation group were remarkably higher (P<0.05); LVEF, FVC, FEV1 and FEV1/FVC in the observation group were remarkably higher (P<0.05); SAS and SDS scores of two groups decreased, and the observation group was notably lower (P<0.05); the QOL scores of symptoms, activities and effects of two groups were notably reduced, and the observation group was remarkably lower (P<0.05). The nursing satisfaction of the observation group was considerably higher than the control group (95.23% vs 76.19%) (P<0.05).

CONCLUSION

Cardiopulmonary rehabilitation nursing has a remarkable effect on COPD patients in stable stage, which can enhance patients' exercise endurance and lung function, reduce adverse emotions, and improve patients' QOL and nursing satisfaction.

Elevated circulating ghrelin in patients with COPD: A meta-analysis

Ghrelin, an endogenous ligand for growth hormone secretagogue receptor, has been implicated in chronic obstructive pulmonary disease (COPD). Recently, several studies reported inconsistent levels of ghrelin in plasma/serum of COPD patients. This meta-analysis aims to determine the circulating level of ghrelin in COPD. Published case–control or cohort studies were retrieved from Pubmed and Embase databases. Pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated in a random-effects model. Nine studies involving 515 subjects were included. Pooled effect size showed that circulating ghrelin levels were significantly enhanced in COPD patients compared with those in controls (SMD: 0.83, 95% CI: 0.04 to 1.62, p = 0.039). Noticeably, five studies stratified for body mass index in COPD group and we further found ghrelin levels were significantly higher in underweight COPD patients than those in normal weight cases (SMD: 1.52, 95% CI: 0.43 to 2.61, p = 0.006). However, no significant difference regarding ghrelin levels was indicated between normal weight COPD and controls (SMD: 0.64, 95% CI: −0.36 to 1.63, p = 0.210). In this meta-analysis, circulating level of ghrelin is significantly elevated in patients with COPD, especially in those underweight, indicating supplement with exogenous ghrelin could be a therapeutic choice for underweight COPD patients.