Fast Prediction of Deterioration and Death Risk in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using Vital Signs and Admission History: Retrospective Cohort Study

Assessment of Initial Oxygenation Levels of Chronic Obstructive Pulmonary Disease (COPD) and Their Impact on Basis and Vital Tools: Retrospective Cohort Study From India

Introduction Chronic obstructive pulmonary disease (COPD) is a significant contributor to global morbidity and mortality. Despite well-established management protocols, treatment remains suboptimal due to high costs and mortality rates. This study aims to compare the impact of initial oxygenation status, Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF), and National Early Warning Score 2 (NEWS2) scores on management outcomes in COPD patients. Methods In this retrospective study, we analyzed 100 consecutive patients admitted for COPD exacerbation. Patients were categorized into four groups based on admission oxygen saturation (SpO2): Group A (≤87%), Group B (88-92%), Group C (93-96%), and Group D (97-100%). Data collected included oxygen saturation, chest X-rays, laboratory findings, DECAF, and NEWS2 scores. Results The mean age of the cohort was 68.54 ± 10.95 years. Groups A and B (SpO2 ≤ 93-96%) had significantly higher rates of hypercapnia (50%), non-invasive ventilation use (63%), and prolonged hospital stays (15%) compared to Groups C and D (p < 0.05). A strong correlation was found between initial SpO2 and both DECAF (p = 0.04) and NEWS2 (p = 0.001) scores. DECAF correlated with arterial oxygen (pO2) and carbon dioxide (pCO2) levels, while NEWS2 was linked with pCO2, albumin, and white blood cell (WBC) counts (p < 0.05). Both DECAF and NEWS2 predicted longer hospital stays (p < 0.05). Conclusion An initial SpO2 ≤ 93-96% was an independent predictor of higher hypercapnia rates, extended hospitalization, and increased use of non-invasive ventilation. This emphasizes the importance of initial oxygenation status in the clinical assessment of COPD patients.

Prognostic risk prediction model for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD): a systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition and a leading cause of mortality, with acute exacerbations (AECOPD) significantly complicating its management and prognosis. Despite the development of various prognostic prediction models for patients with AECOPD, their performance and clinical applicability remain unclear, necessitating a systematic review to evaluate these models and provide guidance for their future improvement and clinical use.

METHOD

PubMed, Web of Science, CINAHL, Scopus, EMBASE, and Medline were searched for studies published from their inception until February 5, 2024. Data extraction and evaluation were conducted using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction model Risk Of Bias Assessment Tool (PROBAST) was employed to assess the risk of bias and applicability of the models.

RESULTS

After deduplication and screening 5942 retrieved articles, 46 studies comprising 53 models were included. Of these, 17 (37.0%) studies developed from studies conducted in China. All models were based on cohort studies. Mortality was the predicted outcome in 27 (50.9%) models. Logistic regression was used in 41 (77.4%) models, while machine learning methods were employed in 9 (17.0%) models. The median (minimum, maximum) sample size for model development was 672 (106, 150,035). The median (minimum, maximum) number of predictors per model was 5 (2, 42). Frequently used predictors included age (n = 28), dyspnea severity scores (n = 12), and PaCO2 (n = 11). The pooled AUC was 0.80 for mortality prediction models and 0.84 for hospitalization-related outcomes. 52 models have a high overall risk of bias, and all models were judged to have low concern regarding applicability. Major sources of bias included insufficient sample sizes (83.0%), reliance on univariate analysis for predictor selection (73.6%), inappropriate internal and external validation methods (54.7%), inappropriate inclusion and exclusion criteria for study subjects (50.9%) and so on. The only model with low bias was the PEARL score.

CONCLUSION

Current prognostic risk prediction models for patients with AECOPD generally exhibit high bias. Future efforts should standardize model development and validation methods, and develop widely usable clinical models.

Logistic Regression Analysis of Clinical Characteristics for Differentiation of Chronic Obstructive Pulmonary Disease Severity

Background

This study aimed to investigate the predictive value of general clinical data, blood test indexes, and ventilation function test indexes on the severity of chronic obstructive pulmonary disease (COPD).

Methods

A total of 141 clinical characteristics of COPD patients admitted to our hospital were collected. A mild-to-moderate group and a severe group were classified depending on the severity of COPD, and their baseline data were compared. The predictive factors of severe COPD were analyzed by univariate and multivariate logistic regression, and the nomogram model of severe COPD was constructed. The clinical variables, including gender, height, weight, body mass index (BMI), age, course, diabetes, hypertension, smoking history, WBC, NEUT, lymphocyte count (LY), MONO, eosinophil count (EOS), PLT, mean platelet volume (MPV), platelet distribution width (PDW), partial pressure of oxygen (PaO₂), and PaCO₂, were collected.

Results

There were 67 mild-to-moderate COPD patients and 74 severe COPD patients in this study cohort. Severe COPD had a higher white blood cell count (WBC), neutrophil count (NEUT), monocyte count (MONO), platelet count (PLT), neutrophil to lymphocyte ratio (NLR), and a lower partial pressure of carbon dioxide (PaCO₂). Univariate logistic regression analysis showed that WBC, NEUT, MONO, PLT, and NLR were contributing factors of severe COPD, while PaCO₂ was an unfavorable factor of severe COPD. Enter, forward, backward, and stepwise multivariate logistic regression analyses all showed that NEUT and PLT were independent contributing factors to severe COPD. Moreover, the nomogram model had good predictive ability, with an area under the curve (AUC) of the receiver operating characteristic (ROC) curve being 0.881. Good calibration and clinical utility were validated through the calibration plot and the decision curve analysis (DCA) plot, respectively.

Conclusion

The severity of COPD was correlated with NEUT and PLT, and the nomogram model based on these factors had good predictive performance.

Efficacy of oseltamivir compared with zanamivir in COPD patients with seasonal influenza virus infection: a randomized controlled trial

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P>0.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.

Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

BACKGROUND

Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established.

AIMS

To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge.

METHODS

Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated.

RESULTS

At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW's in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality.

CONCLUSIONS

HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.