Alcohol use predicts ER visits in individuals with alpha-1 antitrypsin deficiency (AATD) associated COPD

Serum Proteins Associated with Emphysema Progression in Severe Alpha-1 Antitrypsin Deficiency

Computed tomography (CT) lung density is an accepted biomarker for emphysema in alpha-1 antitrypsin deficiency (AATD), although concerns for radiation exposure limit its longitudinal use. Serum proteins associated with emphysema, particularly in early disease, may provide additional pathogenic insights. We investigated whether distinct proteomic signatures characterize the presence and progression of emphysema in individuals with severe AATD and normal forced expiratory volume in 1 second (FEV₁). QUANTitative lung CT UnMasking emphysema progression in AATD (QUANTUM-1) is a multicenter, prospective 3-year study of 49 adults with severe AATD and FEV₁ post-bronchodilator values (Post-BD) ≥ 80% predicted. All participants received chest CT, serial spirometry, and contributed to the serum biobank. Volumetric imaging display and analysis (VIDA) software defined the baseline 15^th percentile density (PD15) which was indexed to CT-derived total lung capacity (TLC). We measured 317 proteins using a multiplexed immunoassay (Myriad Discovery MAP^® panel) in 31 individuals with a complete dataset. We analyzed associations between initial PD15/TLC, PD15/TLC annual decline, body mass index (BMI), and protein levels using Pearson's product moment correlation. C-reactive protein (CRP), adipocyte fatty acid-binding protein (AFBP), leptin, and tissue plasminogen activator (tPA) were found to be associated with baseline emphysema and all but leptin were associated with emphysema progression after adjustments were made for age and sex. All 4 proteins were associated with BMI after further adjustment for multiple comparisons was made. The relationship between these proteins and BMI, and further validation of these findings in replicative cohorts require additional studies.

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

BACKGROUND

There is a growing understanding of the prevalence and impact of psychological disorders on COPD. However, the role of these disorders in early readmission is unclear.

METHODS

We analyzed data from 5% fee-for-service Medicare beneficiaries diagnosed with COPD (International Classification of Diseases, Ninth Revision code, 491.xx, 492.xx, 493.xx, and 496.xx) between 2001 and 2011 who were hospitalized with a primary discharge diagnosis of COPD or a primary discharge diagnosis of respiratory failure (518.xx and 799.1) with secondary diagnosis of COPD. We hypothesized that such psychological disorders as depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with an increased risk of 30-day readmission in patients hospitalized for COPD.

RESULTS

Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare beneficiaries. Of these, 30,218 (22.30%) patients had one or more psychological disorders. In multivariate analyses, odds of 30-day readmission were higher in patients with COPD who had depression (OR, 1.34; 95% CI, 1.29-1.39), anxiety (OR, 1.43; 95% CI, 1.37-1.50), psychosis (OR, 1.18; 95% CI, 1.10-1.27), alcohol abuse (OR, 1.30; 95% CI, 1.15-1.47), and drug abuse (OR, 1.29; 95% CI, 1.11-1.50) compared with those who did not have these disorders. These psychological disorders increased amount of variation in 30-day readmission attributed to patient characteristics by 37%.

CONCLUSIONS

Psychological disorders like depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.