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Li L, Wang L, Zhang L, Zhao C, Wang Q, Liu Y, Liu L, Cheng G, Yuan L, Feng M, Wang G, Kang D, Zhang X. Frailty and in-hospital mortality in older patients with acute exacerbation of COPD: A real-world prospective cohort study. Respir Med 2024; 228:107663. [PMID: 38763445 DOI: 10.1016/j.rmed.2024.107663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Few evidence exists for the effect of frailty on the patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). OBJECTIVE We explored the link between frailty and in-hospital death in AECOPD, and whether laboratory indicators mediate this association. METHODS This was a real-world prospective cohort study including older patients with AECOPD, consisting of two cohorts: a training set (n = 1356) and a validation set (n = 478). The independent prognostic factors, including frail status, were determined by multivariate logistic regression analysis. The relationship between frailty and in-hospital mortality was estimated by multivariable Cox regression. A nomogram was developed to provide clinicians with a quantitative tool to predict the risk of in-hospital death. Mediation analyses for frailty and in-hospital death were conducted. RESULTS The training set included 1356 patients (aged 86.7 ± 6.6 years), and 25.0 % of them were frail. A nomogram model was created, including ten independent variables: age, sex, frailty, COPD grades, severity of exacerbation, mean arterial pressure (MAP), Charlson Comorbidity Index (CCI), Interleukin-6 (IL-6), albumin, and troponin T (TPN-T). The area under the receiver operating characteristic curve (ROCs) was 0.862 and 0.845 for the training set and validation set, respectively. Patients with frailty had a higher risk of in-hospital death than those without frailty (HR,1.83, 95%CI: 1.14, 2.94; p = 0.013). Furthermore, CRP and albumin mediated the associations between frailty and in-hospital death. CONCLUSIONS Frailty may be an adverse prognostic factor for older patients admitted with AECOPD. CRP and albumin may be part of the immunoinflammatory mechanism between frailty and in-hospital death.
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Affiliation(s)
- Li Li
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Wang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chongyang Zhao
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Wang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Gaiping Cheng
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Lishan Yuan
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Min Feng
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China; School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia; Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Sydney, Australia
| | - Gang Wang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Deying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China; Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China.
| | - Xin Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
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Zhou R, Pan D. Association between admission heart rate and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: a retrospective cohort study. BMC Pulm Med 2024; 24:111. [PMID: 38443791 PMCID: PMC10913584 DOI: 10.1186/s12890-024-02934-w] [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: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure (RF) is a chronic respiratory disease that seriously endangers human health. This study aimed to specifically evaluate the relationship between admission heart rate (AHR) and in-hospital mortality in patients with combined AECOPD and RF to better inform clinical treatment. METHODS This retrospective cohort study included 397 patients admitted to a Chinese hospital between January 2021 and March 2023. The primary outcome measure was all-cause in-hospital mortality. Multivariate logistic regression analyses were performed to calculate adjusted hazard ratios (OR) with corresponding 95% confidence intervals (CI), and curve fitting and threshold effect were performed to address nonlinear relationships. RESULTS In total, 397 patients with AECOPD/RF were screened. The mean (± SD) age of the study cohort was 72.6 ± 9.5 years, approximately 49.4% was female, and the overall in-hospital mortality rate was 5%. Multivariate logistic regression analysis and smooth curve fitting revealed a nonlinear association between AHR and in-hospital mortality in the study population, with 100 beats/min representing the inflection point. Left of the inflection point, the effect size (OR) was 0.474 (95% CI 0.016 ~ 13.683; p = 0.6635). On the right side, each 1 beat/min increase in AHR resulted in an effect size (OR) of 1.094 (95% CI 1.01 ~ 1.186; p = 0.0281). CONCLUSIONS Results of the present study demonstrated a nonlinear relationship between AHR and in-hospital mortality in patients with AECOPD/RF. When AHR was < 100 beats/min, it was not statistically significant; however, AHR > 100 beats/min was a predictor of potential mortality, which increased by 9.4% for every 1 beat/min increase in AHR.
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Affiliation(s)
- Ruoqing Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Dianzhu Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
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王 子, 莫 佳, 张 蒙, 廖 纪. [Epidemiology and hospitalization costs analysis of female inpatients with acute exacerbation of chronic obstructive pulmonary disease in Beijing from 2013 to 2020]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:1074-1081. [PMID: 38101792 PMCID: PMC10723980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To study epidemiological characteristics and hospitalization costs of female inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing. METHODS A retrospective study was conducted to analyze electronic hospitalization summary reports of female inpatients with AECOPD in Beijing from 2013 to 2020. Clinical characteristics (age distribution and comorbidities), epidemiological characteristics (temporal and spatial distribution characteristics), hospi-talization times and costs of patients were described. RESULTS A total of 57 911 subjects in 166 hospitals were included in this study, with a mean age of (78.84±8.59) years and the highest number of patients aged 80-89 years (49.06%), followed by patients aged 70-79 years (31.08%), and the lowest number of patients under 50 years (0.41%). The proportions of patients with coronary heart disease, hypertension and heart failure were 30.60%, 30.52% and 26.54% respectively. The median number of daily hospitalizations during the study period was 18 (IQR: 16). The number of daily hospitalizations for AECOPD showed an overall growth trend over the eight years from 2013 to 2020, starting to increase significantly in 2015 and continuing to increase until 2019, then followed by a decline in 2020. The proportion of inpatient admissions was higher in winter and spring (54.09%) than that in summer and autumn (45.91%). The top three districts in terms of the proportion of total inpatient admissions were Xicheng district (14.18%), Chaoyang district (14.12%) and Fengtai district (13.47%). The density of inpatients was relatively high in the western regions, central urban areas and northeastern regions of the city, while the density of inpatients was relatively low in the near suburbs. The median number of hospital days for female patients with AECOPD was 12 days, and the median hospital costs was CNY 20 648.37. Patients from urban areas had longer hospitalization times and higher hospitalization costs than those from suburban areas (P < 0.001). Western medicine expenses accounted for the largest proportion of total hospital expenses (33.32%). During the study period, hospitalization costs exhibited an overall pattern of initial growth, followed by subsequent decline, eventually stabilizing. The differences in hospitalization costs among the patients with different comorbidities were significant. CONCLUSION Female hospitalized patients with AECOPD in Beijing were older than 70 years, often complicated by cardiovascular disease. AECOPD occurred mainly in winter and spring, with regional differences. The hospitalization costs were closely associated with the patients' age, comorbidities, and the geographicical region.
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Affiliation(s)
- 子恺 王
- 北京大学第一医院呼吸和危重症医学科,北京 100034Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
| | - 佳丽 莫
- 北京大学第一医院儿科,北京 100034Departmant of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - 蒙 张
- 北京大学第一医院呼吸和危重症医学科,北京 100034Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
| | - 纪萍 廖
- 北京大学第一医院呼吸和危重症医学科,北京 100034Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
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Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
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Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Naser AY, Dairi MS, Alwafi H, Ashoor DS, Qadus S, Aldhahir AM, Alqarni AA, Elrefaey WA, Qanash S, Hafiz W, Alqahtani JS, Ekram R, Abuirmeileh A, Jarab AS, Badr OI. The rate of ward to intensive care transfer and its predictors among hospitalized COPD patients, a retrospective study in a local tertiary center in Saudi Arabia. BMC Pulm Med 2023; 23:464. [PMID: 37993810 PMCID: PMC10666425 DOI: 10.1186/s12890-023-02775-z] [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: 08/18/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients. METHODS An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis. RESULTS A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41-2.62)), smoking (OR; 1.60 (1.17-2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45-2.71)), Diabetes mellitus (OR; 1.42 (1.04-1.93)), GERD (OR; 2.81 (1.99-3.96)), Ischemic heart disease (OR; 3.22 (2.19-4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38-3.33)), stroke (OR; 4.51 (2.20-9.26))) were predictors of ICU admissions among patients with COPD. CONCLUSIONS Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Mohammad Saleh Dairi
- Pharmacology and Toxicology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Hassan Alwafi
- Pharmacology and Toxicology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia.
| | - Deema Sami Ashoor
- Pharmacology and Toxicology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Sami Qadus
- Department of Pharmacy, Faculty of health sciences, American University of Madaba, Madaba, Jordan
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wael Aly Elrefaey
- Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, Saudi Arabia
| | - Sultan Qanash
- Department of Internal Medicine, National Guard Hospital, Jeddah, Saudi Arabia
| | - Waleed Hafiz
- Pharmacology and Toxicology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Rakan Ekram
- School of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Anan S Jarab
- College of Pharmacy, AL Ain University, P.O. Box 112612, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, P.O. Box 112612, Abu Dhabi, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Omaima Ibrahim Badr
- Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, Saudi Arabia
- Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
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Nava S. Non-Invasive Respiratory Support: How to Get It Right in Clinical Medicine. J Clin Med 2023; 12:5243. [PMID: 37629286 PMCID: PMC10455632 DOI: 10.3390/jcm12165243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
It is with great pleasure and enthusiasm that I introduce this Special Issue of the Journal of Clinical Medicine, entitled "Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine" [...].
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Affiliation(s)
- Stefano Nava
- Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
- Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Bao LK, Khoa ND, Chi LTK, Anh NT. Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study. J Clin Med 2023; 12:4420. [PMID: 37445455 PMCID: PMC10342446 DOI: 10.3390/jcm12134420] [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: 05/21/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. METHODS We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes. RESULTS 18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely "holding breath for about five seconds or as long as comfortable" and "breathing out gently," were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1-25.5, p = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3-20.1, p = 0.017) were associated with increased odds of using the inhaler correctly. CONCLUSIONS Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD.
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Affiliation(s)
- Le Khac Bao
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Dang Khoa
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Le Thi Kim Chi
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Tuan Anh
- Department of Respiratory, University Medical Center Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
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