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Lang-Stöberl A, Fabikan H, Hochmair M, Kirchbacher K, Rodriguez VM, Ay L, Weinlinger C, Rosenthaler D, Illini O, Müser N, Funk GC, Valipour A. The Landsteiner lung cancer research platform (LALUCA) : Objectives, methodology and implementation of a real-world clinical lung cancer registry. Wien Klin Wochenschr 2024:10.1007/s00508-024-02351-3. [PMID: 38652311 DOI: 10.1007/s00508-024-02351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Lung cancer is a major health burden in Austria; however, limited real-world data exist on the diagnostic and treatment reality of lung cancer patients in Austria. The collection of high-quality data in a clinical setting is needed to gain insights into the real-world diagnostic and therapeutic management of lung cancer patients. METHODS The Karl Landsteiner Institute for Lung Research and Pulmonary Oncology implemented the Landsteiner lung cancer research platform (LALUCA), recruiting unselected lung cancer patients from two high volume centers in Vienna. This article describes the objectives, design, methodology of the registry and the process of implementation. RESULTS A multidisciplinary team of lung cancer specialists created a custom designed variable catalogue for the LALUCA platform consisting of 17 categories with 180 variables. Detailed information on clinical characteristics, diagnostic interventions, molecular pathology as well as curative and palliative treatment modalities are collected. During an implementation phase in 2020, the platform was optimized using the data of 50 patients. Since then a total of 1200 patients have been enrolled. Recruitment for the registry is ongoing with a recruitment rate of approximately 400 patients per year. CONCLUSION The LALUCA registry is a web-based platform for the collection of real-world clinical data of lung cancer patients. Combining a large number of patients with a focus on gathering comprehensive data on diagnosis and treatment, the LALUCA registry provides a tool for investigation, evaluation, and improvement of the clinical management, survival and quality of care of Austrian lung cancer patients.
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Affiliation(s)
- Anna Lang-Stöberl
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria.
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Maximilan Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Klaus Kirchbacher
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Vikaela Mania Rodriguez
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Leya Ay
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - David Rosenthaler
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Oliver Illini
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Nino Müser
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Georg-Christian Funk
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Arschang Valipour
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
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Vafai-Tabrizi F, Schwab U, Brecht S, Funk GC. Adjustments to maintenance therapy and the reasoning behind them among COPD outpatients in Austria: the STEP study. ERJ Open Res 2024; 10:00615-2023. [PMID: 38333644 PMCID: PMC10851946 DOI: 10.1183/23120541.00615-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/08/2023] [Indexed: 02/10/2024] Open
Abstract
Background Adjustments to COPD maintenance treatment are based on different guidelines. In Austria, there is a lack of real-world data on treatment adjustments of COPD outpatients and their underlying rationale. The STEP study characterised change patterns of pharmacological maintenance therapy in COPD outpatients in predefined categories of step-up, step-down and switch, the underlying reasons, and predictors in clinical routine in Austria. Methods STEP was a single-visit non-interventional study in Austria. 77 pulmonologists based in outpatient clinics documented previous and adapted COPD therapy, reason for change, patient characteristics, COPD phenotype, and lung function. Patients' COPD symptom burden was assessed by using the COPD Assessment Test (CAT). Predictors for therapy changes were identified. Results 1137 patients were studied (mean±sd age 67±10 years; 56.9% male; mean forced expiratory volume in 1 s 56.3% predicted; Global Initiative for Chronic Obstructive Lung Disease B and E stages 66% and 19%, respectively; mean CAT score 17.5). Therapy step-up was observed in 59.3%, treatment switch in 21.7% and step-down in 19.0% of patients. Triple therapy comprised the biggest proportion of inhalation treatment (53.3%). Physicians reported lung function, symptom burden and exacerbations as the main reasons for step-up or step-down, whereas switches within the same treatment class were predominantly caused by device issues. Predictors for step-up were comorbid asthma and exacerbations among others. Conclusions STEP was the first study to investigate COPD therapy changes in clinical routine in Austria. The most frequent treatment adjustment was step-up, followed by treatment switch and step-down. Symptom burden, stable or improved lung function and inhalation device handling were the most frequently given reasons for adjustments.
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Affiliation(s)
- Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and 2nd Medical Department with Pneumology, Klinik Ottakring, Vienna, Austria
| | | | | | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and 2nd Medical Department with Pneumology, Klinik Ottakring, Vienna, Austria
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Horner A, Olschewski H, Hartl S, Valipour A, Funk GC, Studnicka M, Merkle M, Kaiser B, Wallner EM, Brecht S, Lamprecht B. Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2755-2767. [PMID: 38050481 PMCID: PMC10693753 DOI: 10.2147/copd.s435278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
Background Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease. Methods We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain. Results After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV1%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8-10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C - total score and all subscores). Conclusions In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.
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Affiliation(s)
- Andreas Horner
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, Klinik Penzing and Sigmund Freud University, Medical School, Vienna, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Monika Merkle
- Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria
| | - Bernhard Kaiser
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | | | | | - Bernd Lamprecht
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
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Fraughen DD, Ghosh AJ, Hobbs BD, Funk GC, Meischl T, Clarenbach CF, Sievi NA, Schmid-Scherzer K, McElvaney OJ, Murphy MP, Roche AD, Clarke L, Strand M, Vafai-Tabrizi F, Kelly G, Gunaratnam C, Carroll TP, McElvaney NG. Augmentation Therapy for Severe Alpha-1 Antitrypsin Deficiency Improves Survival and Is Decoupled from Spirometric Decline-A Multinational Registry Analysis. Am J Respir Crit Care Med 2023; 208:964-974. [PMID: 37624745 PMCID: PMC10870866 DOI: 10.1164/rccm.202305-0863oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Rationale: Intravenous plasma-purified alpha-1 antitrypsin (IV-AAT) has been used as therapy for alpha-1 antitrypsin deficiency (AATD) since 1987. Previous trials (RAPID and RAPID-OLE) demonstrated efficacy in preserving computed tomography of lung density but no effect on FEV1. This observational study evaluated 615 people with severe AATD from three countries with socialized health care (Ireland, Switzerland, and Austria), where access to standard medical care was equal but access to IV-AAT was not. Objectives: To assess the real-world longitudinal effects of IV-AAT. Methods: Pulmonary function and mortality data were utilized to perform longitudinal analyses on registry participants with severe AATD. Measurements and Main Results: IV-AAT confers a survival benefit in severe AATD (P < 0.001). We uncovered two distinct AATD phenotypes based on an initial respiratory diagnosis: lung index and non-lung index. Lung indexes demonstrated a more rapid FEV1 decline between the ages of 20 and 50 and subsequently entered a plateau phase of minimal decline from 50 onward. Consequentially, IV-AAT had no effect on FEV1 decline, except in patients with a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 lung index. Conclusions: This real-world study demonstrates a survival advantage from IV-AAT. This improved survival is largely decoupled from FEV1 decline. The observation that patients with severe AATD fall into two major phenotypes has implications for clinical trial design where FEV1 is a primary endpoint. Recruits into trials are typically older lung indexes entering the plateau phase and, therefore, unlikely to show spirometric benefits. IV-AAT attenuates spirometric decline in lung indexes in GOLD stage 2, a spirometric group commonly outside current IV-AAT commencement recommendations.
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Affiliation(s)
- Daniel D. Fraughen
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Auyon J. Ghosh
- Division of Pulmonary, Critical Care, and Sleep Medicine, SUNY Upstate University Hospital, Syracuse, New York
| | - Brian D. Hobbs
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Tobias Meischl
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Noriane A. Sievi
- Department of Pneumology, University Hospital Zurich, Zurich, Switzerland
| | - Karin Schmid-Scherzer
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Oliver J. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Mark P. Murphy
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adam D. Roche
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Clarke
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Geraldine Kelly
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Tomás P. Carroll
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
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Semmler G, Scheiner B, Balcar L, Paternostro R, Simbrunner B, Pinter M, Trauner M, Bofill Roig M, Meyer EL, Hofer BS, Mandorfer M, Pinato DJ, Zauner C, Reiberger T, Funk GC. Disturbances in sodium and chloride homeostasis predict outcome in stable and critically ill patients with cirrhosis. Aliment Pharmacol Ther 2023. [PMID: 37016513 DOI: 10.1111/apt.17507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/12/2022] [Accepted: 03/24/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Hyponatremia has prognostic implications in patients with cirrhosis, and thus, has been incorporated in the 2016 MELD-UNOS update. Changes in serum chloride (Cl) are commonly perceived as 'just' parallel to changes in serum sodium, however, are less well-studied in the context of cirrhosis. AIMS To investigate whether serum chloride independently predicts outcomes in patients with advanced chronic liver disease (ACLD) and stable clinical course or with critical illness. METHODS In total, 891 patients with ACLD (defined by hepatic venous pressure gradient [HVPG] ≥6 mm Hg) were followed after HVPG measurement between 2003 and 2020 (ACLD-cohort). In total, 181 critically ill patients with cirrhosis admitted to the ICU between 2004 and 2007 were recruited for the ICU-cohort. Hypo-/hypernatremia (normal: 136-145 mmol/L) and hypo-/hyperchloremia (normal: 98-107 mmol/L) at baseline were assessed. RESULTS ACLD-cohort: 68% of male patients with a median MELD (adjusted for Na) of 11 (9-17) were included (Child-Pugh-stages-A/B/C: 46%/38%/16%) and followed for a median of 60 months. Lower serum chloride (adjusted average HR per mmol/L: 0.965 [95% confidence interval (95% CI): 0.945-0.986], p = 0.001) showed a significant association with hepatic decompensation/liver-related mortality on multivariable Cox regression analysis adjusted for age, HVPG, albumin and MELD. In line, hypochloremia was significantly associated with hepatic decompensation/liver-related mortality (adjusted average HR: 1.656 [95% CI:1.267-2.163], p < 0.001). ICU-cohort: 70% of patients were male, median MELD was 31(22-39) at ICU admission (92% with Child-Pugh-stage-C). After adjusting for hypo-/hypernatremia, MELD, and blood pH, hypochloremia remained independently associated with ICU-mortality (aOR Cl: 3.200 [95%CI: 1.209-8.829], p = 0.021). CONCLUSION Hypochloremia is associated with increased mortality in clinically stable and critically ill patients with cirrhosis independently of MELD including serum sodium.
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Affiliation(s)
- Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rafael Paternostro
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Benedikt Simbrunner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marta Bofill Roig
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Benedikt Silvester Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - David James Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Christian Zauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Georg-Christian Funk
- 2nd Medical Department with Pneumology, Klinik Ottakring, Vienna, Austria
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
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Meischl T, Schmid-Scherzer K, Vafai-Tabrizi F, Wurzinger G, Traunmüller-Wurm E, Kutics K, Rauter M, Grabcanovic-Musija F, Müller S, Kaufmann N, Löffler-Ragg J, Valipour A, Funk GC. The impact of diagnostic delay on survival in alpha-1-antitrypsin deficiency: results from the Austrian Alpha-1 Lung Registry. Respir Res 2023; 24:34. [PMID: 36707810 PMCID: PMC9881325 DOI: 10.1186/s12931-023-02338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Alpha-1-antitrypsin (AAT) deficiency (AATD) is a genetic disorder that can manifest as lung disease. A delay between onset of symptoms and diagnosis of AATD is common and associated with worse clinical status and more advanced disease stage but the influence on survival is unclear. OBJECTIVE We aimed to investigate the impact of diagnostic delay on overall survival (OS) and transplant-free survival (TS) in AATD patients. METHODS We analysed 268 AATD patients from the prospective multi-centre Austrian Alpha-1 Lung (AAL) Registry, employing descriptive statistics, Chi-square-test as well as univariable (Kaplan-Meier plots, log-rank test) and multivariable survival analysis (Cox regression). RESULTS The predominant phenotype was Pi*ZZ (82.1%). At diagnosis, 90.2% had an AAT level below 0.6 g/L. At inclusion, 28.2% had never smoked, 68.0% had quit smoking and 3.8% continued to smoke. Lung disease was diagnosed in 98.5%, thereof most patients were diagnosed with emphysema (63.8%) and/or chronic obstructive pulmonary disease (44.0%). Median diagnostic delay was 5.3 years (inter-quartile range [IQR] 2.2-11.5 years). In multivariable analysis (n = 229), a longer diagnostic delay was significantly associated with worse OS (hazard ratio [HR] 1.61; 95% CI 1.09-2.38; p = 0.016) and TS (HR 1.43; 95% CI 1.08-1.89; p = 0.011), independent from age, smoking status, body mass index (BMI), forced expiratory volume in one second (FEV1) and long-term oxygen treatment. Furthermore, BMI, age and active smoking were significantly associated with worse OS as well as BMI, active smoking and FEV1 were with worse TS. CONCLUSIONS A delayed diagnosis was associated with significantly worse OS and TS. Screening should be improved and efforts to ensure early AATD diagnosis should be intensified.
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Affiliation(s)
- Tobias Meischl
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Schmid-Scherzer
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
| | - Florian Vafai-Tabrizi
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
| | - Gert Wurzinger
- Center of Pulmology, LKH Graz II, Standort Enzenbach, Gratwein-Strassengel, Austria
| | - Eva Traunmüller-Wurm
- grid.459707.80000 0004 0522 7001Department of Pulmology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Kristina Kutics
- grid.459707.80000 0004 0522 7001Department of Pulmology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Rauter
- grid.415431.60000 0000 9124 9231Department of Pulmonology, Klinikum Klagenfurt Am Woerthersee, Klagenfurt, Austria
| | | | - Simona Müller
- Department of Pulmonology, Landeskrankenhaus Hohenems, Hohenems, Austria
| | - Norbert Kaufmann
- Division of Gastroenterology, Infectiology and Pneumology, Department of Medicine, LKH Graz II, Graz, Austria
| | - Judith Löffler-Ragg
- grid.5361.10000 0000 8853 2677Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Arschang Valipour
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
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Sundaralingam A, Aujayeb A, Akca B, Tiedeman C, George V, Carling M, Brown J, Banka R, Addala D, Bedawi EO, Hallifax RJ, Iqbal B, Denniston P, Tsakok MT, Kanellakis NI, Vafai-Tabrizi F, Bergman M, Funk GC, Benamore RE, Wrightson JM, Rahman NM. Achieving Molecular Profiling in Pleural Biopsies: A Multicenter, Retrospective Cohort Study. Chest 2022; 163:1328-1339. [PMID: 36410492 DOI: 10.1016/j.chest.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pleural biopsy findings offer greater diagnostic sensitivity in malignant pleural effusions compared with pleural fluid. The adequacy of pleural biopsy techniques in achieving molecular marker status has not been studied, and such information (termed "actionable" histology) is critical in providing a rational, efficient, and evidence-based approach to diagnostic investigation. RESEARCH QUESTION What is the adequacy of various pleural biopsy techniques at providing adequate molecular diagnostic information to guide treatment in malignant pleural effusions? STUDY DESIGN AND METHODS This study analyzed anonymized data on 183 patients from four sites across three countries in whom pleural biopsy results had confirmed a malignant diagnosis and molecular profiling was relevant for the diagnosed cancer type. The primary outcome measure was adequacy of pleural biopsy for achieving molecular marker status. Secondary outcomes included clinical factors predictive of achieving a molecular diagnosis. RESULTS The median age of patients was 71 years (interquartile range, 63-78 years), with 92 of 183 (50%) male. Of the 183 procedures, 105 (57%) were local anesthetic thoracoscopies (LAT), 12 (7%) were CT scan guided, and 66 (36%) were ultrasound guided. Successful molecular marker analysis was associated with mode of biopsy, with LAT having the highst yield and ultrasound-guided biopsy the lowest (LAT vs CT scan guided vs ultrasound guided: LAT yield, 95%; CT scan guided, 86%; and ultrasound guided, 77% [P = .004]). Biopsy technique and size of biopsy sample were independently associated with successful molecular marker analysis. LAT had an adjusted OR for successful diagnosis of 30.16 (95% CI, 3.15-288.56; P = .003) and biopsy sample size an OR of 1.18 (95% CI, 1.02-1.37) per millimeter increase in tissue sample size (P < .03). INTERPRETATION Although previous studies have shown comparable overall diagnostic yields, in the modern era of targeted therapies, this study found that LAT offers far superior results to image-guided techniques at achieving molecular profiling and remains the optimal diagnostic tool.
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Affiliation(s)
- Anand Sundaralingam
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Centre for Respiratory Medicine, and Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Trust, Newcastle, UK
| | - Baki Akca
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Vienna, Austria
| | - Clare Tiedeman
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, NSW, Australia
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, NSW, Australia
| | - Michael Carling
- Respiratory Department, Northumbria Healthcare NHS Trust, Newcastle, UK
| | - Jennifer Brown
- Department of Histopathology, Nuffield Orthopaedic Centre, Oxford, UK
| | - Radhika Banka
- PD Hinduja National Hospital and Medical Research Centre
| | - Dinesh Addala
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Centre for Respiratory Medicine, and Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eihab O Bedawi
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Rob J Hallifax
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Beenish Iqbal
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Poppy Denniston
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria T Tsakok
- Oxford Centre for Respiratory Medicine, and Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nikolaos I Kanellakis
- Nuffield Department of Medicine, Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK; Nuffield Department of Medicine, Laboratory of Pleural and Lung Cancer Translational Research, University of Oxford, Oxford, UK; Nuffield Department of Medicine, and the National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Vienna, Austria
| | - Michael Bergman
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Vienna, Austria
| | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Vienna, Austria
| | - Rachel E Benamore
- Oxford Centre for Respiratory Medicine, and Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John M Wrightson
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Pleural Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK; Nuffield Department of Medicine, Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK; Nuffield Department of Medicine, Laboratory of Pleural and Lung Cancer Translational Research, University of Oxford, Oxford, UK; Nuffield Department of Medicine, and the National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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8
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Mayr AK, Wieser V, Funk GC, Asadi S, Sperk I, Urban MH, Valipour A. Impaired Spontaneous Baroreceptor Reflex Sensitivity in Patients With COPD Compared to Healthy Controls: The Role of Lung Hyperinflation. Front Med (Lausanne) 2022; 8:791410. [PMID: 35047532 PMCID: PMC8761648 DOI: 10.3389/fmed.2021.791410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for cardiovascular disease. This study aimed to investigate the relationship between pulmonary hyperinflation and baroreceptor reflex sensitivity (BRS), a surrogate for cardiovascular risk. Methods: 33 patients with COPD, free from clinical cardiovascular disease, and 12 healthy controls were studied. Participants underwent pulmonary function and non-invasive hemodynamic measurements. BRS was evaluated using the sequence method during resting conditions and mental arithmetic stress testing. Results: Patients with COPD had evidence of airflow obstruction [forced expiratory volume in 1 s predicted (FEV1%) 26.5 (23.3-29.1) vs. 91.5 (82.8-100.8); P < 0.001; geometric means (GM) with 95% confidence interval (CI)] and lung hyperinflation [residual volume/total lung capacity (RV/TLC) 67.7 (64.3-71.3) vs. 41.0 (38.8-44.3); P < 0.001; GM with 95% CI] compared to controls. Spontaneous mean BRS (BRSmean) was significantly lower in COPD, both during rest [5.6 (4.2-6.9) vs. 12.0 (9.1-17.6); P = 0.003; GM with 95% CI] and stress testing [4.4 (3.7-5.3) vs. 9.6 (7.7-12.2); P < 0.001; GM with 95% CI]. Stroke volume (SV) was significantly lower in the patient group [-21.0 ml (-29.4 to -12.6); P < 0.001; difference of the means with 95% CI]. RV/TLC was found to be a predictor of BRS and SV (P < 0.05 for both), independent of resting heart rate. Conclusion: We herewith provide evidence of impaired BRS in patients with COPD. Hyperinflation may influence BRS through alteration of mechanosensitive vagal nerve activity.
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Affiliation(s)
- Anna Katharina Mayr
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Victoria Wieser
- Department of Emergency Medicine, Klinik Hietzing, Vienna, Austria
| | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
| | - Sherwin Asadi
- Department of Pediatrics, Klinik Donaustadt, Vienna, Austria
| | - Irene Sperk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Matthias Helmut Urban
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria
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9
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Funk GC, Nell C, Pokieser W, Thaler B, Rainer G, Valipour A. Organizing pneumonia following Covid19 pneumonia. Wien Klin Wochenschr 2021; 133:979-982. [PMID: 33861398 PMCID: PMC8050821 DOI: 10.1007/s00508-021-01852-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
The potential mid-term and long-term consequences after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are as yet unknown. This is the first report of bronchoscopically verified organizing pneumonia as a complication of coronavirus disease 2019 (Covid19). It caused persisting dyspnea, impaired pulmonary function, and radiological abnormalities over 5 weeks after onset of symptoms. While organizing pneumonia frequently requires treatment with systemic corticosteroids, in this case it resolved spontaneously without treatment after 6 weeks. Healthcare professionals should consider organizing pneumonia in patients with persisting respiratory symptoms after Covid19.
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Affiliation(s)
- Georg-Christian Funk
- 2nd Medical Department with Pneumology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Montleartstraße 37, 1160 Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Caroline Nell
- 2nd Medical Department with Pneumology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Montleartstraße 37, 1160 Vienna, Austria
| | - Wolfgang Pokieser
- Department of Pathology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria
| | - Birgit Thaler
- 2nd Medical Department with Pneumology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria
| | | | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Montleartstraße 37, 1160 Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Brünnerstraße 68, 1210 Vienna, Austria
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10
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Steinacher A, Funk GC, Pöchacker S, Scheinost LM, Eisenburger P. [Blood gas analysis error]. Med Klin Intensivmed Notfmed 2021; 117:57-60. [PMID: 34378058 DOI: 10.1007/s00063-021-00847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Steinacher
- Abteilung für Notfallmedizin, Klinik Floridsdorf, Brünner Straße 68 - D - 3, 1210, Wien, Österreich.
| | - Georg-Christian Funk
- Abteilung für Innere Medizin und Pneumologie, Klinik Ottakring, Wien, Österreich
- Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wien, Österreich
| | - Stefan Pöchacker
- Abteilung für Anästhesie und Intensivmedizin, Toxikologische Intensivstation, Klinik Ottakring, Wien, Österreich
| | | | - Philip Eisenburger
- Abteilung für Notfallmedizin, Klinik Floridsdorf, Brünner Straße 68 - D - 3, 1210, Wien, Österreich.
- Sigmund Freud Universität, Wien, Österreich.
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11
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Urban MH, Mayr AK, Schmidt I, Grasmuk-Siegl E, Burghuber OC, Funk GC. Effects of Dynamic Hyperinflation on Left Ventricular Diastolic Function in Healthy Subjects - A Randomized Controlled Crossover Trial. Front Med (Lausanne) 2021; 8:659108. [PMID: 34017848 PMCID: PMC8129530 DOI: 10.3389/fmed.2021.659108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Diastolic dysfunction of the left ventricle is common in patients with chronic obstructive pulmonary disease (COPD). Dynamic hyperinflation has been suggested as a key determinant of reduced diastolic function in COPD. We aimed to investigate the effects of induced dynamic hyperinflation on left ventricular diastolic function in healthy subjects to exclude other confounding mechanisms associated with COPD. Design: In this randomized controlled crossover trial (NCT03500822, https://www.clinicaltrials.gov/), we induced dynamic hyperinflation using the validated method of expiratory resistance breathing (ERB), which combines tachypnea with expiratory resistance, and compared the results to those of tachypnea alone. Healthy male subjects (n = 14) were randomly assigned to the ERB or control group with subsequent crossover. Mild, moderate, and severe hyperinflation (i.e., ERB1, ERB2, ERB3) were confirmed by intrinsic positive end-expiratory pressure (PEEPi) using an esophageal balloon catheter. The effects on diastolic function of the left ventricle were measured by transthoracic echocardiographic assessment of the heart rate-adjusted transmitral E/A-ratio and E/e'-ratio. Results: We randomly assigned seven participants to the ERB group and seven to the control group (age 26 [24-26] vs. 24 [24-34], p = 0.81). Severe hyperinflation decreased the E/A-ratio compared to the control condition (1.63 [1.49-1.77] vs. 1.85 [0.95-2.75], p = 0.039), and moderate and severe ERB significantly increased the septal E/e'-ratio. No changes in diastolic function were found during mild hyperinflation. PEEPi levels during ERB were inversely correlated with the E/A ratio (regression coefficient = -0.007, p = 0.001). Conclusions: Our data indicate dynamic hyperinflation as a determinant of left ventricular diastolic dysfunction in healthy subjects. Therapeutic reduction of hyperinflation might be a treatable trait to improve diastolic function in patients with COPD.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Otto Wagner Hospital, Ludwig-Boltzmann Institute for Lung Health, Vienna, Austria
| | - Anna Katharina Mayr
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Ingrid Schmidt
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Institute for Physical and Rehabilitation Medicine/Cardiorespiratory Therapy, Klinik Floridsdorf, Vienna, Austria
| | - Erwin Grasmuk-Siegl
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Otto Chris Burghuber
- Otto Wagner Hospital, Ludwig-Boltzmann Institute for Lung Health, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
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12
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Kaufmann CC, Ahmed A, Kassem M, Freynhofer MK, Jäger B, Aicher G, Equiluz-Bruck S, Spiel AO, Funk GC, Gschwantler M, Fasching P, Wojta J, Huber K. Mid-regional pro-atrial natriuretic peptide independently predicts short-term mortality in COVID-19. Eur J Clin Invest 2021; 51:e13531. [PMID: 33657664 PMCID: PMC7995001 DOI: 10.1111/eci.13531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a strong prognostic marker in several inflammatory, respiratory and cardiovascular conditions, but has not been studied in COVID-19 yet. METHODS This prospective, observational study of patients with COVID-19 infection was conducted from 6 June to 26 November 2020 in different wards of a tertiary hospital. MR-proANP, N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive cardiac troponin I levels on admission were collected and tested for their association with disease severity and 28-day mortality. RESULTS A total of 213 eligible patients with COVID-19 were included in the final analyses of whom 13.2% (n = 28) died within 28 days. Median levels of MR-proANP at admission were significantly higher in nonsurvivors (307 pmol/L IQR, [161 - 532] vs 75 pmol/L [IQR, 43 - 153], P < .001) compared to survivors and increased with disease severity and level of hypoxaemia. The area under the ROC curve for MR-proANP predicting 28-day mortality was 0.832 (95% CI 0.753 - 0.912, P < .001). An optimal cut-off point of 160 pmol/L yielded a sensitivity of 82.1% and a specificity of 76.2%. MR-proANP was a significant predictor of 28-day mortality independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (HR 2.77, 95% CI 1.21 - 6.37; P = .016), while NT-proBNP failed to independently predict 28-day mortality and had a numerically lower AUC compared to MR-proANP. CONCLUSION Higher levels of MR-proANP at admission are associated with disease severity of COVID-19 and act as a powerful and independent prognostic marker of 28-day mortality.
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Affiliation(s)
- Christoph C Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Amro Ahmed
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Mona Kassem
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Matthias K Freynhofer
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Bernhard Jäger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Gabriele Aicher
- Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
| | | | - Alexander O Spiel
- Department of Emergency Medicine, Wilhelminenhospital, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilhelminenhospital, Vienna, Austria
| | - Michael Gschwantler
- Department of Gastroenterology and Hepatology, Wilhelminenhospital, Vienna, Austria
| | - Peter Fasching
- Department of Endocrinology and Rheumatology, Wilhelminenhospital, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine 2, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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13
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Papaporfyriou A, Domayer J, Meilinger M, Firlinger I, Funk GC, Setinek U, Kostikas K, Valipour A. Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature. Eur Respir Rev 2021; 30:200115. [PMID: 33408086 PMCID: PMC9488937 DOI: 10.1183/16000617.0115-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/02/2020] [Indexed: 11/05/2022] Open
Abstract
Carcinoid tumours are rare neuroendocrine neoplasms that mostly occur in younger adults with low tendencies to metastasise. Based on their histological characteristics, they are divided into typical and atypical subtypes. The most common presenting symptoms are due to central airway obstruction. The first step in the diagnostic assessment should be a computed tomography (CT) scan, as it provides information both for local tumour extent and lymph node involvement. Bronchoscopy is the main tool for histological confirmation, evaluation of bronchial wall invasion and removal of endobronchial manifestation with subsequent resolution of atelectasis. Endobronchial ultrasound may be necessary to rule out lymph node metastasis. Somatostatin receptor scintigraphy in combination with CT can rule out further metastatic disease.Surgical resection using parenchyma-sparing techniques remains the gold standard for treatment. For selected patients, endobronchial therapy could be an alternative for minimal invasiveness. Long-term follow-up is suggested due to the high likelihood of recurrence.Here, we describe our clinical experience in a 35-year-old male patient who originally presented with haemoptysis and a central polypoid tumour in the left main bronchus revealed by a CT scan. The histological characteristics were indicative of a typical carcinoid. The patient was treated using an endobronchial approach only. No complications and no recurrences have been observed in a follow-up of 2 years.
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Affiliation(s)
- Anastasia Papaporfyriou
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Respiratory Medicine Dept, University of Ioannina Medical School, Ioannina, Greece
| | - Julian Domayer
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Michael Meilinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Irene Firlinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, 4 Medizinische Abteilung, Wilhelminenspital, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | | | - Arschang Valipour
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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14
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Kaufmann CC, Ahmed A, Brunner U, Jäger B, Aicher G, Equiluz-Bruck S, Spiel AO, Funk GC, Gschwantler M, Fasching P, Huber K. Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience. Front Med (Lausanne) 2021; 8:652707. [PMID: 33816532 PMCID: PMC8012506 DOI: 10.3389/fmed.2021.652707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19. Methods: This retrospective, observational study of consecutive patients with COVID-19 was conducted from March 12, 2020 to December 4, 2020 in the Wilhelminenhospital, Vienna, Austria. RDWlevels on admission were collected and tested for their predictive value of 28-day mortality. Results: A total of 423 eligible patients with COVID-19 were included in the final analyses and 15.4% died within 28 days (n = 65). Median levels of RDWwere significantly higher in non-survivors compared to survivors [14.6% (IQR, 13.7–16.3) vs. 13.4% (IQR, 12.7– 14.4), P < 0.001]. Increased RDW was a significant predictor of 28-day mortality [crude odds ratio (OR) 1.717, 95% confidence interval (CI) 1.462–2.017; P = < 0.001], independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (adjusted OR of the final model 1.368, 95% CI 1.126–1.662; P = 0.002). This association remained consistent upon sub-group analysis. Our study data also demonstrate that RDW levels upon admission for COVID-19 were similar to previously recorded, non-COVID-19 associated RDW levels [14.2% (IQR, 13.3–15.7) vs. 14.0% [IQR, 13.2–15.1]; P = 0.187]. Conclusions: In this population, RDWwas a significant, independent prognostic marker of short-term mortality in patients with COVID-19.
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Affiliation(s)
- Christoph C Kaufmann
- Third Medical Department With Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Amro Ahmed
- Third Medical Department With Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Ulrich Brunner
- Third Medical Department With Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Bernhard Jäger
- Third Medical Department With Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Gabriele Aicher
- Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
| | | | - Alexander O Spiel
- Department of Emergency Medicine, Wilhelminenhospital, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilhelminenhospital, Vienna, Austria
| | - Michael Gschwantler
- Department of Gastroenterology and Hepatology, Wilhelminenhospital, Vienna, Austria
| | - Peter Fasching
- Department of Endocrinology and Rheumatology, Wilhelminenhospital, Vienna, Austria
| | - Kurt Huber
- Third Medical Department With Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Sigmund Freud University, Medical School, Vienna, Austria
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15
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Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021; 85:63-67. [PMID: 33358686 DOI: 10.1016/j.ejim.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Disorders of sodium and potassium are common and predictors of adverse outcome. Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia were investigated in emergency patients with community-acquired pneumonia (CAP). METHODS Patients ≥18 years presenting to our emergency department between January 1st 2017 and December 31st 2018 with on-admission electrolyte measurements were included. Chart reviews were performed to identify patients with CAP. RESULTS 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%). Prevalence of hypo- and hypernatremia was significantly increased in patients with compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001; hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia was significantly higher in patients with than without CAP (hypokalemia 15.6% vs. 11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia was significantly associated with longer hospital stay in patients with CAP (regression coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence rates. Use of loop diuretics was an independent predictor for 30-day re-admission (OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038). CONCLUSION Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients. Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an independent predictor of prolonged length of hospital stay. Loop diuretic use was associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Rebecca Gygli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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Eschler CM, Antelo A, Funk GC, Exadaktylos AK, Lindner G. High Fluctuation Between Anticoagulants, Frequent Off-Label Dosing, and No Difference Concerning Outcomes: Results of a Real-Life Cohort Study. Am J Med 2021; 134:e165-e170. [PMID: 33645506 DOI: 10.1016/j.amjmed.2020.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recently published studies indicated a high proportion of patients taking direct oral anticoagulants (DOACs) are off-label under- or overdosed. The present study aimed at investigating whether off-label dosages are corrected over time and whether off-label doses are associated with differences in bleeding rates, ischemic stroke, or venous thromboembolism. METHODS In this retrospective cohort study, patients presenting to our emergency department between January 1 and December 31, 2018, with therapeutic oral anticoagulation were included (ie, vitamin-K antagonists [VKAs], rivaroxaban, apixaban, edoxaban, and dabigatran) and follow-up for a maximum of 2 years until December 31, 2019, was made. Detailed chart reviews were performed for each case concerning characteristics, indication, bleeding complications, or changes in the used substance or dosage. RESULTS We reviewed 2588 consultations of 1228 patients receiving therapeutic oral anticoagulation. During the maximum follow-up period of 2 years vitamin K antagonists and rivaroxaban lost the largest proportions in favor of apixaban. The overall distribution of dosage correctness remained almost unimproved (correct dosing in 62.5%, underdosing in 23.6%, coverdosing in 13.9%).The corresponding outcomes did not differ with respect to bleeding events, ischemic stroke, or venous thromboembolism among various anticoagulants as well as between correct and off-label doses. CONCLUSIONS A rising proportion of existing oral anticoagulation regimes was changed to apixaban, while the proportion of off-label dosages of all oral anticoagulants remained stable. No difference in bleeding rates, de novo strokes, or thromboembolisms was found between anticoagulants as well as between correct and off-label doses.
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Affiliation(s)
- Corinne M Eschler
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Ana Antelo
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
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Ravioli S, Pluess E, Funk GC, Walter P, Schwarz C, Exadaktylos AK, Woitok BK, Lindner G. Dyskalemias in patients with acute kidney injury presenting to the emergency department are common and independent predictors of adverse outcome. Int J Clin Pract 2021; 75:e13653. [PMID: 32770846 DOI: 10.1111/ijcp.13653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No data concerning the prevalence and risk factors of dyskalemia in acute kidney injury (AKI) exist. We investigated (a) prevalence rates, (b) risk factors and (c) outcome of hypo- and hyperkalemia in emergency patients. METHODS In this cross-sectional analysis, all patients admitted to the emergency department of a large public hospital in Switzerland between January 1st 2017 and December 31st 2018 with measurements of creatinine and potassium were included. Baseline characteristics, medication and laboratory data were extracted. Chart reviews were performed to identify patients with a diagnosis of chronic kidney disease (CKD) and to extract their baseline creatinine. For all other patients, the ADQI backformula was used in order to calculate baseline creatinine. AKI was graduated using creatinine criteria of the acute kidney injury network. Binary logistic regression analysis was used to identify risk factors for appearance of hyperkalemia and outcome. RESULTS AKI was found in 8% of patients. Hyperkalemia was present in 13% and hypokalemia in 11% of patients with AKI. AKI stage, potassium-sparing diuretics, ACE inhibitors and underlying CKD were the strongest risk factors for hyperkalemia. Hyperkalemia as well as profound hypokalemia were independently associated with prolonged length of stay and in-hospital mortality. The study is limited by its dependency on chart review data in order to identify patients with chronic kidney disease and by limitations of the ADQI backformula to calculate baseline creatinine. CONCLUSIONS Dyskalemias are common in emergency patients with AKI and are independent risk factors for adverse outcomes. Potassium-sparing diuretics, ACE-inhibitors, AKIN stage and CKD are predictors of hyperkalemia in AKI.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Emanuel Pluess
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Philipp Walter
- Department of Laboratory Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine 1, Landeskrankenhaus Steyr, Steyr, Austria
| | | | - Bertram K Woitok
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Woitok BK, Funk GC, Walter P, Schwarz C, Ravioli S, Lindner G. Dysnatremias in emergency patients with acute kidney injury: A cross-sectional analysis. Am J Emerg Med 2020; 38:2602-2606. [DOI: 10.1016/j.ajem.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/25/2019] [Accepted: 01/04/2020] [Indexed: 01/24/2023] Open
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Urban MH, Mayr AK, Schmidt I, Margulies E, Grasmuk-Siegl E, Burghuber OC, Funk GC. Induction of dynamic hyperinflation by expiratory resistance breathing in healthy subjects - an efficacy and safety study. Exp Physiol 2020; 106:532-543. [PMID: 33174314 PMCID: PMC7894562 DOI: 10.1113/ep088439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
New Findings What is the central question of this study? The study aimed to establish a novel model to study the chronic obstructive pulmonary disease (COPD)‐related cardiopulmonary effects of dynamic hyperinflation in healthy subjects. What is the main finding and its importance? A model of expiratory resistance breathing (ERB) was established in which dynamic hyperinflation was induced in healthy subjects, expressed both by lung volumes and intrathoracic pressures. ERB outperformed existing methods and represents an efficacious model to study cardiopulmonary mechanics of dynamic hyperinflation without potentially confounding factors as present in COPD.
Abstract Dynamic hyperinflation (DH) determines symptoms and prognosis of chronic obstructive pulmonary disease (COPD). The induction of DH is used to study cardiopulmonary mechanics in healthy subjects without COPD‐related confounders like inflammation, hypoxic vasoconstriction and rarefication of pulmonary vasculature. Metronome‐paced tachypnoea (MPT) has proven effective in inducing DH in healthy subjects, but does not account for airflow limitation. We aimed to establish a novel model incorporating airflow limitation by combining tachypnoea with an expiratory airway stenosis. We investigated this expiratory resistance breathing (ERB) model in 14 healthy subjects using different stenosis diameters to assess a dose–response relationship. Via cross‐over design, we compared ERB to MPT in a random sequence. DH was quantified by inspiratory capacity (IC, litres) and intrinsic positive end‐expiratory pressure (PEEPi, cmH2O). ERB induced a stepwise decreasing IC (means (95% CI): tidal breathing: 3.66 (3.45–3.88), ERB 3 mm: 3.33 (1.75–4.91), 2 mm: 2.05 (0.76–3.34), 1.5 mm: 0.73 (0.12–1.58) litres) and increasing PEEPi (tidal breathing: 0.70 (0.50–0.80), ERB 3 mm: 11.1 (7.0–15.2), 2 mm: 22.3 (17.1–27.6), 1.5 mm: 33.4 (3.40–63) cmH2O). All three MPT patterns increased PEEPi, but to a far lesser extent than ERB. No adverse events during ERB were noted. In conclusion, ERB was proven to be a safe and efficacious model for the induction of DH and might be used for the investigation of cardiopulmonary interaction in healthy subjects.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Anna Katharina Mayr
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Ingrid Schmidt
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria
| | | | - Erwin Grasmuk-Siegl
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Otto Chris Burghuber
- Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Wilhelminenspital, Vienna, Austria
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Bakeer M, Funk GC, Valipour A. Chronic obstructive pulmonary disease phenotypes: imprint on pharmacological and non-pharmacological therapy. Ann Transl Med 2020; 8:1472. [PMID: 33313217 PMCID: PMC7723612 DOI: 10.21037/atm-20-2219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease associated with significant morbidity and mortality. Over the past few years, there has been cumulating interest in describing this heterogeneity and using this information to group patients into different COPD phenotypes. The term phenotype is defined as single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes. It describes also the physical appearance or biochemical characteristics which result from the genotype-environment interaction. Furthermore, it clearly identifies subgroups with a significant impact in the prognosis. Recently, approaches to COPD phenotyping have been significantly enhanced in tandem with developments in understanding the disease’s various pathological, clinical and genetic features. This knowledge inspired the researchers to investigate more tailored therapeutic strategies that could not only give a more potent effect but also help to avoid the traditional therapy’s undesirable side effects. Eventually, it could be said that the phenotypic approach to COPD in the last decade had a huge impact on daily practice and management delivered to COPD patients. In this review, we highlight the impact of pharmacological and non-pharmacological treatment options on COPD outcomes, using a personalized treatment strategy based on different phenotypes.
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Affiliation(s)
- Mostafa Bakeer
- Chest Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
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Karolyi M, Pawelka E, Kelani H, Funk GC, Lindner B, Porpaczy C, Publig S, Seitz T, Traugott M, Unterweger M, Zoufaly A, Wenisch C. Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season. Infection 2020; 49:103-110. [PMID: 33090329 DOI: 10.1007/s15010-020-01537-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality. MATERIALS/METHODS In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18 years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas® Liat® POCT. RESULTS 490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75 years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75 years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients. CONCLUSIONS Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75 years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75 years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria.
| | - E Pawelka
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - H Kelani
- Medical University of Vienna (MUW), Vienna, Austria
| | - G C Funk
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - B Lindner
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - C Porpaczy
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - S Publig
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - T Seitz
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Traugott
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Unterweger
- Department for Anesthesia and Surgical Intensive Care, Kaiser-Franz-Josef-Hospital (KFJ), Vienna, Austria
| | - A Zoufaly
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
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Woitok BK, Ravioli S, Funk GC, Lindner G. Characteristics of very elderly patients in the emergency department - A retrospective analysis. Am J Emerg Med 2020; 46:200-203. [PMID: 33069543 DOI: 10.1016/j.ajem.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Elderly people, defined by age 65 years and older, made up 18.45% of the Swiss Population in 2018 and their number is projected to rise continuously. Data investigating specific characteristics of this patient subgroup, especially in the emergency setting, is scarce. METHODS Demographic data of admission records from all patients aged 65 years or older admitted to our emergency department (ED) between January 1st 2015 and December 31st 2018 were investigated. Retrospective chart reviews of patients admitted in 2018 were conducted. Comorbidity burden was assessed by Charlson Comorbidity Index. Risk factors for death, longer hospitalization and placement in a nursing facility were identified by multivariate regression. RESULTS The prevalence of elderly patients (≥65 years) admitted to the ED between 2015 and 2018 was rising from 33% in 2015 to 37.8% in 2018. In 2018 709 patients were 90 years and older (3.6%). Age above 90 years and high comorbidity burden were identified as independent risk factors for death. Polypharmacy, hyponatremia and high comorbidity burden were independent risk factors for longer hospitalizations. Advanced age and high comorbidity burden were independent risk factors for placement in a nursing facility. CONCLUSION The number of elderly patients admitted to our ED is continuously rising. There was no difference in overall disease burden, number of medications and hospital length of stay between octogenarians and nonagenarians. We identified risk factors for mortality, long hospitalizations and need of placement in a nursing facility.
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Affiliation(s)
- Bertram K Woitok
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Svenja Ravioli
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Gregor Lindner
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Abstract
BACKGROUND Acid base and electrolyte disorders are frequently reported in the early period after renal transplantation. No comprehensive data exist on the prevalence and patterns of, and contributing factors to, electrolyte disturbances in patients with stable long-term allograft function. METHODS We analysed 576 renal transplant recipients (serum creatinine level <2.0 mg/dl) in a cross-sectional study to evaluate the prevalence of electrolyte disorders and the risk factors associated with their occurrence. RESULTS A total of 369 patients (64%) of all allograft recipients (n = 576) showed at least one electrolyte and acid base disorder. The most abundant disorder was hypomagnesaemia (25%, n = 143), followed by hyperkalaemia (12.8%, n = 74), hypercalcaemia (12%, n = 69), hypophosphataemia (11.6%, n = 67), metabolic acidosis (11.1%, n = 61) and hyponatraemia (9%, n = 52). All other electrolyte disorders were rare (<6%). In most cases the electrolyte disorders could be classified as mild. Forty percent of the cases had a combined disorder, but without a preferential pattern of combinations. In a multivariate logistic regression analysis, the most important factors contributing significantly to the occurrence of electrolyte disorders were renal function and concomitant medications. CONCLUSION Acid base and electrolyte disorders are frequently observed in stable renal allograft recipients, but are usually mild. A combination of two or more electrolyte abnormalities often occurs, although no predominant pattern of a unique combination of electrolyte disorder is recognizable.  .
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Affiliation(s)
- Georg Beilhack
- Department of Nephrology and Dialysis, Medical University Vienna, Austria
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Christoph Schwarz
- Department of Internal Medicine I, Pyhrn-Eisenwurzenklinikum, Steyr, Austria
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Woitok BK, Büttiker P, Ravioli S, Funk GC, Exadaktylos AK, Lindner G. Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis. BMJ Open 2020; 10:e038079. [PMID: 32978199 PMCID: PMC7520836 DOI: 10.1136/bmjopen-2020-038079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED). DESIGN Retrospective chart review. SETTING Large, interdisciplinary ED of a public hospital. PARTICIPANTS All patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality. RESULTS A total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication. CONCLUSIONS Daily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.
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Affiliation(s)
- Bertram K Woitok
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Petra Büttiker
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilhelminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
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Urban MH, Kreibich N, Gleiss A, Funk GC, Hartl S, Burghuber OC. Effects of roflumilast on arterial stiffness in COPD (ELASTIC): A randomized trial. Respirology 2020; 26:153-160. [PMID: 32725799 DOI: 10.1111/resp.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular risk is substantially increased in patients with COPD and can be quantified via arterial stiffness. The PDE-IV inhibitor roflumilast revealed a potential reduction of COPD-related cardiovascular risk. We aimed to investigate the effects of roflumilast on arterial stiffness by quantification of pulse wave velocity (PWV) in stable COPD. METHODS In this randomized placebo-controlled trial, 80 COPD patients received roflumilast or placebo for 24 weeks. The primary outcome was the change in cf-PWV. Secondary outcomes comprised markers of vascular function (e.g. Aix and RHI), systemic inflammation (e.g. IL-6 and TNF-α) and clinical characteristics of COPD (e.g. CAT and 6MWT). RESULTS A total of 33 and 34 patients completed the roflumilast and placebo arm, respectively (age, median (IQR): 64.5 (61-69.5) vs 64.5 (56-72) years; FEV1 , median (IQR): 34.5 (25.5-48.6) vs 35.3 (27-46.8) % predicted; 6MWT, median (IQR): 428 (340-558) vs 456 (364-570) m). Change from baseline PWV did not show a significant difference between roflumilast and placebo (+5.0 (95% CI: -2.0 to +13.0) vs 0.0 (95% CI: -7.0 to +7.0)%, P = 0.268). Roflumilast did not improve markers of vascular function or systemic inflammation. We observed a significant improvement in change from baseline 6MWT with roflumilast versus placebo (+53.0 (95% CI: +19.1 to +86.9) vs -0.92 (95% CI: -35.1 to +33.3) m, P = 0.026). CONCLUSION Our study revealed no beneficial effects of roflumilast on arterial stiffness. Further studies are needed to test a potential improvement of exercise capacity with roflumilast in COPD.
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Affiliation(s)
- Matthias H Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Nicole Kreibich
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Internal and Respiratory Medicine, Wilhelminenspital, Vienna, Austria.,Karl-Landsteiner Institute for Respiratory Research and Pneumological Oncology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Hospital and Sigmund Freud University, Medical School, Vienna, Austria
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Eschler CM, Woitok BK, Funk GC, Walter P, Maier V, Exadaktylos AK, Lindner G. Oral Anticoagulation in Patients in the Emergency Department: High Rates of Off-Label Doses, No Difference in Bleeding Rates. Am J Med 2020; 133:599-604. [PMID: 31668901 DOI: 10.1016/j.amjmed.2019.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Empirically, a significant proportion of patients using direct oral anticoagulation (DOAC) take off-label reduced doses. We aimed to investigate the prevalence, indications, dosages, and bleeding complications of oral anticoagulants on admission to the emergency department. METHODS In this retrospective analysis, patients presenting to our emergency department between January 1 and December 31, 2018, with therapeutic oral anticoagulation were included (ie, vitamin-K antagonists, rivaroxaban, apixaban, edoxaban, and dabigatran). A detailed chart review was performed for each case concerning characteristics, indication, and bleeding complications. RESULTS A total of 19,662 consecutive cases in the emergency department were reported: 1721 (9%) had therapeutic oral anticoagulation. Vitamin-K antagonists (41%), rivaroxaban (36%), and apixaban (19%) were the most common. Stroke prophylaxis in patients with atrial fibrillation (63.2%) and venous thromboembolism (24.1%) were the most common indications. In 27 cases (1.6%), no indication could be identified; further, 32% of patients were classified to have either off-label doses of DOACs or an international normalized ratio (INR) out of range (in vitamin-K antagonists), whereas 20% were classified as off-label underdosed and 12% as overdosed. No difference in the likelihood of bleeding on admission could be found between the respective drugs. Only concomitant use of aspirin was significantly associated with presence and higher severity of bleeding. CONCLUSIONS Vitamin-K antagonists are still the most widely used drug followed by rivaroxaban. A significant proportion of patients are being prescribed off label-doses. While no difference was found for the respective anticoagulants with respect to bleeding, concomitant aspirin use was a significant predictor for bleeding in our collective.
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Affiliation(s)
- Corinne M Eschler
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Bertram K Woitok
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Philipp Walter
- Department of Laboratory Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Volker Maier
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
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Vonbank K, Marzluf B, Knötig M, Funk GC. Agreement between Cardiopulmonary Exercise Test and Modified 6-Min Walk Test in Determining Oxygen Uptake in COPD Patients with Different Severity Stages. Respiration 2020; 99:225-230. [PMID: 32008003 DOI: 10.1159/000505856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In moderate-to-severe chronic obstructive pulmonary disease (COPD) patients the 6-min walk test (6MWT) is often exhaustive and correlates with the incremental cycle cardiopulmonary exercise test (CPET). OBJECTIVES The aim of this study was to assess the agreement between oxygen uptake (VO2) measured during the 6MWT by portable equipment and incremental cycle exercise in COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-IV. METHODS A total of 30 patients with COPD GOLD I-IV (14 patients GOLD stage I and II and 16 patients GOLD stage III and IV) underwent a 6MWT and an incremental CPET. Breath-by-breath analysis for VO2, carbon dioxide output (VCO2), and minute ventilation (VE) were measured during each test. Blood gas analysis and lactate measurements were performed before, during, and after the test. RESULTS VO2 in COPD patients GOLD stage I and II was 16.2 ± 4.2 mL/kg/min measured by 6MWT and 20.5 ± 7.0 mL/kg/min measured by CPET as compared to GOLD stage III and IV (11.2 ± 3.7 mL/kg/min measured by 6MWT and 15.5 ± 4.3 mL/kg/min measured by CPET). No significant correlation in VO2 measurements could be found between both tests in COPD GOLD I and II (r = 0.17), whereas the VO2 significantly correlated in patients with COPD stage III and IV (r = 0.7). CONCLUSIONS A significant relationship between VO2 measured by 6MWT and CPET could only be found in patients with more severe COPD but not in milder stages. 6MWT and CPET provide different VO2 measurements in COPD patients. The two methods cannot be used interchangeably.
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Affiliation(s)
- Karin Vonbank
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria,
| | - Beatrice Marzluf
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
| | - Monika Knötig
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Abstract
Keeping blood pH levels stable within narrow limits is prerequisite for maintaining normal body function. Disruptions of this equilibrium can occur for a variety of reasons and may result in life-threatening conditions. Therefore, the identification and the interpretation of acid-base disorders are of great importance in emergency medicine. The same applies to intensive care as well as to almost all areas of internal medicine. In this article, we provide a practical overview of all relevant acid-base disorders that are due to both metabolic and respiratory disturbances. In addition, it shows how they can be diagnosed in everyday clinical practice by applying the simplified Stewart Approach.
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Affiliation(s)
- Mathis Hochrainer
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord - Klinik Floridsdorf, Brünner Str. 68, 1210, Wien, Österreich.
- Karl Landsteiner Institut für Lungenforschung und Pneumologische Onkologie, Wien, Österreich.
| | - Georg-Christian Funk
- Medizinische Abteilung mit Pneumologie, Wilhelminenspital, Wien, Österreich
- Karl Landsteiner Institut für Lungenforschung und Pneumologische Onkologie, Wien, Österreich
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Gäbler M, Ohrenberger G, Funk GC. Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties. ERJ Open Res 2019; 5:00163-2018. [PMID: 31544110 PMCID: PMC6745412 DOI: 10.1183/23120541.00163-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction End-stage chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure are often treated by representatives from different medical specialties. This study investigates if the choice of treatment is influenced by the medical specialty. Methods An online cross-sectional survey among four Austrian medical societies was performed, accompanied by a case vignette of a geriatric end-stage COPD patient with acute respiratory failure. Respondents had to choose between noninvasive ventilation (NIV), a conservative treatment attempt (without NIV) and a palliative approach. Ethical considerations and their impact on decision making were also assessed. Results Responses of 162 physicians (67 from intensive care units (ICUs), 51 from pulmonology or internal departments and 44 from geriatric or palliative care) were included. The decision for NIV (instead of a conservative or palliative approach) was associated with working in an ICU (OR 14.9, 95% CI 1.87-118.8) and in a pulmonology or internal department (OR 9.4, 95% CI 1.14-78.42) compared with working in geriatric or palliative care (Model 1). The decision for palliative care was negatively associated with working in a pulmonology or internal department (OR 0.16, 95% CI 0.05-0.47) and (nonsignificantly) in an ICU (OR 0.41, 95% CI 0.15-1.12) (Model 2). Conclusions Department association was shown to be an independent predictor for treatment decisions in end-stage COPD with acute respiratory failure. Further research on these differences and influential factors is necessary.
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Affiliation(s)
- Martin Gäbler
- Institute of Preventive and Applied Sports Medicine, Krems University Hospital, Karl Landsteiner University of Health Sciences, Krems, Austria.,Dept of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria
| | | | - Georg-Christian Funk
- Medical Dept II and Karl-Landsteiner Institute für Lungenforschung und Pneumologische Onkologie Wilheminenspital, Vienna, Austria
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Kink E, Erler L, Fritz W, Funk GC, Gäbler M, Krenn F, Kühteubl G, Schindler O, Wanke T. Beatmung bei COPD: von der Präklinik bis zur außerklinischen Beatmung. Eine Übersicht des Arbeitskreises für Beatmung und Intensivmedizin der österreichischen Gesellschaft für Pneumologie. Wien Klin Wochenschr 2019; 131:417-427. [PMID: 31111203 DOI: 10.1007/s00508-019-1515-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper was created by the Austrian Society of Pneumology (Working group Ventilation and Intensive Care) to summarize the specific characteristics of mechanical ventilation in patients presenting with chronic obstructive pulmonary disease (COPD). The main differences in pathophysiology and mechanical ventilation are shown, including acute respiratory failure and out-of-hospital mechanical ventilation.
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Affiliation(s)
- Eveline Kink
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Hörgas 30, 8112, Gratwein-Straßengel, Österreich
| | - Lorenz Erler
- Abteilung für Lungenkrankheiten, Leoben, Österreich
| | - Wilfried Fritz
- Klinische Abteilung für Lungenkrankheiten, Universitätsklinikum für Innere Medizin, LKH.-Univ. Klinikum Graz, Graz, Österreich
| | | | - Martin Gäbler
- Institut für Präventiv- und Angewandte Sportmedizin, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Mitterweg 10, 3500, Krems an der Donau, Österreich
| | | | | | - Otmar Schindler
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Hörgas 30, 8112, Gratwein-Straßengel, Österreich
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Fazekas AS, Aboulghaith M, Kriz RC, Urban M, Breyer MK, Breyer-Kohansal R, Burghuber OC, Hartl S, Funk GC. Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation. Wien Klin Wochenschr 2018; 130:561-568. [PMID: 30066095 PMCID: PMC6209011 DOI: 10.1007/s00508-018-1364-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) is used to treat acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD); however, long-term outcomes following discharge are largely unknown. This study aimed to characterize long-term outcomes and identify associated markers in patients with COPD after surviving the first episode of HRF requiring NIV. METHODS This study retrospectively analyzed 122 patients, mean age 62 ± 8 years, 52% female and forced expiratory volume in 1 s (FEV1) predicted 30 ± 13%, admitted with an acute hypercapnic exacerbation of COPD and receiving a first-ever NIV treatment between 2000 and 2012. RESULTS A total of 40% of the patients required hospital readmission due to respiratory reasons within 1 year. Persistent hypercapnia leading to the prescription of domiciliary NIV, older age and lower body mass index (BMI) were risk factors for readmission due to respiratory reasons. Survival rates were 79% and 63% at 1 and 2 years after discharge, respectively. A shorter time to readmission and recurrent hypercapnic failure, lower BMI and acidemia on the first admission, as well as hypercapnia at hospital discharge were correlated with a decreased long-term survival. CONCLUSION Patients with COPD surviving their first episode of AHRF requiring NIV are at high risk for readmission and death. Severe respiratory acidosis, chronic respiratory failure and a lower BMI imply shorter long-term survival.
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Affiliation(s)
- Andreas S Fazekas
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Mei Aboulghaith
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Ruxandra C Kriz
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Matthias Urban
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Marie-Kathrin Breyer
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Otto-Chris Burghuber
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria.
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
- Medical University of Vienna, Vienna, Austria.
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Drolz A, Horvatits T, Roedl K, Rutter K, Brunner R, Zauner C, Schellongowski P, Heinz G, Funk GC, Trauner M, Schneeweiss B, Fuhrmann V. Acid-base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease. Ann Intensive Care 2018; 8:48. [PMID: 29675709 PMCID: PMC5908779 DOI: 10.1186/s13613-018-0391-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values < 7.1 showed a 100% mortality rate. Acidosis attributable to lactate and unmeasured anions was independently associated with mortality in liver cirrhosis. Conclusions Cirrhosis and especially ACLF are associated with metabolic acidosis and acidemia owing to lactate and unmeasured anions. Acidosis and acidemia, respectively, are associated with increased 28-day mortality in liver cirrhosis. Lactate and unmeasured anions are main contributors to metabolic imbalance in cirrhosis and ACLF. Electronic supplementary material The online version of this article (10.1186/s13613-018-0391-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Drolz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. .,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Horvatits
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karoline Rutter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Richard Brunner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Division of Oncology and Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute for COPD, Otto-Wagner Hospital, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Valentin Fuhrmann
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Affiliation(s)
- Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria.
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Scheiner B, Lindner G, Reiberger T, Schneeweiss B, Trauner M, Zauner C, Funk GC. Acid-base disorders in liver disease. J Hepatol 2017; 67:1062-1073. [PMID: 28684104 DOI: 10.1016/j.jhep.2017.06.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 01/15/2023]
Abstract
Alongside the kidneys and lungs, the liver has been recognised as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common acid-base disorder in chronic liver disease, various complex metabolic acid-base disorders may occur with liver dysfunction. While the standard variables of acid-base equilibrium, such as pH and overall base excess, often fail to unmask the underlying cause of acid-base disorders, the physical-chemical acid-base model provides a more in-depth pathophysiological assessment for clinical judgement of acid-base disorders, in patients with liver diseases. Patients with stable chronic liver disease have several offsetting acidifying and alkalinising metabolic acid-base disorders. Hypoalbuminaemic alkalosis is counteracted by hyperchloraemic and dilutional acidosis, resulting in a normal overall base excess. When patients with liver cirrhosis become critically ill (e.g., because of sepsis or bleeding), this fragile equilibrium often tilts towards metabolic acidosis, which is attributed to lactic acidosis and acidosis due to a rise in unmeasured anions. Interestingly, even though patients with acute liver failure show significantly elevated lactate levels, often, no overt acid-base disorder can be found because of the offsetting hypoalbuminaemic alkalosis. In conclusion, patients with liver diseases may have multiple co-existing metabolic acid-base abnormalities. Thus, knowledge of the pathophysiological and diagnostic concepts of acid-base disturbances in patients with liver disease is critical for therapeutic decision making.
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Affiliation(s)
- Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria
| | - Gregor Lindner
- Department of General Internal Medicine & Emergency Medicine, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Division of Oncology and Hematology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria.
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Pfortmueller C, Funk GC, Potura E, Reiterer C, Luf F, Kabon B, Druml W, Fleischmann E, Lindner G. Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation : Prospective, randomized, controlled trial. Wien Klin Wochenschr 2017; 129:598-604. [PMID: 28255797 PMCID: PMC5599439 DOI: 10.1007/s00508-017-1180-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
Abstract
Background Infusion therapy is one of the most frequently prescribed medications in hospitalized patients. Currently used crystalloid solutes have a variable composition and may therefore influence acid-base status, intracellular and extracellular water content and plasma electrolyte compositions and have a major impact on organ function and outcome. The aim of our study was to investigate whether use of acetate-based balanced crystalloids leads to better hemodynamic stability compared to 0.9% saline. Methods We performed a sub-analysis of a prospective, randomized, controlled trial comparing effects of 0.9% saline or an acetate-buffered, balanced crystalloid during the perioperative period in patients with end-stage renal disease undergoing cadaveric renal transplantation. Need for catecholamine therapy and blood pressure were the primary measures. Results A total of 150 patients were included in the study of which 76 were randomized to 0.9% saline while 74 received an acetate-buffered balanced crystalloid. Noradrenaline for cardiocirculatory support during surgery was significantly more often administered in the normal saline group, given earlier and with a higher cumulative dose compared to patients receiving an acetate-buffered balanced crystalloid (30% versus 15%, p = 0.027; 68 ± 45 µg/kg versus 75 ± 60 µg/kg, p = 0.0055 and 0.000492 µg/kg body weight/min, ±0.002311 versus 0.000107 µg/kg/min, ±0.00039, p = 0.04, respectively). Mean minimum arterial blood pressure was significantly lower in patients randomized to 0.9% saline than in patients receiving the balanced infusion solution (57.2 [SD 8.7] versus 60.3 [SD 10.2] mm Hg, p = 0.024). Conclusion The use of an acetate-buffered, balanced infusion solution results in reduced need for use of catecholamines and cumulative catecholamine dose for hemodynamic support and in less occurrence of arterial hypotension in the perioperative period. Further research in the field is strongly encouraged.
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Affiliation(s)
- Carmen Pfortmueller
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Eva Potura
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian Reiterer
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Florian Luf
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Barbara Kabon
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wilfred Druml
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Edith Fleischmann
- Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Gregor Lindner
- Department of Emergency Medicine, Hirslanden - Klinik Im Park, Zurich, Switzerland
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Urban MH, Eickhoff P, Funk GC, Burghuber OC, Wolzt M, Valipour A. Increased brachial intima-media thickness is associated with circulating levels of asymmetric dimethylarginine in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:169-176. [PMID: 28115840 PMCID: PMC5221539 DOI: 10.2147/copd.s118596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with an increased cardiovascular risk. However, the mechanisms for this association are yet unclear. The aim of this study was to investigate the relationship between brachial intima-media thickness (B-IMT), an independent predictor of cardiovascular risk, systemic inflammation, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, in patients with COPD and respective controls. METHODS The study sample consisted of 60 patients with stable COPD, free from overt cardiovascular disorders, as well as 20 smoking and 20 nonsmoking controls. Ultrasound assessment of B-IMT, spirometry, venous blood sampling for quantification of inflammatory markers and ADMA levels were carried out, and individual cardiovascular risk was calculated via the Framingham risk score. RESULTS Patients with COPD showed significantly higher B-IMT compared to smoking (P=0.007) and nonsmoking controls (P=0.033). COPD patients with elevated B-IMT had a twofold increased calculated 10-year risk for cardiovascular events compared to those below the recommended cutoff (P=0.002). B-IMT was significantly associated with systemic inflammation (interleukin-6 [IL-6]; r=0.365, P=0.006) and ADMA (r=0.331, P=0.013) in COPD. Multivariate linear regression revealed male sex and ADMA as independent predictors of B-IMT in this study sample. CONCLUSION B-IMT is significantly increased in patients with COPD and is associated with systemic inflammation and ADMA levels.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Philipp Eickhoff
- Department of Obstetrics and Gynecology, St. Josef Hospital, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Otto Chris Burghuber
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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Pfortmueller CA, Lindner G, Funk GC, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK. Role of D-Dimer testing in venous thromboembolism with concomitant renal insufficiency in critical care. Intensive Care Med 2016; 43:470-471. [PMID: 28011988 DOI: 10.1007/s00134-016-4646-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Carmen A Pfortmueller
- Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Gregor Lindner
- Department of Emergency Medicine, Hirslanden Klinik am Park, Zurich, Switzerland
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alexander B Leichtle
- Inselspital, Center for Laboratory Medicine, University Hospital Bern, Bern, Switzerland
| | - Georg M Fiedler
- Inselspital, Center for Laboratory Medicine, University Hospital Bern, Bern, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine, Landeskrankenhaus Steyr, Steyr, Austria
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
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Schenk P, Eber E, Funk GC, Fritz W, Hartl S, Heininger P, Kink E, Kühteubl G, Oberwaldner B, Pachernigg U, Pfleger A, Schandl P, Schmidt I, Stein M. [Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology]. Wien Klin Wochenschr 2016; 128 Suppl 1:S1-36. [PMID: 26837865 DOI: 10.1007/s00508-015-0899-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.
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Affiliation(s)
- Peter Schenk
- Abteilung für Pulmologie, Landesklinikum Hochegg, Hocheggerstraße 88, 2840, Grimmenstein, Österreich.
| | - Ernst Eber
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Georg-Christian Funk
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | - Wilfried Fritz
- Klinische Abteilung für Lungenkrankheiten, Universitätsklinik für Innere Medizin, Universitätsklinikum Graz, Graz, Österreich
| | - Sylvia Hartl
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | | | - Eveline Kink
- Abteilung für Lungenkrankheiten, Landeskrankenhaus Hörgas-Enzenbach, Eisbach, Österreich
| | - Gernot Kühteubl
- Abteilung für Pulmologie, Landesklinikum Hochegg, Hocheggerstraße 88, 2840, Grimmenstein, Österreich
| | | | - Ulrike Pachernigg
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Andreas Pfleger
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Petra Schandl
- 1. Allgemeine Intensivstation, Wilhelminenspital, Wien, Österreich
| | - Ingrid Schmidt
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | - Markus Stein
- Abteilung für Pneumologie, Landeskrankenhaus Hochzirl-Natters, Standort Natters, Natters, Österreich
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Vincent JL, Shehabi Y, Walsh TS, Pandharipande PP, Ball JA, Spronk P, Longrois D, Strøm T, Conti G, Funk GC, Badenes R, Mantz J, Spies C, Takala J. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med 2016; 42:962-71. [PMID: 27075762 PMCID: PMC4846689 DOI: 10.1007/s00134-016-4297-4] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/26/2016] [Indexed: 02/07/2023]
Abstract
We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH—early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Yahya Shehabi
- Program of Critical Care, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Melbourne, VIC, 3800, Australia
| | - Timothy S Walsh
- Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK
| | - Pratik P Pandharipande
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jonathan A Ball
- Department of Intensive Care Medicine, St George's Hospital, London, UK
| | - Peter Spronk
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Dan Longrois
- Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Thomas Strøm
- Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Giorgio Conti
- Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, University Hospital Clinic Valencia, Valencia, Spain
| | - Jean Mantz
- Department of Anesthesia and Intensive Care, European Hospital Georges Pompidou, Paris Descartes University, Paris, France
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jukka Takala
- Department of Intensive Care Medicine, Berne University Hospital and University of Berne, Berne, Switzerland
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Pfortmueller CA, Funk GC, Potura E, Reitere C, Kabon B, Druml W, Fleischmann E, Lindner G. Balanced Crystalloid Use Is Associated With Haemodynamic Stability And Less Need For Vasopressors in Patients Receiving Renal Transplantation Compared To 0.9% Saline. Intensive Care Med Exp 2015. [PMCID: PMC4796209 DOI: 10.1186/2197-425x-3-s1-a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Urban M, Burghuber OC, Dereci C, Aydogan M, Selimovic E, Catic S, Funk GC. Tobacco addiction and smoking cessation in Austrian migrants: a cross-sectional study. BMJ Open 2015; 5:e006510. [PMID: 26044757 PMCID: PMC4458634 DOI: 10.1136/bmjopen-2014-006510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Recent observations revealed substantial differences in smoking behaviour according to individuals' migration background. However, smoking cessation strategies are rarely tailored on the basis of a migration background. We aimed to determine whether smoking behaviour and preferences for smoking cessation programmes differ between Austrian migrant smokers and Austrian smokers without a migration background. STUDY DESIGN Cross-sectional study. SETTING Recruitment and interview were performed at public places in Vienna, Austria. PARTICIPANTS The 420 smokers included: 140 Bosnian, 140 Turkish migrant smokers of the first or second generation, as well as 140 Austrian smokers without a migration background. METHODS We cross-sectionally assessed determinants of smoking behaviour and smoking cessation of every participant with a standardised questionnaire. PRIMARY OUTCOME MEASURE The Fagerström Test for Nicotine Dependence. SECONDARY OUTCOME MEASURES Determinants of smoking behaviour, willingness to quit smoking and smoking cessation. RESULTS Nicotine addiction expressed via the Fagerström score was significantly higher in smokers with a migration background versus those without (Bosnian migrant smokers 4.7 ± 2.5, Turkish migrant smokers 4.0 ± 2.0, Austrian smokers without a migration background 3.4 ± 2.3, p<0.0001). Bosnian and Turkish migrant smokers described a greater willingness to quit, but have had more previous cessation trials than Austrian smokers without a migration background, indicating an increased demand for cessation strategies in these study groups. They also participated in counselling programmes less often than Austrian smokers without a migration background. Finally, we found significant differences in preferences regarding smoking cessation programmes (ie, preferred location, service offered in another language besides German, and group rather than single counselling). CONCLUSIONS We found significant differences in addictive behaviour and cessation patterns between smokers with and without a migration background. Our results indicate a strong demand for adjusting cessation programmes to the cultural background.
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Affiliation(s)
- Matthias Urban
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Otto Chris Burghuber
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | | | | | | | | | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
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Potura E, Lindner G, Biesenbach P, Funk GC, Reiterer C, Kabon B, Schwarz C, Druml W, Fleischmann E. An acetate-buffered balanced crystalloid versus 0.9% saline in patients with end-stage renal disease undergoing cadaveric renal transplantation: a prospective randomized controlled trial. Anesth Analg 2015; 120:123-129. [PMID: 25185593 DOI: 10.1213/ane.0000000000000419] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent studies have shown a decline in glomerular filtration rate and increased renal vasoconstriction after administration of normal saline when compared with IV solutions with less chloride. In this study, we investigated the impact of normal saline versus a chloride-reduced, acetate-buffered crystalloid on the incidence of hyperkalemia during cadaveric renal transplantation. The incidence of metabolic acidosis and kidney function were secondary aims. METHODS In this prospective randomized controlled trial, 150 patients received normal saline or an acetate-buffered balanced crystalloid during and after cadaveric renal transplantation. Venous blood gases were obtained at the start of anesthesia and every 30 minutes until discharge from the postoperative surveillance unit. Serum creatinine and 24-hour urine output were obtained on postoperative days 1, 3, and 7. RESULTS Patients received a similar amount of fluid (median: 2625mL [interquartile range: 2000 to 3100] vs 2500 mL [2000 to 3050], P = 0.83). Hyperkalemia, defined as serum potassium >5.9 mmol/L, occurred in 13 patients (17%) in the saline and 15 (21%) in the balanced group (P = 0.56; difference between proportions -0.037 [-16.5% to 8.9%]). Minimum base excess was lower in the saline group compared with the balanced regimen (-4.5 mmol/L [-6 to -2.4] vs -2.6 mmol/L [-4 to -1], P < 0.001) and maximum chloride was significantly higher in the saline group (109 mmol/L [107 to 111] vs 107 mmol/L [105 to 109], P < 0.001). No difference in creatinine or urine output was seen postoperatively. Significantly more patients needed catecholamines in the saline group (30% vs 15%, P = 0.03). CONCLUSIONS The incidence of hyperkalemia differed by less than 17% between groups. Use of balanced crystalloid resulted in less hyperchloremia and metabolic acidosis. Significantly more patients in the saline group required administration of catecholamines for circulatory support.
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Affiliation(s)
- Eva Potura
- From the *Department of Anaesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Vienna, Austria; †Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna, Sozialmedizinisches Zentrum Baumgartner Höhe, Vienna, Austria; ‡Department of Nephrology, Medical University of Vienna, Vienna, Austria; §Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna, Austria; ∥Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria; and ¶Department of Nephrology, Landeskrankenhaus Steyr, Steyr, Austria
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Lindner G, Funk GC, Pfortmueller CA, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Puig S. D-dimer to rule out pulmonary embolism in renal insufficiency. Am J Med 2014; 127:343-7. [PMID: 24355353 DOI: 10.1016/j.amjmed.2013.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND D-dimer levels are often elevated in renal insufficiency. The diagnostic accuracy of D-dimer to rule out pulmonary embolism in patients with renal insufficiency is unclear. METHODS We evaluated the data of patients presenting to our Emergency Department and receiving computed tomography angiography to rule out pulmonary embolism with measurement of D-dimer and creatinine. Glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. RESULTS There were 1305 patients included; 1067 (82%) had an estimated glomerular filtration rate (eGFR) exceeding 60 mL/min, 209 (16%) 30-60 mL/min, and 29 (2%) <30 mL/min. One hundred fifty-two patients (12%) had D-dimer below 500 μg/L. eGFR (R = -0.1122) correlated significantly with D-dimer (P <.0001). One hundred sixty-nine patients (13%) were found to have pulmonary embolism. Sensitivity of D-dimer for patients with an eGFR >60 mL/min was 96% (confidence interval [CI], 0.93-0.99) and 100% (CI, 100-100) for those with 30-60 mL/min, while specificity decreased significantly with impaired renal function. Area under the curve of the receiver operating characteristic for D-dimer was 0.734 in patients with an eGFR of >60 mL/min, and 0.673 for 30-60 mL/min. CONCLUSIONS D-dimer levels were elevated in patients with an eGFR <60 mL/min, but proved to be highly sensitive for the exclusion of pulmonary embolism. However, because almost all patients with impaired renal function had elevated D-dimer irrespective of the presence of pulmonary embolism, studies should be performed to determine renal function-adjusted D-dimer cutoffs.
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Affiliation(s)
- Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Department of Internal Medicine, Inselspital, University Hospital Bern, Switzerland.
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Carmen A Pfortmueller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Department of Internal Medicine, Inselspital, University Hospital Bern, Switzerland
| | - Alexander B Leichtle
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland
| | - Georg M Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland
| | | | | | - Stefan Puig
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Switzerland
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Pfortmueller CA, Funk GC, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Lindner G. Electrolyte disorders and in-hospital mortality during prolonged heat periods: a cross-sectional analysis. PLoS One 2014; 9:e92150. [PMID: 24651296 PMCID: PMC3961302 DOI: 10.1371/journal.pone.0092150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background Heat periods during recent years were associated with excess hospitalization and mortality rates, especially in the elderly. We intended to study whether prolonged warmth/heat periods are associated with an increased prevalence of disorders of serum sodium and potassium and an increased hospital mortality. Methods In this cross-sectional analysis all patients admitted to the Department of Emergency Medicine of a large tertiary care facility between January 2009 and December 2010 with measurements of serum sodium were included. Demographic data along with detailed data on diuretic medication, length of hospital stay and hospital mortality were obtained for all patients. Data on daily temperatures (maximum, mean, minimum) and humidity were retrieved by Meteo Swiss. Results A total of 22.239 patients were included in the study. 5 periods with a temperature exceeding 25°C for 3 to 5 days were noticed and 2 periods with temperatures exceeding 25°C for more than 5 days were noted. Additionally, 2 periods with 3 to 5 days with daily temperatures exceeding 30°C were noted during the study period. We found a significantly increased prevalence of hyponatremia during heat periods. However, in the Cox regression analysis, prolonged heat was not associated with the prevalence of disorders of serum sodium or potassium. Admission during a heat period was an independent predictor for hospital mortality. Conclusions Although we found an increased prevalence of hyponatremia during heat periods, no convincing connection could be found for hypernatremia or disorders of serum potassium.
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Affiliation(s)
- Carmen A. Pfortmueller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Spital Vienna and Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Alexander B. Leichtle
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Georg M. Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | | | | | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- * E-mail:
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Lindner G, Doberer D, Schwarz C, Schneeweiss B, Funk GC. Evaporation of free water causes concentrational alkalosis in vitro. Wien Klin Wochenschr 2013; 126:201-7. [PMID: 24343045 DOI: 10.1007/s00508-013-0486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The development of metabolic alkalosis was described recently in patients with hypernatremia. However, the causes for this remain unknown. The current study serves to clarify whether metabolic alkalosis develops in vitro after removal of free water from plasma and whether this can be predicted by a mathematical model. MATERIALS AND METHODS Ten serum samples of healthy humans were dehydrated by 29 % by vacuum centrifugation corresponding to an increase of the contained concentrations by 41 %. Constant partial pressure of carbon dioxide at 40 mmHg was simulated by mathematical correction of pH [pH(40)]. Metabolic acid-base state was assessed by Gilfix' base excess subsets. Changes of acid-base state were predicted by the physical-chemical model according to Watson. RESULTS Evaporation increased serum sodium from 141 (140-142) to 200 (197-203) mmol/L, i.e., severe hypernatremia developed. Acid-base analyses before and after serum concentration showed metabolic alkalosis with alkalemia: pH(40): 7.43 (7.41 to 7.45) vs 7.53 (7.51 to 7.55), p = 0.0051; base excess: 1.9 (0.7 to 3.6) vs 10.0 (8.2 to 11.8), p = 0.0051; base excess of free water: 0.0 (- 0.2 to 0.3) vs 17.7 (16.8 to 18.6), p = 0.0051. The acidifying effects of evaporation, including hyperalbuminemic acidosis, were beneath the alkalinizing ones. Measured and predicted acid-base changes due to serum evaporation agreed well. CONCLUSIONS Evaporation of water from serum causes concentrational alkalosis in vitro, with good agreement between measured and predicted acid-base values. At least part of the metabolic alkalosis accompanying hypernatremia is independent of renal function.
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Affiliation(s)
- Gregor Lindner
- Department of Internal Medicine, Inselspital,University Hospital Bern, Bern, Switzerland
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Urban MH, Ay L, Funk GC, Burghuber OC, Eickhoff P, Wolzt M, Valipour A. Insulin resistance may contribute to vascular dysfunction in patients with chronic obstructive pulmonary disease. Wien Klin Wochenschr 2013; 126:106-12. [PMID: 24343042 DOI: 10.1007/s00508-013-0478-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 11/19/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are at an increased cardiovascular risk; however, the underlying mechanisms for this relationship are ill defined. Altered glucose metabolism may increase cardiovascular risk via impaired endothelial function. METHODS We conducted a longitudinal pilot study to assess the interrelationship between systemic vascular function, glucose metabolism, and lung function in patients with COPD. Eighteen non-smoking patients with stable moderate-to-severe COPD [67 % male; median (first to third quartiles) Forced Expiratory Volume in 1 second (FEV1) % predicted: 38 % (28-55 %); body mass index: 26 kg/m(2) (24-28 kg/m(2))] free from cardiovascular risk factors were evaluated. Systemic vascular function was assessed by means of flow-mediated dilation technique of the brachial artery. Laboratory measurements included fasting blood glucose levels, circulating concentrations of insulin, C-reactive protein, and fibrinogen. Homeostatic model assessment of insulin resistance (HOMA-IR) was determined. Measurements were performed at baseline and were repeated after 12 months. RESULTS Flow-mediated dilation significantly decreased from 13.5 % (11-15 %) at baseline to 9.8 % (6-12 %; p = 0.002) at the follow-up visit, whereas both fasting blood glucose concentrations and HOMA-IR increased from 94 mg/dl (86-103 mg/dl) to 102 mg/dl (94-111 mg/dl; p = 0.027) and from 1.2 (0.8-2.1) to 1.7 (1.2-3.0; p = 0.023), respectively. There was a significant relationship between changes in endothelial function and changes in fasting serum glucose (r = - 0.483, p = 0.009), HOMA-IR (r = - 0.441, p = 0.019), and FEV1 (r = 0.336, p = 0.05). CONCLUSION Altered glucose metabolism may be associated with progression of endothelial dysfunction in patients with COPD.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
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Pfortmueller CA, Funk GC, Marti G, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Lindner G. Diagnostic performance of high-sensitive troponin T in patients with renal insufficiency. Am J Cardiol 2013; 112:1968-72. [PMID: 24091183 DOI: 10.1016/j.amjcard.2013.08.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 12/27/2022]
Abstract
In the present study, we wanted to (1) evaluate whether high-sensitive troponin T levels correlate with the grade of renal insufficiency and (2) test the accuracy of high-sensitive troponin T determination in patients with renal insufficiency for diagnosis of acute myocardial infarction (AMI). In this cross-sectional analysis, all patients who received serial measurements of high-sensitive troponin T from August 1, 2010, to October 31, 2012, at the Department of Emergency Medicine were included. We analyzed data on baseline characteristics, reason for referral, medication, cardiovascular risk factors, and outcome in terms of presence of AMI along with laboratory data (high-sensitive troponin T, creatinine). A total of 1,514 patients (67% male, aged 65 ± 16 years) were included, of which 382 patients (25%) had moderate to severe renal insufficiency and significantly higher levels of high-sensitive troponin T on admission (0.028 vs 0.009, p <0.0001). In patients without AMI, high-sensitive troponin T correlated inversely with the estimated glomerular filtration rate (R = -0.12, p <0.0001). Overall, sensitivity of an elevated high-sensitive troponin for diagnosis of AMI was 0.64 (0.56 to 0.71) and the specificity was 0.48 (0.45 to 0.51). The area under the curve of the receiver operating characteristic for all patients was 0.613 (standard error [SE] 0.023), whereas it was 0.741 (SE 0.029) for patients with a Modification of Diet in Renal Disease estimated glomerular filtration rate >60 ml/min presenting with acute chest pain or dyspnea and 0.535 (SE 0.056) for patients with moderate to severe renal insufficiency presenting with acute chest pain or dyspnea. In conclusion, the diagnostic accuracy for presence of AMI of a baseline measurement of high-sensitive troponin in patients with renal insufficiency was poor and resembles tossing a coin.
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Kneidinger N, Funk GC, Lindner G, Drolz A, Schenk P, Fuhrmann V. Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis. Wien Klin Wochenschr 2013; 125:474-80. [DOI: 10.1007/s00508-013-0400-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 06/23/2013] [Indexed: 02/06/2023]
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Lindner G, Funk GC. Hypernatremic alkalosis or chloride depletion alkalosis? Reply to Vasconcelos et al. Intensive Care Med 2013; 39:1332. [DOI: 10.1007/s00134-013-2929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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Lindner G, Pfortmueller CA, Funk GC, Leichtle AB, Fiedler GM, Exadaktylos AK. High-Sensitive Troponin Measurement in Emergency Department Patients Presenting with Syncope: A Retrospective Analysis. PLoS One 2013; 8:e66470. [PMID: 23823330 PMCID: PMC3688899 DOI: 10.1371/journal.pone.0066470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/08/2013] [Indexed: 12/03/2022] Open
Abstract
Objective To study the relevance of high-sensitive troponin measurements in the acute workup in patients admitted to the emergency department of a large university hospital due to syncope. Methods In this retrospective study all patients admitted to the emergency department because of syncope of the Inselspital, University Hospital Bern between 01 August 2010 and 31 October 2012, with serial determination of high-sensitive troponin (baseline and three hours control) were included. Of all identified patients we obtained data on demographics, laboratory data, ECG as well as on outcome. A change in high-sensitive troponin in the three hours control of +/−30% compared to baseline was considered significant. Results A total of 121 patients with a mean age of 67 years (SD 16) were included in the study. 79 patients (65%) were male and 42 (35%) were female. There was no significant difference in the median high sensitive-troponin level at baseline and in the three hours control (0.01 mcg/L [0.003 to 0.022] versus 0.011 mcg/L [0.003 to 0.022], p = 0.47). Median percent change in high-sensitive troponin level between baseline and control was 0% (−9.1 to 5). 51 patients (42%) had elevated high-sensitive troponin levels at baseline with 7 patients (6%) showing a dynamic of +/−30% change from the baseline measurement in the 3 hours control. 3 of these patients received coronary angiography due to the dynamic in high-sensitive troponin, none of whom needed intervention for coronary revascularization. Conclusions On basis of the current study, where no single patient took benefit from determination of high-sensitive troponin, measurement of cardiac troponins should be reserved for patients with syncope presenting with symptoms suggestive for the presence of an acute cardiac syndrome.
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Affiliation(s)
- Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- * E-mail:
| | - Carmen A. Pfortmueller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Spital Vienna and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Alexander B. Leichtle
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Georg Martin Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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