Midregional proatrial naturetic peptide (MRproANP) and copeptin (COPAVP) as predictors of all-cause mortality in recently diagnosed mild to moderate COPD-results from COSYCONET

BACKGROUND

MRproANP and COPAVP are prognostic markers for mortality in chronic obstructive pulmonary disease (COPD). Furthermore, these biomarkers predict mortality due to cardiovascular diseases, which are important prognostically determining comorbidities in patients with COPD. However, less is known about these biomarkers in recently diagnosed mild to moderate COPD. Therefore, we analyzed these biomarkers as potential predictors of mortality in recently diagnosed mild to moderate COPD.

METHODS

The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional proatrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable "recently diagnosed mild to moderate COPD" defined by GOLD grades 0-2 and diagnosis of COPD ≤ 5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP.

RESULTS

655 patients with recently diagnosed mild to moderate COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p < 0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n = 1470 finally).

CONCLUSION

In patients with recently diagnosed mild to moderate COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD.

Detection of invasive pulmonary aspergillosis in critically ill patients by combined use of conventional culture, galactomannan, 1-3-beta-D-glucan and Aspergillus specific nested polymerase chain reaction in a prospective pilot study

Invasive pulmonary aspergillosis (IPA) is an emerging and life-threatening infectious disease in patients admitted to the intensive care unit (ICU). Most diagnostic studies are conducted in hematological patients and results cannot readily be transferred to ICU patients lacking classical host factors. In a multicenter, prospective clinical trial including 44 ICU patients, hematological (n = 14) and non-hematological patients (n = 30), concurrent serum and bronchoalveolar lavage (BAL) samples were analyzed by conventional culture, galactomannan (GM), 1-3-beta-D-glucan (BDG) as well as an Aspergillus specific nested polymerase chain reaction (PCR). Nine patients (20%) had putative IPA according to AspICU classification. GM and PCR showed superior performance in BAL with sensitivity/specificity of 56%/94% and 44%/94% compared to 33%/97% and 11%/94% in serum. Despite better sensitivity of 89%, BDG showed poor specificity of only 31% (BAL) and 26% (serum). Combination of GM and PCR (BAL) with BDG (serum) resulted in 100% sensitivity, but also reduced specificity to 23%. Whereas mean GM levels were significantly higher in hematological patients BDG and PCR did not differ between hematological and non-hematological patients. Under present clinical conditions test combinations integrating both BAL and blood samples are advantageous. BDG might best serve as possible indicator for ruling out IPA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01695499. First posted: September 28, 2012, last update posted: May 8, 2017.

Comparison of bioreactance non-invasive cardiac output measurements with cardiac magnetic resonance imaging

Impedance cardiography measurement of cardiac output gained wide interest due to its ease of use and non-invasiveness. However, validation studies of different algorithms yielded diverging results. Bioreactance (BR) as a recent adaption differs fundamentally as the flow signal is derived from phase shifts. Our aim was to assess the accuracy and reproducibility of BR, as compared to the non-invasive gold standard--cardiac magnetic resonance imaging (CMR). We prospectively included 32 stable patients. BR was performed twice in the supine position and averaged over 30 seconds. Mean bias was 0.2 ± 1.8 l/minute (1 ± 28%, percentage error 55%) with limits of agreement ranging from  -3.4 to 3.7 l/minute. Reproducibility was acceptable with a mean bias of 0.1 ± 0.9 l/minute (1 ± 14%, 27%). Low cardiac output was significantly overestimated (-1.1 ± 1.5 l/minute), while high cardiac output was underestimated (1.5 ± 1.7 l/minute), (P=0.001), although reproducibility was unaffected. Bias and weight were moderately correlated in men (r = 0.50, P=0.02). No differences for accuracy were found in nine patients who had an arrhythmia (0.3 ± 1.4 versus 0.1 ± 2.0 l/minute, P=0.76), while clinically relevant differences were found in patients with mild aortic valve disease (1.9 ± 2.2 versus -0.3 ± 1.7 l/minute, P=0.02). Overall, BR showed insufficient agreement with CMR, overestimating low and underestimating high cardiac output states. Reproducibility was acceptable and not negatively affected by the circulatory condition. Consequently, absolute values acquired with BR should be interpreted with caution and must not be used interchangeably in clinical practice.

Body consciousness, illness-related impairment, and patient adherence in hemodialysis

Recent theory and evidence suggests that bodily self-focusing tendencies (e.g. private body consciousness) may be associated with medical regimen adherence among chronically ill patients. The present study examined the joint effects of private body consciousness and degree of illness-related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis patients. It was predicted that the effect of PBC on adherence would vary as a function of patients' level of illness-related physical impairment. For patients experiencing more severe impairment, higher PBC scores were associated with poorer adherence to the prescribed medication and dietary regimen. In contrast, for patients experiencing a relatively low degree of disease-related physical impairment, higher private body consciousness was associated with more favorable adherence. Results are discussed in terms of self-focused attention and behavioral self-regulation theories. Implications for future research and clinical intervention are also discussed.

Body consciousness, illness-related impairment, and patient adherence in hemodialysis

Recent theory and evidence suggests that bodily self-focusing tendencies (e.g. private body consciousness) may be associated with medical regimen adherence among chronically ill patients. The present study examined the joint effects of private body consciousness and degree of illness-related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis patients. It was predicted that the effect of PBC on adherence would vary as a function of patients' level of illness-related physical impairment. For patients experiencing more severe impairment, higher PBC scores were associated with poorer adherence to the prescribed medication and dietary regimen. In contrast, for patients experiencing a relatively low degree of disease-related physical impairment, higher private body consciousness was associated with more favorable adherence. Results are discussed in terms of self-focused attention and behavioral self-regulation theories. Implications for future research and clinical intervention are also discussed.

Precooking and Flake Size Effects on Spent Fowl Restructured Steaks

Four formulations of spent fowl muscle, each made to contain 40% dark muscle and 60% white muscle, were prepared as follows: (a) raw meat, large flake size; (b) raw meat, small flake size; (c) precooked meat, large flake size and (d) precooked meat, small flake size. Each formulation was mixed with 0.3% NaCl, 0.25% Na tripolyphosphate and 0.25% hydrolyzed vegetable protein for 10 min, pressed into logs under 400 psi, frozen and cut into steaks. Steaks were evaluated for moisture and fat content, cooking properties, texture and sensory attributes. Restructured steaks made from precooked chicken muscle had lower initial moisture contents and lost less moisture during cooking than restructured steaks made from raw meat. Flake size had no significant effect on cooking losses; however, the smaller flake sizes contributed to a more tender product. Steaks made from the raw chicken meat were of a more acceptable flavor. Restructured steaks made from raw flakes were significantly more desirable in texture and overall palatability and were more tender and juicy than restructured steaks made from precooked chicken.

Effect of Comminution Method and Pressure on Restructured Beef Steaks

Restructured steaks were made using six methods of meat comminution: (a) sliced parallel, (b) sliced perpendicular to muscle fibers (2-mm thick slice), (c) flaked at -5 C, (d) flaked at -2.2 C, (e) flaked at 2.2 C and (f) ground through a 3.2-mm plate. Meat used was from cow inside rounds. After comminution, meat was stuffed into casings and pressed under pressure (200, 600 or 1,000 psi). The "logs" were then frozen, cut into steaks and evaluated for cooking characteristics and sensory attributes. Intact round steaks were used for controls. The amount of pressure used to form the restructured steaks had no effect (P>.05) on any of the cooking characteristics or sensory properties. Particle production method had no effect (P>.05) on cooking characteristics; however, tenderness, texture description and flavor desirability ratings were higher (P>.05) for flaked steaks as compared to the sliced or intact steaks.