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Crescioli E, Riis JØ, Weinreich UM, Jensen JUS, Poulsen LM, Brøchner AC, Lange T, Perner A, Klitgaard TL, Schjørring OL, Rasmussen BS. Long-term cognitive and pulmonary functions following a lower versus a higher oxygenation target in the HOT-ICU and HOT-COVID trials: A protocol update. Acta Anaesthesiol Scand 2024; 68:575-578. [PMID: 38272985 DOI: 10.1111/aas.14379] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial was a multicentre, randomised, parallel-group trial of a lower oxygenation target (arterial partial pressure of oxygen [PaO2 ] = 8 kPa) versus a higher oxygenation target (PaO2 = 12 kPa) in adult ICU patients with acute hypoxaemic respiratory failure; the Handling Oxygenation Targets in coronavirus disease 2019 (HOT-COVID) tested the same oxygenation targets in patients with confirmed COVID-19. In this study, we aim to evaluate the long-term effects of these oxygenation targets on cognitive and pulmonary function. We hypothesise that a lower oxygenation target throughout the ICU stay may result in cognitive impairment, whereas a higher oxygenation target may result in impaired pulmonary function. METHODS This is the updated protocol and statistical analysis plan of two pre-planned secondary outcomes, the long-term cognitive function, and long-term pulmonary function, in the HOT-ICU and HOT-COVID trials. Patients enrolled in both trials at selected Danish sites and surviving to 1 year after randomisation are eligible to participate. A Repeatable Battery for the Assessment of Neuropsychological Status score and a full-body plethysmography, including diffusion capacity for carbon monoxide, will be obtained. The last patient is expected to be included in the spring of 2024. CONCLUSION This study will provide important information on the long-term effects of a lower versus a higher oxygenation target on long-term cognitive and pulmonary functions in adult ICU patients with acute hypoxaemic respiratory failure.
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Affiliation(s)
- Elena Crescioli
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Østergaard Riis
- Department of Neurology and Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Ulrik Staehr Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Anne Craveiro Brøchner
- Department of Anaesthesia and Intensive Care, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Lass Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Olav Lilleholt Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Johansen ND, Vaduganathan M, Bhatt AS, Lee SG, Modin D, Claggett BL, Dueger EL, Samson S, Loiacono MM, Harris RC, Køber L, Solomon SD, Sivapalan P, Jensen JUS, Martel CJM, Valentiner-Branth P, Krause TG, Biering-Sørensen T. Electronic nudges to increase influenza vaccination uptake among patients with heart failure: A pre-specified analysis of the NUDGE-FLU trial. Eur J Heart Fail 2023; 25:1450-1458. [PMID: 37211967 DOI: 10.1002/ejhf.2913] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Seasonal influenza vaccination is strongly recommended in patients with heart failure (HF). The NUDGE-FLU trial recently found two electronic behavioural nudging letter strategies - a letter highlighting potential cardiovascular benefits of vaccination and a repeated letter at day 14 -effective in increasing influenza vaccination in Denmark. The aims of this pre-specified analysis was to further examine vaccination patterns and effects of these behavioural nudges in patients with HF including potential off-target effects on guideline-directed medical therapy (GDMT) use. METHODS AND RESULTS The nationwide NUDGE-FLU trial randomized 964 870 Danish citizens ≥65 years to usual care or nine different electronic nudging letter strategies. Letters were delivered through the official Danish electronic letter system. The primary endpoint was the receipt of an influenza vaccine; additional outcomes for this analysis included GDMT use. In this analysis, we also assessed influenza vaccination rates in the overall Danish HF population including those <65 years (n = 65 075). During the 2022-2023 season, influenza vaccination uptake was 71.6% in the overall Danish HF population but this varied considerably with only 44.6% uptake in those <65 years. A total of 33 109 NUDGE-FLU participants had HF at baseline. Vaccination uptake was higher among those on higher levels of baseline GDMT (≥3 classes: 85.3% vs. ≤2 classes: 81.9%; p < 0.001). HF status did not modify the effects of the two overall successful nudging strategies on influenza vaccination uptake (cardiovascular gain-framed letter: pinteraction = 0.37; repeated letter: pinteraction = 0.55). No effect modification was observed across GDMT use levels for the repeated letter (pinteraction = 0.88), whereas a trend towards attenuated effect among those on low levels of GDMT was observed for the cardiovascular gain-framed letter (pinteraction = 0.07). The letters had no impact on longitudinal GDMT use. CONCLUSIONS Approximately one in four patients with HF did not receive influenza vaccination with a pronounced implementation gap in those <65 years where less than half were vaccinated. HF status did not modify the effectiveness of cardiovascular gain-framed and repeated electronic nudging letters in increasing influenza vaccination rates. No unintended negative effects on longitudinal GDMT use were observed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT05542004.
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Affiliation(s)
- Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Ankeet S Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
- Kaiser Permanente San Francisco Medical Center & Division of Research, San Francisco, CA, USA
| | - Simin Gharib Lee
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pradeesh Sivapalan
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Staehr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Cyril Jean-Marie Martel
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Palle Valentiner-Branth
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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3
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Hertz FB, Ahlström MG, Bestle MH, Hein L, Mohr T, Lundgren JD, Galle T, Andersen MH, Murray D, Lindhardt A, Itenov TS, Jensen JUS. Early biomarker-guided prediction of bloodstream infection in critically ill patients: C-reactive protein, procalcitonin and leukocytes. Open Forum Infect Dis 2022; 9:ofac467. [PMID: 36225739 PMCID: PMC9547526 DOI: 10.1093/ofid/ofac467] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background Bloodstream infections (BSIs) often lead to critical illness and death. The primary aim of this study was to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and leukocyte count for the diagnosis of BSI in critically ill patients. Methods This was a nested case–control study based on the Procalcitonin And Survival Study (PASS) trial (n = 1200). Patients who were admitted to the intensive care unit (ICU) <24 hours, and not expected to die within <24 hours, were recruited. For the current study, we included patients with a BSI within ±3 days of ICU admission and matched controls without a BSI in a 1:2 ratio. Diagnostic accuracy for BSI for the biomarkers on days 1, 2, and 3 of ICU admission was assessed. Sensitivity, specificity, and negative and positive predictive values were calculated for prespecified thresholds and for a data-driven cutoff. Results In total, there were 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L; leucocytes = 10 × 109/L; PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP = 0.91; 95% CI, 0.75–1.00; leukocyte = 0.75; 95% CI, 0.68–0.81; PCT = 0.91; 95% CI, 0.84–0.96). Combining the 3 biomarkers yielded similar results as PCT alone (P = .5). Conclusions CRP and PCT could in most cases rule out BSI in critically ill patients. As almost no patients had low CRP and ∼20% had low PCT, a low PCT could be used, along with other information, to guide clinical decisions.
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Affiliation(s)
- Frederik Boetius Hertz
- Department of Clinical Microbiology, Rigshospitalet , Copenhagen , Denmark
- Department of Clinical Microbiology, Slagelse Hospital , Slagelse , Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Herlev & Gentofte Hospital , Herlev , Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
| | - Lars Hein
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
| | - Thomas Mohr
- Department of Anaesthesia and Intensive Care, Gentofte University Hospital , Copenhagen , Denmark
| | - Jens D Lundgren
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
| | - Tina Galle
- Department of Anaesthesia and Intensive Care, Glostrup University Hospital , Copenhagen , Denmark
| | | | - Daniel Murray
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
| | - Anne Lindhardt
- Department of Anaesthesiology, Sjællands Universitets Hospital Køge , Køge , Denmark
| | - Theis Skovsgaard Itenov
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital , Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
| | - Jens Ulrik Staehr Jensen
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital , Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
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4
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Haase N, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen VL, Winding R, Iversen S, Pedersen HP, Madsen J, Sølling C, Garcia RS, Michelsen J, Mohr T, Michagin G, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Buck DL, Ribergaard NE, Pedersen HS, Christensen BV, Nielsen LP, Clapp E, Jonassen TB, Weihe S, la Cour K, Nielsen FM, Madsen EK, Haberlandt TN, Meier N, Perner A. Changes over time in characteristics, resource use and outcomes among ICU patients with COVID-19 - a nationwide, observational study in Denmark. Acta Anaesthesiol Scand 2022; 66:987-995. [PMID: 35781689 PMCID: PMC9544552 DOI: 10.1111/aas.14113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/15/2022] [Revised: 05/01/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Characteristics and care of ICU patients with COVID-19 may have changed during the pandemic, but longitudinal data assessing this are limited. We compared patients with COVID-19 admitted to Danish ICUs in the first wave with those admitted later. METHODS Among all Danish ICU patients with COVID-19, we compared demographics, chronic comorbidities, use of organ support, length of stay and vital status of those admitted 10th March to 19th May 2020 (first wave) versus 20th May 2020 to 30th June 2021. We analysed risk factors for death by adjusted logistic regression analysis. RESULTS Among all hospitalised patients with COVID-19, a lower proportion was admitted to ICU after the first wave (13 vs 8%). Among all 1374 ICU patients with COVID-19, 326 were admitted during the first wave. There were no major differences in patient's characteristics or mortality between the two periods, but use of invasive mechanical ventilation (81% vs 58% of patients), renal replacement therapy (26% vs. 13%) and ECMO (8% vs 3%) and median length of stay in ICU (13 vs 10 days) and in hospital (20 vs 17 days) were all significantly lower after the first wave. Risk factors for death were higher age, larger burden of co-morbidity (hearth failure, pulmonary disease, and kidney disease), and active cancer, but not admission during or after the first wave. CONCLUSIONS After the first wave of COVID-19 in Denmark, a lower proportion of hospitalised patients with COVID-19 was admitted to ICU. Among ICU patients, use of organ support was lower and length of stay was reduced, but mortality rates remained at a relatively high level. EDITORIAL COMMENT This study assessed the temporal changes in the care of patients with COVID-19 requiring ICU care in Denmark. The findings showed that while a lower ratio of patients with documented infections required ICU and they required less organ support, ICU mortality remained unchanged. This might reflect the effects of vaccines on disease severity and improvement in floor management of hypoxic patients, but also underscores that COVID-19 remains a serious threat to the health of many patients, in particularly elderly patients with a high degree of comorbidity.
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Affiliation(s)
- Nicolai Haase
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ronni Plovsing
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | | | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Hanna Siegel
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Michael Ibsen
- Department of Anaesthesiology and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | | | - Robert Winding
- Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
| | - Susanne Iversen
- Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Planck Pedersen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Jacob Madsen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Christoffer Sølling
- Department of Anaesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
| | | | - Jens Michelsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - George Michagin
- Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Svendborg, Denmark
| | | | - Helle Bundgaard
- Department of Anaesthesiology and Intensive Care, Randers Hospital, Randers, Denmark
| | - Lynge Kirkegaard
- Department of Anaesthesiology and Intensive Care, Åbenrå Hospital, Åbenrå, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - David Levarett Buck
- Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Niels-Erik Ribergaard
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Helle Scharling Pedersen
- Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Lone Pia Nielsen
- Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Rønne, Denmark
| | - Esben Clapp
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Trine Bak Jonassen
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Sarah Weihe
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Kirstine la Cour
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | | | - Emilie Kabel Madsen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | - Nick Meier
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
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5
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Kristensen A, Sivapalan P, Bagge K, Biering-Sørensen T, Sørensen R, Eklöf J, Jensen JUS. Association between anticoagulant therapy, exacerbations and mortality in a Danish cohort of patients with Chronic Obstructive Pulmonary Disease. Sci Prog 2022; 105:368504221104331. [PMID: 35673760 PMCID: PMC10358626 DOI: 10.1177/00368504221104331] [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] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Pulmonary Embolism has been frequently reported in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD). The study aimed to determine whether COPD patients who receive anticoagulant (AC) therapy have a reduced risk of hospitalization due to AE-COPD and death. METHODS This nationwide population-based study was based on data from the Danish Register of COPD (DrCOPD), which contains complete data on COPD outpatients between 1st January 2010 and 31st December 2018. National registers were used to obtain information regarding comorbidities and vital status. Propensity-score matching and Cox proportional hazards models were used to assess AE-COPD and death after one year. RESULTS The study cohort consisted of 58,067 patients with COPD. Of these, 5194 patients were on AC therapy. The population was matched 1:1 based on clinical confounders and AC therapy, resulting in two groups of 5180 patients. We found no association between AC therapy and AE-COPD or all-cause mortality in the propensity-score matched population (HR 1.03, 95% CI 0.96-1.10, p = 0.37). These findings were confirmed in a competing risk analysis. In the sensitivity analysis, we performed an adjusted analysis of the complete cohort and found a slightly increased risk of AE-COPD or death in patients treated with AC therapy. This study found a low incidence of pulmonary embolisms and deep venous thrombosis in both groups. CONCLUSIONS AC therapy was not associated with the risk of hospitalization due to AE-COPD or all-cause mortality.
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Affiliation(s)
- A Kristensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - P Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - K Bagge
- Department of Clinical Microbiology, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - T Biering-Sørensen
- Department of Internal Medicine, Section of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - R Sørensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - JUS Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- PERSIMUNE: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, institution-id-type="Ringgold" />Faculty of Health Sciences, University of Copenhagen, Denmark
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6
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Lassen MCH, Skaarup KG, Lind JN, Alhakak AS, Sengeløv M, Nielsen AB, Espersen C, Ravnkilde K, Hauser R, Schöps LB, Holt E, Johansen ND, Modin D, Djernaes K, Graff C, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Lebech AM, Kirk O, Bodtger U, Lindholm MG, Joseph G, Wiese L, Schiødt FV, Kristiansen OP, Walsted ES, Nielsen OW, Madsen BL, Tønder N, Benfield T, Jeschke KN, Ulrik CS, Knop FK, Lamberts M, Sivapalan P, Gislason G, Marott JL, Møgelvang R, Jensen G, Schnohr P, Søgaard P, Solomon SD, Iversen K, Jensen JUS, Schou M, Biering-Sørensen T. Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study. ESC Heart Fail 2020; 7:4189-4197. [PMID: 33089972 PMCID: PMC7755011 DOI: 10.1002/ehf2.13044] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 07/24/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death. METHODS AND RESULTS In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease. CONCLUSIONS RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.
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Affiliation(s)
| | | | - Jannie Nørgaard Lind
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alia Saed Alhakak
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Espersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Ravnkilde
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Hauser
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Liv Borum Schöps
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eva Holt
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Djernaes
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Slagelse Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Matias Greve Lindholm
- Department of Cardiology, Zealand University Hospital Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Gowsini Joseph
- Department of Cardiology, Zealand University Hospital Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Frank Vinholt Schiødt
- Department of Medical Gastroenterology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emil Schwarz Walsted
- Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard Madsen
- Department of Respiratory Medicine and Infectious Diseases, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Filip Krag Knop
- Department of Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Lamberts
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kasper Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ulrik Staehr Jensen
- Department of Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Andersen D, Moegelvang R, Schnohr P, Lange P, Modin D, Alhakak AS, Jensen MT, Sivapalan P, Jensen JUS, Gislason G, Biering-Soerensen T. P2442Myocardial performance index predicts mortality in people with obstructive lung function from the general population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0774] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Forced expiratory volume in one second (FEV1) is a significant predictor of mortality in patients with obstructive lung function (OL). Whether echocardiography can be used to identify patients at high risk, and whether it provides incremental prognostic information on mortality in patients with OL, remains unknown.
Methods
In a large, low-risk general population study, 1873 participants underwent a health examination with spirometry and echocardiography, including tissue Doppler imaging (TDI). The myocardial performance index (MPI) was calculated as the sum of the isovolumic contraction time (IVCT) and the isovolumic relaxation time (IVRT) divided by the left ventricle ejection time (LVET). Spirometry included measurements of (FEV1) and the forced vital capacity (FVC). OL was defined as FEV1/FVC <0.70. The primary endpoint was all-cause mortality.
Results
The mean age was 59±16 years, 57% were women, 43% had hypertension, 11% had diabetes, and 6% had ischemic heart disease. Of the 1873 included participants, 288 (15%) were classified as having OL at baseline. During follow up (median 13.7 years (IQR 13.2–16.2)), 584 (31%) persons died, hereof 178 (62%) in the subgroup of participants with OL and 406 (26%) in the subgroup of participants with normal lung function.
OL was associated with presence of left ventricular hypertrophy (higher left ventricular mass index), impaired diastolic function (lower E, higher A, lower E/A ratio, longer deceleration time, lower e' and higher E/e'), lower global longitudinal strain, and higher MPI.
In unadjusted analysis, higher MPI was associated with all-cause mortality for participants with OL (HR=1.18 (1.11–1.26), p<0.001, per 0.1 increase) and for participants with normal lung function (HR=1.42 (1.34–1.50), p<0.001, per 0.1 increase). The predictive value of MPI was significantly modified by the presence of obstructive lung function (p<0.001).
After multivariable adjustment for age, sex, FEV1/FVC, heart rate, systolic blood pressure, smoking status, body mass index (BMI), hypertension, diabetes, ischemic heart disease, ischemic stroke and heart failure at baseline, MPI remained an independent predictor of all-cause mortality (HR=1.19 (1.06–1.34), p=0.004, per 0.1 increase) for participants with OL but not for participants with normal lung function (HR=1.02 (0.94–1.11), p=0.598, per 0.1 increase).
When adding the MPI to the updated Age, Dyspnea and Obstruction (ADO) index, MPI provided incremental prognostic information beyond the updated ADO index, as determined from a significant increase in the Harrell's C-statistics (0.785 to 0.792, p=0.003).
Conclusion
Presence of OL is associated with subtle impairment of left ventricular systolic function, impaired left ventricular diastolic function, and higher MPI. MPI is an independent predictor of mortality in people with OL and provides incremental prognostic information regarding all-cause mortality in this population.
Acknowledgement/Funding
Herlev & Gentofte University Hospital PhD fund
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Affiliation(s)
- D Andersen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Moegelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Schnohr
- University of Copenhagen, Copenhagen, Denmark
| | - P Lange
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A S Alhakak
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M T Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Sivapalan
- Gentofte University Hospital, Department of Pulmonary Medicine, Copenhagen, Denmark
| | - J U S Jensen
- Gentofte University Hospital, Department of Pulmonary Medicine, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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Eklöf J, Sørensen R, Ingebrigtsen TS, Sivapalan P, Achir I, Boel JB, Bangsborg J, Ostergaard C, Dessau RB, Jensen US, Browatzki A, Lapperre TS, Janner J, Weinreich UM, Armbruster K, Wilcke T, Seersholm N, Jensen JUS. Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients. Clin Microbiol Infect 2019; 26:227-234. [PMID: 31238116 DOI: 10.1016/j.cmi.2019.06.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 03/04/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The role of Pseudomonas aeruginosa in the long-term prognosis of chronic obstructive pulmonary disease (COPD) is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with COPD. METHODS This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalization-demanding exacerbations and death after 2 years, separately and in combination. RESULTS A total of 22 053 COPD outpatients were followed for a median of 1082 days (interquartile-range: 427-1862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalization for exacerbation or all-cause death (HR 2.8, 95%CI 2.2-3.6; p <0.0001) and all-cause death (HR 2.7, 95%CI 2.3-3.4; p <0.0001) in analyses adjusted for known and suspected confounders. The signal remained unchanged in unadjusted analyses as well as propensity-matched subgroup analyses. Among patients 'ever colonized' with P. aeruginosa, the incidence of hospital-demanding exacerbations doubled after the time of the first colonization. CONCLUSIONS COPD patients in whom P. aeruginosa can be cultured from the airways had a markedly increased risk of exacerbations and death. It is still not clear whether this risk can be reduced by offering patients targeted antipseudomonal antibiotics. A randomized trial is currently recruiting patients to clarify this (ClinicalTrials.gov: NCT03262142).
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Affiliation(s)
- J Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
| | - R Sørensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - T S Ingebrigtsen
- Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - P Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - I Achir
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - J B Boel
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - J Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - C Ostergaard
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - R B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - U S Jensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - A Browatzki
- Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Denmark
| | - T S Lapperre
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Janner
- Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - U M Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - K Armbruster
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - T Wilcke
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - N Seersholm
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - J U S Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark; PERSIMUNE: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
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