scholarly journals Eosinopenia and neutrophil-to-lymphocyte count ratio as prognostic factors in exacerbation of COPD

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tomasz Karauda ◽  
Kamil Kornicki ◽  
Amer Jarri ◽  
Adam Antczak ◽  
Joanna Miłkowska-Dymanowska ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sensitivity And Specificity ◽  
Lymphocyte Count ◽  
Statistical Significance ◽  
Hospital Death ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hospital Deaths ◽  
Exacerbation Of Copd

AbstractExacerbations of Chronic Obstructive Pulmonary Disease (AECOPDs) are one of the most important clinical aspects of the disease, and when requiring hospital admission, they significantly contribute to mortality among COPD patients. Our aim was to assess the role of eosinopenia and neutrophil-to-lymphocyte count (NLR) as markers of in-hospital mortality and length of hospitalization (LoH) among patients with ECOPD requiring hospitalization. We included 275 patients. Eosinopenia was associated with in-hospital deaths only when coexisted with lymphocytopenia, with the specificity of 84.4% (95% CI 79.6–88.6%) and the sensitivity of 100% (95% CI 35.9–100%). Also, survivors presented longer LoH (P < 0.0001). NLR ≥ 13.2 predicted in-hospital death with the sensitivity of 100% (95% CI 35.9–100%) and specificity of 92.6% (95% CI 88.8–95.4%), however, comparison of LoH among survivors did not reach statistical significance (P = 0.05). Additionally, when we assessed the presence of coexistence of eosinopenia and lymphocytopenia first, and then apply NLR, sensitivity and specificity in prediction of in-hospital death was 100% (95% CI 35.9–100) and 93.7% (95% CI 90.1–96.3), respectively. Moreover, among survivors, the occurrence of such pattern was associated with significantly longer LoH: 11 (7–14) vs 7 (5–10) days (P = 0.01). The best profile of sensitivity and specificity in the prediction of in-hospital mortality in ECOPD can be obtained by combined analysis of coexistence of eosinopenia and lymphocytopenia with elevated NLR. The occurrence of a such pattern is also associated with significantly longer LoH among survivors.

scholarly journals A STUDY OF MODIFIED DECAF SCORE IN PREDICTING HOSPITAL MORTALITY IN PATIENTS OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Sumit Prakash ◽  
Dr. Shruti Jain ◽  
Dr. Lalit Singh ◽  
Dr. Rajeev Tandon
Keyword(s):  
Hospital Mortality ◽  
Acute Exacerbation ◽  
Respiratory Acidosis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Social Burden ◽  
Prediction Of Mortality ◽  
Study Population ◽  
Exacerbation Of Copd

Background:  COPD is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing .The modified DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. Methods: Hospital based descriptive type of observational study was. After applying inclusion and exclusion criterias, study population for acute exacerbation of COPD was selected. Admission clinical data, including modified DECAF indices, and mortality were recorded. Results: In our study there was a statistically significant value (p <0.05) between grade of dyspnea, respiratory acidosis (pH < 7.30) and frequency of admission in the Modified DECAF score and in-hospital mortality of Acute Exacerbation of COPD. There was insignificant relationship between Eosinopenia & consolidation and in hospital mortality  Conclusion-We concluded that the Modified DECAF score is a powerful score to predict in hospital mortality from AECOPD. Keywords: COPD, DECAF, Exacerbations, Modified DECAF.

scholarly journals High hemoglobin is associated with increased in-hospital death in patients with chronic obstructive pulmonary disease and chronic kidney disease: a retrospective multicenter population-based study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Libin Xu ◽  
◽  
Yuanhan Chen ◽  
Zhen Xie ◽  
Qiang He ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Population Based ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Chronic kidney disease (CKD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). Although high hemoglobin (Hb) is detrimental to CKD patients, its relationship with poor outcomes in the COPD population has not been reported. This study aimed to investigate the relationship between high Hb and in-hospital mortality and to explore reference Hb intervals in patients with COPD and CKD. Methods This retrospective study was multicenter population-based. A total of 47,209 patients who presented with COPD between January 2012 and December 2016 were included. The average Hb level during hospitalization was used as the Hb level. CKD and advanced CKD were defined as estimated glomerular filtration rates < 60 and < 30 ml/min/1.73 m2, respectively. The association between Hb level (measured in 1 g/dL intervals) and in-hospital mortality was analyzed in different multivariable logistic regression models by CKD stratification. Results The Hb level was decreased in the CKD subgroup. In the non-CKD group, a higher Hb level was not associated with an increased risk of in-hospital death. However, the Hb level and mortality showed a U-shaped relationship in the CKD group. After adjusting for age and Charlson Comorbidity Index, multivariable regression analysis showed that an Hb level > 17 g/dL was associated with an increased risk of death in the CKD group with an odds ratio (OR) of 2.085 (95% CI, 1.019–4.264). Hb > 14 g/dL was related to an increased risk of death in advanced CKD patients (OR, 4.579 (95% CI, 1.243–16.866)). Conclusions High Hb is associated with an increased risk of in-hospital death in COPD patients with CKD, especially among those with advanced CKD. In this group of patients, attention should be paid to those with high Hb levels.

scholarly journals Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

2021 ◽  
Vol 10 (2) ◽  
pp. 318
Author(s):  
Modesto M. Maestre-Muñiz ◽  
Ángel Arias ◽  
Laura Arias-González ◽  
Basilio Angulo-Lara ◽  
Alfredo J. Lucendo
Keyword(s):  
Hospital Mortality ◽  
Rural Community ◽  
Respiratory Insufficiency ◽  
Medical Records ◽  
Cumulative Effect ◽  
Teaching Hospitals ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Central Spain ◽  
Obstructive Pulmonary Disease

Background: Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic. Methods: A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020–31 May 2020 were reviewed. Results: Mean age was 71.2 ± 14.6 years (rank 22–98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients’ age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 109/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission. Conclusions: Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.

scholarly journals Eosinopenia as a marker of outcome in acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Author(s):  
Sneha Biradar ◽  
Balakrishna Teli ◽  
Prashanth V. N.
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
P Value ◽  
Obstructive Pulmonary Disease ◽  
Duration Of Hospitalization ◽  
Exacerbation Of Copd

Background: Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the world.Acute exacerbation of COPD has 10% mortality rate at admission and 1/3rd die within a year of hospitalization. Eosinopenia typically accompanies the response to acute inflammation or infection. The objective of this study was to know whether eosinopenia is an economical marker in predicting the outcome in patients hospitalized due to acute exacerbation of COPD.Methods: This is a prospective study conducted on 121 patients presenting with AECOPD satisfying inclusion and exclusion criteria admitted in hospitals attached to Bangalore Medical College and Research Institute. All necessary investigations were done. Patients with AECOPD were divided in two groups: One with eosinopenia and other without eosinopenia. Duration of hospitalization, need for mechanical ventilation and in-hospital mortality was assessed in both the groups.  Results: Among 121 patients with AECOPD, 56 were eosinopenic and 65 patients were non-eosinopenic. Majority of patients belonged to age group of 51-60 years with mean age was 62.06±10.783 years. Duration of hospitalization of patients with eosinopenia was 9.04±5.18 days and that of patients without eosinopenia was 6.15±2.89 (p value<0.001). Among them, 41 (73.2%) patients with eosinopenia and 21 (32.3%) patients without eosinopenia needed mechanical ventilation (p≤0.001). In-hospital mortality rates among eosinopenic and non-eosinopenic patients were 53.6% and 15.4% respectively.  Conclusions: There is a significant relationship between eosinopenia and outcomes of patients with AECOPD. Thus, eosinopenia is a useful, easy-to-measure, inexpensive biomarker for predicting the prognosis and outcome in patients with AECOPD.

scholarly journals Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Male Gender ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
University Hospitals ◽  
Adverse Cardiovascular Event ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

scholarly journals A comparative study of chest CT findings regarding the effects of regional dust exposure on patients with COPD living in urban areas and rural areas near cement plants

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junghyun Kim ◽  
Bom Kim ◽  
So Hyeon Bak ◽  
Yeon-Mok Oh ◽  
Woo Jin Kim
Keyword(s):  
Sex Education ◽  
Rural Areas ◽  
Urban Areas ◽  
Smoking Status ◽  
Statistical Significance ◽  
Dust Exposure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Wall Area ◽  
Copd Patients

Abstract Background The clinical and radiological presentation of chronic obstructive pulmonary disease (COPD) is heterogenous depending on the characterized sources of inflammation. This study aimed to evaluate COPD phenotypes associated with specific dust exposure. Methods This study was designed to compare the characteristics, clinical outcomes and radiological findings between two prospective COPD cohorts representing two distinguishing regions in the Republic of Korea; COPD in Dusty Area (CODA) and the Korean Obstructive Lung Disease (KOLD) cohort. A total of 733 participants (n = 186 for CODA, and n = 547 for KOLD) were included finally. A multivariate analysis to compare lung function and computed tomography (CT) measurements of both cohort studies after adjusting for age, sex, education, body mass index, smoking status, and pack-year, Charlson comorbidity index, and frequency of exacerbation were performed by entering the level of FEV1(%), biomass exposure and COPD medication into the model in stepwise. Results The mean wall area (MWA, %) became significantly lower in COPD patients in KOLD from urban and metropolitan area than those in CODA cohort from cement dust area (mean ± standard deviation [SD]; 70.2 ± 1.21% in CODA vs. 66.8 ± 0.88% in KOLD, p = 0.028) after including FEV1 in the model. COPD subjects in KOLD cohort had higher CT-emphysema index (EI, 6.07 ± 3.06 in CODA vs. 20.0 ± 2.21 in KOLD, p < 0.001, respectively). The difference in the EI (%) was consistently significant even after further adjustment of FEV1 (6.12 ± 2.88% in CODA vs. 17.3 ± 2.10% in KOLD, p = 0.002, respectively). However, there was no difference in the ratio of mean lung density (MLD) between the two cohorts (p = 0.077). Additional adjustment for biomass parameters and medication for COPD did not alter the statistical significance after entering into the analysis with COPD medication. Conclusions Higher MWA and lower EI were observed in COPD patients from the region with dust exposure. These results suggest that the imaging phenotype of COPD is influenced by specific environmental exposure.

scholarly journals Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Rivadeneira Ruiz ◽  
DF Arroyo Monino ◽  
T Seoane Garcia ◽  
MP Ruiz Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Funding Sources ◽  
Copd Patients ◽  
The Mean ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

Abstract WP340: Prevalence and Influence of Chronic Obstructive Pulmonary Disease on Stroke Outcomes in Hospitalized Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Oladimeji Akinboro ◽  
Odunayo Olorunfemi ◽  
Stanley Holstein ◽  
Daniel Pomerantz ◽  
Stephen Jesmajian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Chronic Obstructive ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Index Stroke ◽  
Nationally Representative ◽  
Shared Risk

Background: COPD recently overtook stroke as the third leading cause of death in the United States. Intriguingly, smoking is an important shared risk factor for both stroke and COPD; COPD patients have baseline cerebral hypoxia and hypercapnia that could potentially exacerbate vascular brain injury; and stroke patients with COPD are at higher risk of aspiration than those without COPD. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke. Objective: To assess prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with risk of dying in the hospital after a stroke. Methods: Data were obtained for patients, 18 years and older, from the National Inpatient Sample from 2004-2009 (n=48,087,002). Primary discharge diagnoses of stroke were identified using ICD-9 diagnosis codes 430-432 and 433-436, of which a subset with comorbid COPD were defined with secondary ICD-9 diagnoses codes 490-492, 494, and 496. In-hospital mortality rates were calculated, and independent associations of COPD with in-hospital mortality following stroke were evaluated with logistic regression. All analysis were survey-weighted. Results: 11.71% (95% CI 11.48-11.94) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI 6.14-6.53) and 5.99% (95% CI 4.05-7.94), respectively. COPD was independently and modestly associated with overall stroke mortality (OR 1.03, 95% CI 1.01-1.06; p=0.02). However, when analyzed by subtype, greater risks of mortality were seen in those with intracerebral hemorrhage (OR 1.12, 95% CI 1.03-1.20; p<0.01), and ischemic stroke (OR 1.08; 95% CI 1.03-1.13, p<0.01), but not subarachnoid hemorrhage (OR 0.98, 95% CI 0.85-1.13; p=0.78). There were no statistically significant interactions between COPD and age, gender, or race. Conclusion: 12% of hospitalized stroke patients have COPD. Presence of COPD is independently associated with higher odds of dying during ischemic stroke hospitalization. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.

scholarly journals Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

2003 ◽  
Vol 29 (2) ◽  
pp. 107-115 ◽  
Author(s):  
Ivone Martins Ferreira
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Statistical Significance ◽  
Nutritional Therapy ◽  
Nutritional Supplementation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled Studies ◽  
Cytokine Inhibitors

OBJECTIVES: To review the mechanisms involved in the origin of malnutrition in patients with chronic obstructive pulmonary disease (COPD), and to make a systematic review of randomized controlled studies, to clarify the contribution of nutritional supplementation in patients with stable COPD. METHOD: A systematic review of articles published in the field of nutrition, in any language and from several sources, including Medline, Embase, Cinahl, and the Cochrane Registry on COPD, as well as studies presented at congresses in the US and Europe. RESULTS: Studies on nutritional supplementation for more than two weeks showed a very small effect, not reaching statistical significance. A linear regression study found that old age, relative anorexia, and high inflammatory response are associated with non-response to nutritional therapy. CONCLUSION: Currently, there is no evidence that nutritional supplementation is truly effective in patients with COPD. Factors associated with non-response suggest a relationship with the degree of inflammation, including high TNF-alpha levels. Measuring inflammation markers may be useful to determine prognosis and adequate therapy. Treatment with anti-inflammatory cytokines or cytokine inhibitors seems promising for the future.

The Effects of Oral Almitrine on Pattern of Breathing and Gas Exchange in Patients with Chronic Obstructive Pulmonary Disease

1984 ◽  
Vol 66 (4) ◽  
pp. 435-442 ◽  
Author(s):  
J. R. Stradling ◽  
C. G. Nicholl ◽  
D. Cover ◽  
E. E. Davies ◽  
J. M. B. Hughes ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Gas Exchange ◽  
Pulmonary Disease ◽  
Low Dose ◽  
Statistical Significance ◽  
Chronic Obstructive ◽  
Inspiratory Flow Rate ◽  
Obstructive Pulmonary Disease ◽  
Oxygen Breathing ◽  
Arterial Po2

1. Almitrine at a low dose of 100 mg orally significantly raises Pao2 and lowers Paco2 in patients with chronic obstructive pulmonary disease, compared with placebo, when they were breathing air or 28% oxygen. 2. The estimated ideal alveolar — arterial Po2 difference was less after almitrine compared with placebo, when patients were breathing either air or 28% oxygen. 3. After almitrine overall ventilation breathing air increased by 10% but this did not reach statistical significance. During 28% oxygen breathing almitrine hardly altered overall ventilation but the inspiratory duty cycle (Ti/Ttot.) decreased and mean inspiratory flow rate (VT/Ti) increased compared with placebo. These changes were significant on a paired t-test (P<0.05). 4. Changes in both volume and pattern of breathing may explain the improved gas exchange in the lung after almitrine.

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