The Association Between Serum Human Epididymis Protein 4 Level and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease

2020 ◽  
Author(s):  
Hui Lin ◽  
Jianhong Xiao ◽  
Xianghua Su ◽  
Bin Song
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Logistic Regression ◽  
Hazard Analysis ◽  
Chronic Obstructive ◽  
Proportional Hazard ◽  
Obstructive Pulmonary Disease ◽  
Human Epididymis Protein 4 ◽  
Human Epididymis ◽  
Cox Proportional Hazard

Abstract Objective Serum human epididymis protein 4 (HE4) is associated with immune and inflammatory responses. This study aimed to assess the performance of serum HE4 in the early detection of cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD). Methods Serum HE4 levels were measured in 199 patients with COPD, all of whom were prospectively followed up for a median period of 36 months (range = 3 months–38 months). Logistic regression analysis was performed to assess the association between cardiovascular disease (CVD) history and HE4 in patients with COPD. Cox proportional hazard analysis was performed to assess the prognostic value of serum HE4 for predicting CV events. Results Serum HE4 levels were higher in patients with COPD with CV events than in those without CV events (252.6 pmol/L [186.4–366.8] vs 111.0 pmol/L [84.8–157.1]; P <.001). The multivariate logistic regression model revealed that serum HE4 (odds ratio = 1.639; 95% confidence interval [CI], 1.213–2.317; Ptrend =.009) was independently associated with CVD history after adjusting for age, sex, body mass index, current smoking status, current alcohol consumption status, admission systolic blood pressure and diastolic blood pressure, hyperlipidemia, left ventricular ejection fraction, primary diseases, and laboratory measurements in patients with COPD at baseline. The multivariate Cox proportional hazard analysis revealed that serum HE4 (hazard ratio = 2.012; 95% CI, 1.773–4.469; P <.001) was an independent prognostic factor for CV events in these patients. The Kaplan-Meier analysis showed that the rate of CV events was higher in patients with COPD with HE4 levels above the median (187.5 pmol/L) than in those with HE4 levels below the median. Conclusion Our results showed that serum HE4 was significantly and independently associated with CVD history and had independent predictive value for CV events in patients with COPD. Serum HE4 may enable early recognition of CV complication development among patients with COPD.

CHARACTERISTICS OF 24-HOUR BLOOD PRESSURE INDICATORS IN PATIENTS WITH HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2020 ◽  
pp. 31-41
Author(s):  
M.A. Bubnova ◽  
O.N. Kryuchkova
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Mean Arterial Pressure ◽  
High Risk ◽  
Arterial Pressure ◽  
Pulmonary Disease ◽  
Comparison Group ◽  
Cardiovascular Complications ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Patients with hypertension (HT) and chronic obstructive pulmonary disease (COPD) have a high risk of cardiovascular complications. Up to now, there is no optimal strategy for combined antihypertensive therapy. Still, the data of 24-hour blood pressure monitoring (BPM) are important while choosing treatment tactics. The aim of the paper is to study the features of indicators in patients with arterial hypertension (AH) and COPD. Materials and methods. 130 patients with HT were included in the study. The main group (n=90) included comorbid patients with HT and COPD, their average age was 61.30±1.01; the comparison group (n=40) consisted of patients with HT, their average age was 59.10±1.53. All patients underwent 24-hour BPM. Results. Comorbid patients revealed an increase in the mean 24-hour and night systolic and mean arterial pressure values as well as a significant increase in the load index of systolic, diastolic and mean arterial pressure. Also, comorbid patients demonstrated higher blood pressure in contrast to the patients of the comparison group. They had increased systolic, diastolic and mean blood pressure variability and a quicker rate of morning blood pressure rise. According to 24-hour blood pressure dynamics, pathological types of the 24-hour blood pressure curve, a higher frequency of the night-peaker profile dominated in patients with COPD if compared to patients with HT. Conclusion. The obtained data indicated a high risk of cardiovascular complications in comorbid patients, early target organ damage and an unfavorable disease prognosis. It means that both further study of hypertension clinical course in such patients and personalization of antihypertensive therapy are relevant. Keywords: hypertension, chronic obstructive pulmonary disease, 24-hour monitoring, blood pressure. Пациенты с артериальной гипертензией (АГ) и хронической обструктивной болезнью легких (ХОБЛ) имеют высокий риск возникновения кардиоваскулярных осложнений. В настоящее время в лечении не определена наиболее оптимальная стратегия комбинированной антигипертензивной терапии. Для выбора тактики терапии важную роль играют показатели суточного мониторирования артериального давления (СМАД). Цель. Изучить особенности показателей СМАД у пациентов с АГ на фоне ХОБЛ. Материалы и методы. В исследование включено 130 пациентов с АГ. В основную группу (n=90) вошли пациенты с АГ и ХОБЛ (средний возраст – 61,30±1,01 года), в группу сравнения (n=40) – больные только АГ (средний возраст – 59,10±1,53 года). Всем пациентам проведено СМАД. Результаты. У пациентов с коморбидностью выявлены следующие особенности суточных показателей артериального давления: увеличение значений среднесуточных и средненочных показателей систолического и среднего артериального давления; существенное повышение индекса нагрузки систолическим, диастолическим и средним артериальным давлением. Также эти больные отличались от пациентов группы сравнения более высокими значениями пульсового давления, имели повышенную вариабельность систолического, диастолического и среднего артериального давления, у них наблюдалось увеличение скорости утреннего подъема артериального давления. Суточная динамика артериального давления у пациентов с ХОБЛ характеризовалась преобладанием патологических типов суточной кривой АД, более высокой частотой профиля night-peaker по сравнению с больными только АГ. Выводы. Выявленные особенности свидетельствуют о высоком риске сердечно-сосудистых осложнений у пациентов с коморбидностью, раннем поражении органов-мишеней и неблагоприятном прогнозе заболевания, что требует дальнейшего изучения особенностей клинического течения АГ у таких больных и индивидуализации антигипертензивной терапии. Ключевые слова: артериальная гипертензия, хроническая обструктивная болезнь легких, суточное мониторирование, артериальное давление.

scholarly journals Effect of nutritional risk on cognitive function in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052199012
Author(s):  
Yiben Huang ◽  
Jiedong Ma ◽  
Bingqian Jiang ◽  
Naiping Yang ◽  
Fangyi Fu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Pulmonary Disease ◽  
Nutritional Risk ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Nrs 2002

Objective We aimed to clarify the cognitive function of patients with chronic obstructive pulmonary disease (COPD) and different nutritional status. Methods Among 95 patients with COPD in this retrospective study, we administered the Nutritional Risk Screening 2002 (NRS 2002) and Mini-Mental State Examination (MMSE). We recorded patients’ clinical characteristics, comorbidities, and laboratory measurements. According to NRS 2002 scores, patients were divided into two groups: no nutritional risk with NRS 2002 < 3 ( n = 54) and nutritional risk, with NRS 2002 ≥ 3 ( n = 41). Results We found a negative correlation between NRS 2002 and MMSE scores in participants with COPD ( r = −0.313). Patients with nutritional risk were more likely to be cognitively impaired than those with no nutritional risk. Multivariate logistic regression analysis indicated that malnutrition was an independent risk factor for cognitive impairment, after adjusting for confounders (odds ratio [OR] = 4.120, 95% confidence interval [CI]: 1.072–15.837). We found a similar association between NRS 2002 and MMSE scores at 90-day follow-up using a Pearson’s correlation test ( r = −0.493) and logistic regression analysis (OR = 7.333, 95% CI: 1.114–48.264). Conclusions Patients with COPD at nutritional risk are more likely to have cognitive impairment.

Possibilities of cardiovascular events in patients with chronic obstructive pulmonary disease and newly diagnosed tuberculosis, including those associated with HIV infection, when prescribing long-acting β2-agonists

MedAlliance ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 32-39
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
External Respiration ◽  
Obstructive Pulmonary Disease ◽  
Tb Treatment ◽  
Long Acting ◽  
Β2 Agonists

Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) are a common pathology among respiratory diseases. Both conditions may have common risk factors, aggravating each other, accom-panied by the development of bronchial obstructive syndrome, requiring mandatory medical correction to increase the effectiveness of therapy for both the main and concomitant pathologies. The aim of the study was to study the effectiveness of treatment of TB in patients with COPD first diagnosed with tuberculosis, including those associated with HIV when prescribing long-acting β2-agonists. Materials and methods. A simple com-parative study included 60 patients of a TB dispensary aged 30–65 years. Patients were divided into 2 groups of 30 people (TB+COPD and TB+COPD+HIV), each of whom for 2 months received a long-acting β-agonist (indacaterol) as an accompanying therapy for the cor-rection of bronchial obstructive syndrome (BOS), with subsequent assessment of the effectiveness of therapy. Results. Subjectively, patients of both groups noted the rapid development of positive dynamics (short-ness of breath decreased from 1–3 days of taking the drug, coughing — within a week, tolerance to physical exertion improved), which was confirmed by indica-tors of the function of external respiration (FEV1). The state of the cardiovascular system was assessed by the results of daily monitoring of blood pressure (BPM). In the COPD+TB group, there is a certain average daily systolic blood pressure (SBP) with a tendency to nor-malize indicators, which is possibly associated with a decrease in the severity of hypoxia during bronchodi-lator therapy. In the COPD+TB+HIV group, the average daily level of SBP increased by 1 mm Hg, but given the very low starting rates, the increase in blood pressure had a positive effect on the patients' condition. The average heart rate (HR) during bronchodilator thera-py did not tend to increase. The best TB treatment re-sults were obtained in the TB+COPD group. In terms of the closure rate of TB+COPD decay cavities — 26.6%, TB+COPD+HIV — 20.0%), the TB+COPD+HIV group had longer periods of abacillation and closure of decay cav-ities, which is associa ted with the severity of the under-lying and associated diseases. The drug was well toler-ated in both groups. Conclusion. The use of 300 mcg long-acting β-adrenomimetics in the complex therapy of β2-adrenergic agonists for patients with TB+COPD and TB+ COPD+HIV can reduce the severity of bronchial obstruction syndrome, improve quality of life, increase adherence to TB treatment, thereby shortening hospi-talization and reduce the likelihood of disability of pa-tients, without the development of side effects from other organs and systems.

scholarly journals Incidence and Risk Factors for Prolonged Opioid Use after Arthroscopic Meniscal Surgery: An Analysis of 107,717 Cases

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Jacqueline Baron ◽  
Alan Shamrock ◽  
Trevor Gulbrandsen ◽  
Brian Wolf ◽  
Kyle Duchman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Obstructive Pulmonary Disease ◽  
Logistic Regression ◽  
Chronic Obstructive ◽  
Multiple Logistic Regression ◽  
Opioid Use ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Meniscal Surgery

Objectives: The current opioid epidemic in the United States is a significant cause of increasing morbidity and mortality. The purpose of this study was to determine rate of opioid use before and after arthroscopic meniscal surgery, and assess patient factors associated with prolonged opioid use following primary arthroscopic meniscal surgery. Methods: Patients undergoing primary arthroscopic meniscal surgery procedures from 2007-2016 were retrospectively accessed from the Humana Inc. administrative claims database. Patients were categorized as patients who filled opioid prescriptions within 3 months (OU), within 1 month (A-OU), between 1 to 3 months (C-OU), and never filled opioid prescriptions (N-OU) before surgery. Rates of opioid use were evaluated preoperatively and longitudinally tracked for OU and N-OU cohorts. Prolonged opioid use was defined as continued opioid prescription filling at ≥3 months after surgery. Multiple logistic regression analysis was used to control for various patient characteristics and identify factors associated with opioid use at 12 months after surgery, with significance defined as P<0.05 Results: There were 107,717 patients (54% female) that underwent arthroscopic meniscal surgery during the study period, of which 46.1% (n=49,630) were N-OU. One year after surgery, opioid fill rate was significantly higher in the OU group compared to the N-OU group with a relative risk of 6.98 (21.1% vs 3.02%; 95% CI: 6.61-7.36; p<0.0001). Multiple logistic regression model identified C-OU (OR:10.23, 95% CI: 9.74-10.76, p<0.0001) as the strongest predictor of opioid use at 12 months postoperatively. Furthermore, patients with acute preoperative opioid use (p<0.0001), preoperative diagnosis of diabetes mellitus (p<0.0001), hypertension (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), anxiety or depression (p<0.0001), alcohol abuse (p= 0.0019), and tobacco use (p=0.0345) had a significantly increased odds of opioid use at 12 months postoperatively. However, males (p<0.0001) and patients <40 years (p<0.0001) had a significantly decreased odds of opioid use 12 months postoperatively. Conclusion: Preoperative opioid use is a significant risk factor for opioid use at 12 months following surgery. Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, smoking status, and psychiatric diagnosis were independent risk factors for opioid use 1-year following surgery.

scholarly journals Human epididymis protein 4 is a new biomarker to predict the prognosis of progressive fibrosing interstitial lung disease

2020 ◽  
Author(s):  
Naoki Nishiyama ◽  
Masahiro Masuo ◽  
Yoshihisa Nukui ◽  
Tomoya Tateishi ◽  
Mitsuhiro Kishino ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Interstitial Lung Diseases ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
High Resolution Computed Tomography ◽  
Human Epididymis Protein 4 ◽  
Derivation Cohort ◽  
Human Epididymis ◽  
Cox Proportional Hazard ◽  
The Relationship

Abstract BACKGROUND The clinical course and prognosis of progressive fibrosing interstitial lung diseases ( PF-ILDs) vary from individual to individual. Predictive serum biomarkers for the management of the disease are needed. Serum human epididymis protein 4 (HE4) has been reported to be elevated in patients with IPF, yet its clinical utility has not been elucidated. We evaluated whether serum HE4 could be a biomarker for patients with PF-ILD. METHODS Serum HE4 was measured in a retrospective study that consisted of 34 patients with PF-ILD and 40 healthy volunteers. The relationship between serum HE4 levels and clinical parameters or prognosis was investigated. To validate the significance of the results, a prospective observational study that consisted of 37 patients with PF-ILD and 40 control patients without PF-ILD was performed.RESULTS Serum HE4 was higher in patients with PF-ILD than in health volunteers ( P < 0.01). A correlation of the serum HE4 levels with the extent of honeycombing on chest high-resolution computed tomography was identified (r = 0.41, P = 0.015). In multivariate analysis by the Cox proportional hazard model, higher HE4 levels (> 238 pmol/l) were associated with elevated mortality risk (HR 7.27, 95% CI 1.56-34.0, P = 0.01 in the derivation cohort; HR 44.3, 95% CI 4.19-468, P < 0.01 in validation cohort). CONCLUSIONS Serum HE4 levels may serve as a new diagnostic and prognostic biomarker for patients with PF-ILD.

scholarly journals Machine learning methods for diagnosis of chronic obstructive pulmonary disease in healthy subjects: Analysis of Risk factors To DEtect COPD (ARTDECO) (Preprint)

2020 ◽  
Author(s):  
Shigeo Muro ◽  
Masato Ishida ◽  
Yoshiharu Horie ◽  
Wataru Takeuchi ◽  
Shunki Nakagawa ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Chronic Obstructive Pulmonary Disease ◽  
Logistic Regression ◽  
Pulmonary Disease ◽  
Vital Capacity ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Diagnosis

BACKGROUND Airflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances including tobacco smoke is an established risk. However, not all long-term smokers develop COPD, meaning that other risk factors exist. OBJECTIVE To predict risk factors for COPD diagnosis using machine learning in an annual medical check-up database. METHODS In this retrospective, observational cohort study (Analysis of Risk factors To DEtect COPD [ARTDECO]), annual medical check-up records for all Hitachi Ltd. employees in Japan collected from April 1998 to March 2019 were analyzed. Employees who provided informed consent via an opt-out model were screened and those aged 30–75 years, without prior diagnosis of COPD, asthma, or history of cancer were included. The database included clinical measurements (e.g., pulmonary function tests) and questionnaire responses. To predict risk factors for COPD diagnosis within a 3-year period, the Gradient Boosting Decision Tree machine learning method (XGBoost) was applied as a primary approach, with logistic regression as a secondary method. A diagnosis of COPD was made when the ratio of the pre-bronchodilator forced expiratory volume in 1 second (FEV1) to pre-bronchodilator forced vital capacity (FVC) was <0.7 during two consecutive examinations. RESULTS Of the 26,101 individuals screened, 1,213 met the exclusion criteria and thus 24,815 individuals were included in the analysis. The top 10 predictors for COPD diagnosis were FEV1/FVC, smoking status, allergic symptoms, cough, pack years, hemoglobin A1c, serum albumin, mean corpuscular volume, percent predicted vital capacity value, and percent predicted value of FEV1. The area under the receiver operating characteristic curves of the XGBoost model and the logistic regression model were 0.956 and 0.943, respectively. CONCLUSIONS Using a machine learning model in this longitudinal database, we identified a set multiple of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of COPD. Further research to confirm our results is warranted, as our analysis involved a database used only in Japan. CLINICALTRIAL Not applicable.

scholarly journals Features of cerebral blood flow in patients with chronic obstructive pulmonary disease associated with hypertension

2021 ◽  
Vol 26 (6) ◽  
pp. 676-687
Author(s):  
N. B. Poletaeva ◽  
O. V. Teplyakova ◽  
I. F. Grishina ◽  
A. A. Klepikova
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Blood Flow Velocity ◽  
Flow Index ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Blood Flow Index

Objective. The aim of the work was to study the features of cerebral blood flow in patients with chronic obstructive pulmonary disease (COPD) associated with hypertension (HTN). Design and methods. A crosssectional study was conducted, which included 90 males 40–60 years old. Of these, 30 patients with chronic COPD associated with HTN (COPD + HTN) were included in the study group, 30 individuals with isolated COPD were in the comparison group, 30 healthy volunteers were included in the control group. All participants underwent physical examination, spirography, 24-hour blood pressure monitoring and ultrasound examination of cerebral vessels. Results. Patients with COPD + HTN in comparison with the control showed an increase in the diameter (p = 0,018) and complex of the intima-media of the common carotid artery (p = 0,003) while the velocities, resistance index (RI) and pulsation index (PI) did not change. In the basin of the internal carotid artery an increase in RI values was noted (p = 0,018). At the intracranial level there was a decrease in the end-diastolic velocity (p = 0,03) and the time-averaged average blood flow velocity (TAV) (p = 0,033) without due changes RI and PI. At the same time no changes in speed indicators and indices were noted in the vertebral artery basin. Among the indicators of cerebral perfusion in patients with COPD + HTN, hydrodynamic resistance (p = 0,0015), intracranial pressure (ICP) (p = 0,0048) significantly increased, and the cerebral blood flow index was comparable with the control. Assessment of venous cerebral blood flow showed an increase in the diameter of the internal jugular vein (p = 0,021) with unchanged TAV together with an increase in ICP indicating the formation of venous dysfunction. It was shown that the body mass index, forced expiratory volume at the first second, systolic and diastolic blood pressure together determine the peak systolic blood flow velocity from the midbrain artery. Conclusions. The cerebral blood flow in patients with COPD + HTN is characterized by a change in arterial blood flow at the level of both intra- and extracranial vessels, while maintaining a normal cerebral blood flow index, as well as the formation of arteriovenous dyshemia against the background of remodeling of the cerebral vascular bed.

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