Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

2021 ◽  
pp. postgradmedj-2021-141206
Author(s):  
Konstantinos Bartziokas ◽  
Christos Kyriakopoulos ◽  
Evangelia Dounousi ◽  
Konstantinos Kostikas
Keyword(s):  
Acute Exacerbation ◽  
Chronic Obstructive Lung Disease ◽  
Multivariate Regression Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Tertiary Hospitals ◽  
Exacerbation Of Copd

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD).MethodsWe evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause.ResultsPatients with documented MAB (urinary albumin excretion of 30–300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons).ConclusionsThe presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.

scholarly journals Study of Serum B-Type Natriuretic Peptide (BNP) Levels as a Prognostic Marker in Acute Exacerbation of COPD in HSK Hospital, Bagalkot, Karnataka

2021 ◽  
Vol 8 (19) ◽  
pp. 1332-1335
Author(s):  
Sunil Baragi ◽  
Kadappa Jaligidad ◽  
Joachim Piedade Souza
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Partial Pressure ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Duration Of Hospital Stay ◽  
Life Threatening ◽  
Exacerbation Of Copd

BACKGROUND Pulmonary hypertension (PH) and heart failure are common comorbidities in 20 – 30 % of chronic obstructive pulmonary disease (COPD) patients with acute exacerbation. Similarities in signs and symptoms and lack of objective measures to stratify them at emergency department makes the management difficult. Echocardiography though useful requires specialised training. Hence, B-Type Natriuretic Peptide (BNP) is a simple test that can prognosticate the severity and can influence management in such patients. The purpose of the study was to estimate the significance of BNP during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an important marker of severity and to study its correlation with duration of hospital stay, place and mode of management in patients with severe and life-threatening exacerbation of COPD. METHODS This is a prospective longitudinal observational study conducted on 50 patients of severe and life-threatening COPD exacerbation admitted to General Medicine department of HSK hospital, Bagalkot and their outcomes were noted based on the BNP levels. RESULTS The study showed higher levels of BNP in patients admitted to ICU as compared to emergency ward (P = 0.001). Greater values among those on invasive mechanical ventilation vs. non-invasive ventilation (NIV). There was a positive correlation and statistical significance of BNP values with arterial blood gases (ABG) parameters like pulmonary hypertension (PH), partial pressure of carbondi-oxide (PaCO2), partial pressure of oxygen (PaO2), echo parameters like right ventricle (RV) diameter and pulmonary artery systolic pressure (PASP) and duration of hospital stay. CONCLUSIONS BNP is a simple, low cost and easily available blood test that can prognosticate oxygen requirement, mode of ventilation, place of management and can grade and reflect the severity in acute exacerbation of COPD. KEYWORDS AECOPD, BNP, Prognostic Marker, Outcome

scholarly journals Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

2012 ◽  
Vol 140 (7-8) ◽  
pp. 436-440 ◽  
Author(s):  
Milos Novovic ◽  
Vesna Topic
Keyword(s):  
Acute Exacerbation ◽  
Venous Blood ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Arterial Blood ◽  
Exacerbation Of Copd ◽  
Venous Blood Gas ◽  
Oxygen Status

Introduction. Arterial blood gas (ABG) analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG) values of pH, partial pressure of carbon dioxide (PCO2), partial oxygen pressure (PO2), bicarbonate (HCO3), and venous and arterial blood oxygen saturation (SO2) can reliably predict ABG levels in patients with acute exacerbation of COPD. Methods. Forty-seven patients with a prior diagnosis of COPD were included in this prospective study. The patients with acute exacerbation of this disease were examined at the General Hospital EMS Department in Prijepolje. ABG samples were taken immediately after venous sampling, and both were analyzed. Results. The Pearson correlation coefficients between arterial and venous parameters were 0.828, 0.877, 0.599, 0.896 and 0.312 for pH, PCO2, PO2, HCO3 and SO2, respectively. The statistically significant correlation between arterial and venous pH, PCO2 and HCO3, values was found in patients with acute exacerbation of COPD (p<0.001). Conclusion. When we cannot provide arterial blood for analysis, venous values of the pH, Pv,CO2 and HCO3 parameters can be an alternative to their arterial equivalents in the interpretation of the metabolic status in patients with acute exacerbation of COPD, while the values of venous Pv,O2 and Sv,O2 cannot be used as predictors in the assessment of oxygen status of such patients.

Serum Electrolyte in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 13 (1) ◽  
pp. 9-13
Author(s):  
Chandra Prasad Acharya ◽  
Kalpana Paudel
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Serum Electrolyte ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Electrolyte Disorder ◽  
The Mean ◽  
Exacerbation Of Copd

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and morbidity worldwide. Though COPD is mainly a chronic disease, many patients experience exacerbations that are related to worst survival outcome, especially with abnormal serum electrolyte level. The objective of this study was to evaluate serum electrolyte levels among the patients with acute exacerbation of COPD. Methods: Structured questionnaire and patients’ charts were used to collect data. Data was analyzed using Statistical Package for the Social Sciences (SPSS) software version 16.0 and descriptive statistics were used to generate the research findings. Results: The mean age of the patients with Acute exacerbation of COPD was 69.57± 9.765 years. Among 100 patients, (83%) belonged to the age group of 60 years and above, (54%) were male, (74%) were married, (52%) were illiterate and (41%) were engaged in agriculture, (41%) consumed alcohol and (67%) were smokers. Dyspnoea (90%) was the most common symptom. The mean level of sodium and potassium were 133.8±4.830 mEq/L, 3.6±0.533 mmol/L, respectively. Fifty seven percent patients had electrolyte disorder. More than half (51%) had hyponatremia and (40%) had hypokalemia. The average value of pH, PaCO2 and PaO2 are 7.34 ± 0.727, 46.64 ± 9.787 mm Hg and 69.38 ± 9.255 mm Hg respectively. Among them, (18%) were in respiratory failure. Conclusion: This study concluded that hyponatremia and hypokalemia are prevalent electrolyte disorder with AE of COPD patients. Therefore, we recommend routine monitoring of the serum electrolytes for better outcomes of patients.

Pilot Study to Assess the Credibility of Acupuncture in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

2009 ◽  
Vol 27 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Claudia A Whale ◽  
Sarah J A MacLaran ◽  
Christopher I Whale ◽  
Mandy Barnett
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pilot Study ◽  
Visual Analogue Scale ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Analogue Scale ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Exacerbation Of Copd

Background Exacerbation of chronic obstructive pulmonary disease (COPD) is a common reason for hospital admission, and adjunctive non-pharmacological treatments would be welcomed. A pilot study was undertaken to assess the feasibility of conducting a study of acupuncture during an acute exacerbation of COPD. We also examined the credibility of a sham device in this setting and assessed the effect of acupuncture on breathlessness and anxiety. Methods A prospective, randomised, patient- and assessor-blinded, sham controlled study was conducted on three consecutive days in a district general hospital. Credibility of both acupuncture and the Park sham device were assessed using the Borkovec and Nau questionnaire. Dyspnoea was measured on the modified Borg score and a 10 cm visual analogue scale, while anxiety was measured on a 10 cm visual analogue scale. Results 11 patients were recruited and nine completed the study. There were no adverse events with either intervention. Acupuncture was well tolerated and credibility scores were similar before and after real and sham acupuncture. Symptoms improved after both treatments, with no significant difference between groups. Conclusion In this pilot study acupuncture was well tolerated by subjects experiencing an acute exacerbation of COPD. Acupuncture treatment and the Park sham device were both credible. Although recruitment was slow, a further trial with a larger sample size is feasible and recommended.

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 Clinical Study on the Aerosol Inhalation of Budesonide in Treatment of Acute Exacerbation of COPD

2015 ◽  
Vol 4 (3) ◽  
pp. 40
Author(s):  
Huifeng Duan
Keyword(s):  
Adverse Reaction ◽  
Acute Exacerbation ◽  
Clinical Effect ◽  
Control Group ◽  
Chronic Obstructive ◽  
Observation Group ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Aerosol Inhalation ◽  
Exacerbation Of Copd

<p><strong>Objective</strong>: To observe the clinical effect and adverse reaction of aerosol inhalation of budesonide in treatment of acute exacerbation of COPD. 110 cases of patients with acute exacerbation of chronic obstructive pulmonary disease, who were treated in our department from January 2009 to January 2011, were selected as research objects (69 males, 41 females). All the patients were divided into control group and observation group. The two groups were treated routinely, in addition, the control group was treated with vein administration of methylprednisolone, the observation group received aerosol inhalation of budesonide, observed the clinical effect.<strong> Result: </strong>The clinical effect of observation group is better and the adverse reaction rate is clearly lower. <strong>Conclusion: </strong>Comparing with the control group which is treated with vein administration of methylprednisolone on the basis of routine treatment<strong>, </strong>the effect of observation group which is treated with aerosol inhalation of budesonide is extremely precise and its adverse reaction is also relatively less. Meanwhile, it has a higher security and its clinical effect is worth applying.</p>

scholarly journals ANTIBIOTIC THERAPY IN ACUTE EXACERBATION OF COPD:AN OPTIMAL WAY TO SUCCESS

2021 ◽  
Vol 29 (2) ◽  
pp. 35-40
Author(s):  
L. V. Yudina
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Antibiotic Therapy ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Family Practitioner ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Exacerbation Of Copd

Currently, chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Acute exacerbation of the disease is associated with fast clinical deterioration, increased respiratory tract inflammation and lung function disorders. Acute exacerbation of COPD dramatically worsens patient�s prognosis and serves as an important indicator of therapy effectiveness. Family practitioner should recognize this condition and correctly chose proper antibiotic. Diagnosis of COPD exacerbation is based on clinical manifestations of the disease. Depending on presence of primary or secondary symptoms COPD exacerbations are divided into several types. Antibiotic therapy appears to be more beneficial in patients with type 2 or 3 exacerbation. Sputum purulence is considered an obligatory symptom. As a rule, in complicated course of acute exacerbation of COPD protected aminopenicillins or 3rd generation cephalosporins are the firsline antibiotics. In most cases of COPD exacerbation antibiotics are prescribed orally. If first-line antibacterial therapy fails, the respiratory fluoroquinolones (levofloxacin of moxifloxacin) are prescribed. The author, using her own experience with levofloxacin, gives an example of proper choice of antibiotic if such a situation. Successful experience of management of acute exacerbation of COPD may be useful for general practitioners, physicians, pulmonologists. Key words: chronic obstructive pulmonary disease, exacerbation, antibiotic therapy, levofloxacin.

scholarly journals Comparison of different staging methods for COPD in predicting outcomes

2018 ◽  
Vol 51 (3) ◽  
pp. 1700577 ◽  
Author(s):  
Tang-Hsiu Huang ◽  
Tzuen-Ren Hsiue ◽  
Sheng-Hsiang Lin ◽  
Xin-Ming Liao ◽  
Po-Lan Su ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Chronic Obstructive Lung Disease ◽  
Ethnically Diverse ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Acute Exacerbation ◽  
Frequent Exacerbation ◽  
Global Initiative ◽  
Future Work

Chronic obstructive pulmonary disease (COPD) is commonly staged according to the percentage of predicted forced expiratory volume in 1 s (FEV1 % pred), but other methods have been proposed. In this study we compared the performance of seven staging methods in predicting outcomes.We retrospectively studied 296 COPD outpatients. For each patient the disease severity was staged by separately applying the following methods: the criteria proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), quartiles of FEV1 % pred and z-score of FEV1, quartiles and specified cut-off points of the ratio of FEV1 over height squared ((FEV1·Ht−2)A and (FEV1·Ht−2)B, respectively), and quartiles of the ratio of FEV1 over height cubed (FEV1·Ht−3) and of FEV1 quotient (FEV1Q). We evaluated the performance of these methods in predicting the risks of severe acute exacerbation and all-cause mortality.Overall, staging based on the reference-independent FEV1Q performed best in predicting the risks of severe acute exacerbation (including frequent exacerbation) and mortality, followed by (FEV1·Ht−2)B. The performance of staging methods could also be influenced by the choice of cut-off values. Future work using large and ethnically diverse populations to refine and validate the cut-off values would enhance the prediction of outcomes.

scholarly journals Study of Factors Determining Outcomes in the Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

2014 ◽  
Vol 2 (2) ◽  
pp. 28-34
Author(s):  
MJ Sijapati ◽  
N Bhatta ◽  
B Khanal ◽  
M Lamsal ◽  
S Chaudhary
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Univariate Analysis ◽  
Hospitalized Patients ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Arterial Blood ◽  
Exacerbation Of Copd

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of mortality and morbidity across the world. Information related to the factors associated with COPD exacerbation and factors determining outcome in hospitalized patient with acute exacerbation of COPD are very important for effective long-term management of this disease. Within this background we attempted to study the factors determining outcome in hospitalized patients with acute exacerbation of COPD. METHODS: The study was prospective observational study. Hundred consecutive patients hospitalized with acute exacerbation of COPD were prospectively assessed. RESULTS: Patients required mechanical ventilation and Intensive Care Unit (ICU) transfer were 17 (17%). Patients with hypercapnia pCO2 [(80.24 ± 10.76mmHg P=0.001], pH [(7.24 ± 0.062) P=0.004] with type 2 respiratory failure required ICU transfers with mechanical ventilatory support and these variables were statistically significant in univariate analysis. Patients who were in COPD stage III (FEV1/FVC ratio < 0.35) and having the poor arterial blood gas parameters pH (7.24±0.02) P=0.001, pCO2 [(76.5±13.12mmHg,P=0.006] had bad prognosis. The patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who were smokers and exposed to indoor air pollution due to use of biomass fuels had poor outcomes. CONCLUSION: Patients with AECOPD hospitalized in a tertiary care center in a developing country suggest that FEV1/FVC impairment, decreased pH, increased pC02, current smoking status and presence of biomass exposure are associated with prolonged hospitalization, ICU admission and death. DOI: http://dx.doi.org/10.3126/jucms.v2i2.11171   Journal of Universal College of Medical Sciences (2014) Vol.2(2): 28-34

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