scholarly journals Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study

2021 ◽  
Author(s):  
Blandine Tramunt ◽  
Sarra Smati ◽  
Sandrine Coudol ◽  
Matthieu Wargny ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Microvascular Complications ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Female Sex ◽  
Patients With Diabetes ◽  
History Of ◽  
Biological Determinants ◽  
Stratified Analysis

Objective: Male sex is a determinant of severe coronavirus disease-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. Methods: We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation [IMV], death, intensive care unit [ICU] admission and home discharge at day 7 [D7] or day 28 [D28]) in 2,380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). Results: The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR 0.66 [0.49-0.88]), death (OR 0.49 [0.30-0.79]) and ICU admission (OR 0.57 [0.43-0.77]) at D7, but only with ICU admission (OR 0.58 [0.43-0.77]) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, CRP, AST and eGFR predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. Conclusions: In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.

Effect of Anemia on Mortality in Mechanically Ventilated Patients With Chronic Obstructive Pulmonary Disease

2017 ◽  
Vol 35 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Shruti K. Gadre ◽  
Aravdeep Singh Jhand ◽  
Sami Abuqayyas ◽  
Xiaofeng Wang ◽  
Jorge Guzman ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Pulmonary Disease ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Overall Mortality

Rationale: The effect of anemia on patients with chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation for acute respiratory failure is unknown. Objectives: To examine the association between anemia (hemoglobin <12 g/dL) and 90-day and overall mortality in patients with COPD having acute respiratory failure requiring invasive mechanical ventilation. Methods: Retrospective study of patients admitted to a quaternary referral medical intensive care unit (ICU) between October 2007 and December 2012 with a diagnosis of COPD and requiring invasive mechanical ventilation for acute respiratory failure of any cause. Results: We identified 1107 patients with COPD who required invasive mechanical ventilation for acute respiratory failure. Mean age was 64.2 ± 12.7 years; 563 (50.9%) were females. The mean Acute Physiology and Chronic Health Evaluation III score at ICU admission was 80.5 ± 29.3. The median duration of mechanical ventilation was 35.7 hours (interquartile range: 20.0-54.0). In all, 885 (79.9%) patients were anemic (Hb < 12g/dL) on ICU admission, and 312 patients (28.2%) received blood transfusion during their ICU stay. A total of 351 inhospital deaths were recorded, the majority (n = 320) occurring in the ICU. The 90-day mortality, though lower in the nonanemic patients compared to the patients with anemia, was not statistically significant (35.6% vs 44.9%; hazard ratio [HR] [95% confidence interval; CI] = 1.16 [0.91 -1.48], P = .22). The overall mortality was lower in the nonanemic patients compared to patients with anemia (HR [95% CI] = 0.68 [0.55-0.83], P < .001). There was a 5% decrease in risk of death for every unit increase in hemoglobin ( P = .01). There was no difference in terms of both 90-day and overall mortality in patients who received blood transfusions compared to patients who did not receive any transfusion. Conclusions: Critically ill patients with COPD requiring invasive mechanical ventilation for acute respiratory failure without anemia on admission had a better overall survival when compared to those with anemia. No difference was noted in the 90-day mortality. Further studies are needed to determine the impact of the trajectory of hemoglobin on mortality.

scholarly journals Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 9 (9) ◽  
pp. 2884
Author(s):  
Ernesto Crisafulli ◽  
Catia Cillóniz ◽  
Adamantia Liapikou ◽  
Marcello Ferrari ◽  
Fabiana Busti ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Smoking Habit ◽  
Invasive Mechanical Ventilation ◽  
Community Acquired Pneumonia ◽  
Systemic Inflammatory Response ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Increased Risk

The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.

scholarly journals Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 53
Author(s):  
Jun Horie ◽  
Koichiro Takahashi ◽  
Shuuichi Shiranita ◽  
Kunihiko Anami ◽  
Shinichiro Hayashi
Keyword(s):  
Gait Speed ◽  
Pulmonary Rehabilitation ◽  
Exercise Tolerance ◽  
Respiratory Illness ◽  
Forced Expiratory Volume ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
St George's Respiratory Questionnaire ◽  
History Of

This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

scholarly journals Imaging in alpha-1 antitrypsin deficiency: a window into the disease

2021 ◽  
Vol 12_suppl ◽  
pp. 204062232110245
Author(s):  
Yuh-Chin Tony Huang ◽  
Marion Wencker ◽  
Bastiaan Driehuys
Keyword(s):  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Essential Information ◽  
Plain Chest Radiograph ◽  
Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin Deficiency ◽  
History Of ◽  
Detailed Assessment ◽  
Alpha 1 Antitrypsin ◽  
Magnetic Resonance Imaging Mri

Imaging modalities such as plain chest radiograph and computed tomography (CT) are important tools in the assessment of patients with chronic obstructive pulmonary disease (COPD) of any etiology. These methods facilitate differential diagnoses and the assessment of individual lung pathologies, such as the presence of emphysema, bullae, or fibrosis. However, as emphysema is the core pathological consequence in the lungs of patients with alpha-1 antitrypsin deficiency (AATD), and because AATD is associated with the development of other lung pathologies such as bronchiectasis, there is a greater need for patients with AATD than those with non-AATD-related COPD to undergo more detailed assessment using CT. In the field of AATD, CT provides essential information regarding the presence, distribution, and morphology of emphysema. In addition, it offers the option to quantify the extent of emphysema. These data have implications for treatment decisions such as initiation of alpha-1 antitrypsin (AAT) therapy, or suitability for surgical or endoscopic interventions for reducing lung volume. Furthermore, CT has provided vital insight regarding the natural history of emphysema progression in AATD, and CT densitometry has underpinned research into the efficacy of AAT therapy. Moving forward, hyperpolarized xenon gas (129Xe) lung magnetic resonance imaging (MRI) is emerging as a promising complement to CT by adding comprehensive measures of regional lung function. It also avoids the main disadvantage of CT: the associated radiation. This chapter provides an overview of technological aspects of imaging in AATD, as well as its role in the management of patients and clinical research. In addition, perspectives on the future potential role of lung MRI in AATD are outlined.

scholarly journals Association between Chronic Obstructive Pulmonary Disease and Ménière’s Disease: A Nested Case–Control Study Using a National Health Screening Cohort

2021 ◽  
Vol 18 (9) ◽  
pp. 4536
Author(s):  
So-Young Kim ◽  
Chang-Ho Lee ◽  
Dae-Myoung Yoo ◽  
Chan-Yang Min ◽  
Hyo-Geun Choi
Keyword(s):  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Chronic Obstructive ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Obstructive Pulmonary Disease ◽  
Region Of Residence ◽  
History Of ◽  
Ménière's Disease

This study explored the relation between Ménière’s disease and chronic obstructive pulmonary disease (COPD). The ≥40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort was included. In total, 7734 Ménière’s disease patients and 30,936 control participants were enrolled. Control participants were matched for age, sex, income, and region of residence with Ménière’s disease participants. The odds of having Ménière’s disease given a history of COPD were analyzed using conditional logistic regression. Subgroup analyses were conducted according to age, sex, income, and region of residence. The odds of having Ménière’s disease were found to be 1.18-fold higher with a history of COPD than with no history of COPD (95% confidence intervals (CI) = 1.06–1.32, E-value (CI) = 1.64 (1.31)). The ≥60 years old, male, low-income, and rural subgroups showed increased odds of developing Ménière’s disease when a history of COPD was reported. A history of COPD was associated with an increased risk of Ménière’s disease in the adult population.

scholarly journals Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

2015 ◽  
Vol 22 (4) ◽  
pp. 209-214 ◽  
Author(s):  
Chantal Robitaille ◽  
Esther Dajczman ◽  
Andrew M Hirsch ◽  
David Small ◽  
Pierre Ernst ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Screening Program ◽  
Tertiary Care ◽  
Airflow Obstruction ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Targeted Screening ◽  
History Of

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

scholarly journals High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000848 ◽  
Author(s):  
Andreas Jönsson ◽  
Artur Fedorowski ◽  
Gunnar Engström ◽  
Per Wollmer ◽  
Viktor Hamrefors
Keyword(s):  
Myocardial Ischaemia ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Clinical Factors ◽  
Obstructive Pulmonary Disease ◽  
Presenting Symptoms ◽  
High Prevalence ◽  
History Of ◽  
Artery Disease ◽  
Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

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