Objective To evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To improve the awareness of acute exacerbation of idiopathic pulmonary fibrosis ( AEIPF) and discuss its clinical characteristics, diagnosis, treatment and outcome. Methods The clinical data of patients with AEIPF from June 2006 to June 2011 in 11 hospitals in Jiangsu were collected and analyzed. Resluts There were 18 males and 3 females in the AEIPF patients with mean age of ( 67.4 ± 8.1) years. The duration from IPF diagnosis was ( 7.4 ±8.2) months. The duration of acute symptom before admission was ( 7.0 ±5.3) days. The distribution pattern of new groud-glass opacity was peripheral in 3 patients,multifocal in 5 patients, and diffuse in13 patients. All patients were treated with corticosteroid pulse therapy. Nine patients survived and 12 patients died. The mortality rate was 57.1% . Conclusions AEIPF progresses quickly and the mortality rate is very high. Corticosteroid pulse therapy is the mainstay of therapy in AEIPF patients.
Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.
Objective To evaluate the effects of indoor temperature and relative humidity on acute exacerbations of chronic obstructive pulmonary disease（AECOPD）.Methods A total of 70 moderate to very severe COPD patients were recruited.The data including indoor temperature and relative humidity twice daily，increase over their stable symptoms in "major" symptoms（dyspnea，sputum purulence，sputum amount） and "minor" symptoms（nasal discharge/congestion，sore throat，cough），and adjustment of medication were recorded on diary cards.All data were collected from Jan 2005 to Dec 2005 by telephone inquiring or home visiting.Furthermore，the corresponding median outdoor temperature，relative humidity and air pressure from atmosphere bureau were compared with indoors parameters to examine the different effects on AECOPD.Results Fifty-five cases completed the whole investigation.Indoor temperature and relative humidity were both risk factors when logistic regression was used to evaluate the effect.Our research showed that AECOPD was significantly related to indoor and ourdoor environment factors.The correlation coefficient of all factors were r=－0.686（indoor temperature），r=－0.671（outer temperature），r=0.105（indoor humidity），r=－0.115（outer humidity），r=0.545（atmospheric pressure） respectively.Conclusions The indoor temperature and relative humidity，especially low temperature and high relative humidity，had important effects on AECOPD of moderate to very severe patients.It may be helpful to prevent AECOPD by adjusting the indoor temperature and relative humidity.
ObjectiveTo investigate the prevalence and risk factors of deep venous thrombosis (DVT) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). MethodsOne hundred and eight patients with acute exacerbation of COPD admitted between March 2009 and September 2010 were consecutively included.On admission,color Doppler ultrasound examination of lower extremities was performed for diagnosing DVT in all cases.The patients with DVT were compared with those without DVT in demographics,symptoms,physical signs,risk factors and laboratory examination including Ⅷ factor and von Willebrand factor (VWF). ResultsAmong 108 patients with acute exacerbation of COPD,DVT was detected in 11 cases (10.1%).In the COPD patients with DVT,the duration of hospitalization was longer (P<0.001) and the mechanical ventilation requirement increased (P=0.024) compared those without DVT.Other indicators for more possibility of DVT were immobility over 3 days (P=0.001),pneumonia as concomitance (P=0.004),type Ⅱ respiratory failure (P=0.011),and current smoking (P=0.002).The plasma leukocytes,D-dimer and Ⅷ factor levels were significantly higher in the COPD patients with DVT than those without DVT (P=0.005;P<0.001;P=0.009). ConclusionThe incidence of DVT in patients with acute exacerbation of COPD is 10.1%.The prevalence of DVT is higher in distal extremities than that in proximal,especially the intermuscular veins.The patients with acute exacerbation of COPD have a higher risk of DVT when immobilized over 3 days,complicated by pneumonia or type Ⅱ respiratory failure,and having a high levels of plasma leukocytes,D-dimer and Ⅷ factor.
ObjectiveTo explore the value of three brief scales (BAP-65 class, DECAF score, and CAPS) on assessing the severity of acute exacerbation in patients with chronic obstructive pulmonary disease(COPD) complicated by hypercapnic respiratory failure. MethodsTwo hundred and forty-four cases with acute exacerbation of COPD complicated by hypercapnic respiratory failure, admitted in West China Hospital from August 2012 to December 2013, were analyzed retrospectively.The scores of each scale were calculated.The areas under the receiver operating characteristic curves (AUROC) of each scale for hospital mortality, mechanical ventilation use, mortality of patients requiring mechanical ventilation, invasive mechanical use were analyzed and compared. ResultsThe AUROCs of BAP-65 class, DECAF score and CAPS for hospital mortality were 0.731, 0.765, and 0.711; for mechanical ventilation were 0.638, 0.702, and 0.617; for mortality of patients requiring mechanical ventilation were 0.672, 0.707, and 0.677; for invasive mechanical ventilation use were 0.745, 0.732, and 0.627(BAP-65 vs.CAPS, P < 0.05).Mortality and mechanical ventilation use increased as the three scales escalated.In the patients whose BAP-65 or DECAF score were more than 4 points, the hospital mortality was nearly 50%, and about 95% of the patients underwent mechanical ventilation. ConclusionsThe BAP-65 class, DECAF score, and CAPS of patients on admission have predictive values on assessing the severity of acute exacerbation in patients with COPD complicated by hypercapnic respiratory failure, especially the simple and practical BAP-65 class and DECAF score.
ObjectiveTo assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange) of patients with severe stable chronic obstructive pulmonary disease (COPD) with respiratory failure treated by noninvasive positive pressure ventilation (NPPV).MethodsA meta-analysis of randomized controlled trials was carried out by searching PubMed, Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test.ResultsSix studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia.ConclusionCurrent evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients’ mortality with the aim of reducing hypercapnia.
ObjectiveTo observe the dynamic changes of plasma Clara cell secretory protein (CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance.MethodsA total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day 1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second (FEV1%pred), percentage of forced vital capacity in the estimated value (FVC%pred), FEV1/FVC ratio, arterial partial pressure of carbon dioxide (PaCO2), white blood cell count (WBC), the proportion of neutrophils (NEUT%), C-reactive protein (CRP), procalcitonin (PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay.ResultsThe plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant (P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences (P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score (r=–0.704, P<0.001), and also was negatively correlated with the length of stay (r=–0.351, P=0.003).ConclusionsCC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.