ObjectiveThrough measuring fractional exhaled nitric oxide (FeNO) and eosinophil levels of peripheral blood in chronic obstructive pulmonary disease (COPD) patients with different phenotype of acute exacerbation frequency, to predict the therapeutic effect of glucocorticoid therapy and guide the clinical treatment of different subtypes patients with acute exacerbations of COPD.MethodsA total of 127 patients with acute exacerbation of COPD in Suining Central Hospital from February 2017 to October 2019 were recruited. They were divided four groups according to the number of acute exacerbations in the past one year and the treatment scheme, ie. a frequent acute exacerbation with glucocorticoid treatment group (34 cases), a frequent acute exacerbation with non-glucocorticoid treatment group (31 cases), a non-frequent acute exacerbation with glucocorticoid treatment group (30 cases), and a non-frequent acute exacerbation with non-glucocorticoid treatment group (32 cases). FeNO value, eosinophil ratio in peripheral blood, COPD assessment test (CAT) score, and interleukin-8 (IL-8) concentration were measured before and on the 10th day of treatment, and the differences within group and between groups before and after treatment were compared.ResultsCAT score, FeNO, eosinophil ratio and IL-8 level in the four groups were significantly improved on the 10th day after treatment (all P<0.05). The declines of FeNO value, eosinophil ratio, and IL-8 level on the 10th day of treatment compared with those before treatment in the frequent acute exacerbation with glucocorticoid treatment group and the frequent acute exacerbations with non-glucocorticoid treatment group were larger than those in the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (all P<0.05). The declines of FeNO value, blood eosinophil ratio and IL-8 level in the frequent acute exacerbation with glucocorticoid treatment group were also statistically significantly larger than those in the frequent acute exacerbations with non-glucocorticoid treatment group (all P<0.05). The improvement of CAT score in the frequent acute exacerbation with glucocorticoid treatment group was greater than that in other three groups (all P<0.05). There was no significant difference in CAT score between the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (P>0.05).ConclusionsThe degree of airway inflammation is more obvious in patients with frequent acute exacerbation phenotype of COPD. FeNO value can reflect the level of airway inflammation in patients with frequent acute exacerbation of COPD and evaluate the response to glucocorticoid therapy.
Objective To compare the clinical characteristics and treatment of patients with chronic obstructive pulmonary disease (COPD) in the year of 2018, 2019, 2020, and 2021. Methods A cross-sectional multicenter study was conducted on patients with stable COPD from 13 hospitals of China south area in year of 2018, 2019, 2020 and 2021. The demographic data, pulmonary function, COPD assessment test (CAT), exacerbation in the past year and treatment regimens were collected. Results The CAT scores of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (16.5±6.7), (14.5±6.7), (14.1±6.2) and (13.4±6.6), respectively. The CAT scores decreased year by year (P<0.05). The forced expiratory volume in one second percentage predicted value (FEV1%pred) of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (52.8±21.4)%, (51.3±19.2)%, (53.4±21.5)% and (56.6±21.7)%, respectively. Compared with year of 2018, the patients in 2019, 2020 and 2021 had higher FEV1%pred. Compared with year of 2019 and 2020, the patients 2021 had higher FEV1%pred (P<0.05). The median of exacerbation in the past year of the COPD patients in the year of 2018, 2019, 2020 and 2021 were 1, 1, 0 and 0, respectively. Compared with year of 2018 and 2019, the median of exacerbation in the past year in 2020 and 2021 were lower (P<0.05). The proportion of double [long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA)] and triple inhaled [LAMA+LABA+ inhaled corticosteroid (ICS)] drugs were 0%, 0.7%, 3.5% and 17.0%, as well as 47.9%, 41.2%, 27.8% and 26.0%. Compared with year of 2018 and 2019, the proportion of double inhaled drugs in 2020 and 2021 was higher, while triple inhaled drugs was lower (P<0.05). In addition, the proportion of influenza vaccine/pneumonia vaccine was 0%, 0.1%, 3.5% and 4.3%, respectively. Compared with year of 2018 and 2019, the proportion of influenza vaccine/pneumonia vaccine in year of 2020 and 2021 was higher (P<0.05). Conclusions Symptoms and exacerbation burden of patients with COPD tend to be less in China in recent years and the time of patients visited hospital tends to move forward. Furthermore, the proportion of patients with double inhaled drugs (LABA+LAMA) increased, while triple inhaled (LAMA+LABA+ICS) decreased. In addition, the proportion of patients vaccinated with influenza/pneumonia is increased but the overall proportion is still low.
Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
ObjectiveTo study the clinical features, short-term prognosis and risk factors of Pseudomonas Aeruginosa (P.aeruginosa) infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with P.aeruginosa infection were included as case group, AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 2∶1. The differences in basic conditions, complications, clinical manifestations on admission and in-hospital prognosis between the two groups were compared, and the risk factors of P.aeruginosa infection were analyzed. ResultsA total of 14007 inpatients with AECOPD were included in this study, and 338 patients were confirmed to have P.aeruginosa infection during hospitalization, with an incidence rate of 2.41%. The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group, which was manifested in higher hospital mortality (4.4% vs. 1.9%, P=0.02) and longer hospital stay [13.0 (9.0, 19.25)d vs. 11.0 (8.0, 15.0)d, P=0.002]. In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, dyspnea in the case group were higher than those in the control group, and the inflammatory indicators (neutrophil ratio, erythrocyte sedimentation rate) and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group, while the serum albumin was significantly lower than that in the control group (all P<0.05). Multivariate logistic regression analysis showed that Parkinson's disease [odds ratio (OR)=5.14, 95% confidence interval (CI): 1.43 to 18.49, P=0.012], bronchiectasis (OR=4.97, 95%CI: 3.70 to 6.67, P<0.001), invasive mechanical ventilation (OR=2.03, 95%CI: 1.23 to 3.36, P=0.006), serum albumin<35 g/L (OR=1.40, 95%CI: 1.04 to 1.88, P=0.026), partial pressure of carbon dioxide ≥45 mm Hg (OR=1.38, 95%CI: 1.01 to 1.90, P=0.046) were independent risk factors for P.aeruginosa infection in AECOPD patients. ConclusionsP.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients. Parkinson’s disease, bronchiectasis, invasive mechanical ventilation, serum albumin below 35 g/L, partial pressure of carbon dioxide ≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.
Objective To investigate the characteristics of micro-biology in the respiratory tract in the patients who were suffering acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with/without their respiratory failures as well as with the high/low frequency of exacerbation. MethodsSixty confirmed subjects in the Department of Respiratory and Critical Care in Guizhou Provincial Hospital from Nov. 2021 to Mar. 2022 were chosen and then divided them into two pairs of sub-groups randomly. Sub-group pairs one were based on the frequency of AECOPD: higher frequency and lower frequency. Sub-group pairs two were based on whether the patients were once with respiratory failure or not. 16S rRNA high-throughput sequencing method was used to detect sputum microecology. The Alpha and Beta diversity of each subgroup, and the differences in bacterial composition and relative abundance, were compared. Results For the AECOPD group with low-frequent of exacerbation, its diversity and abundance of microbiology were higher than those group with high-frequent of exacerbation. The group of AECOPD with respiratory failure had lower bacteria micro diversity but abundancy was higher than those group without respiratory failure. ConclusionThe frequency of AECOPD and whether it is with respiratory failure is related to the change of micro-biology in respiratory tract, so such change plays a great role in this disease.
Objective To systematically evaluate risk prediction models for acute exacerbation of chronic obstructive pulmonary disease (COPD), and provide a reference for early clinical identification. Methods The literature on the risk prediction models of acute exacerbation of COPD published by CNKI, VIP, Cochrane, Embase and Web of Science database was searched in Chinese and English from inception to April 2022, and relevant studies were collected on the development of risk prediction models for acute exacerbations of COPD. After independent screening of the literature and extraction of information by two independent researchers, the quality of the included literature was evaluated using the PROBASTA tool. Results Five prospective studies, one retrospective case-control study and seven retrospective cohort studies were included, totally 13 papers containing 24 models. Twelve studies (92.3%) reported the area under the receiver operator characteristic curve ranging 0.66 to 0.969. Only five studies reported calibrated statistics, and three studies were internally and externally validated. The overall applicability of 13 studies was good, but there was a high risk of bias, mainly in the area of analysis. Conclusions The existing predictive risk models for acute exacerbations of COPD are unsatisfactory, with wide variation in model performance, inappropriate and incomplete inclusion of predictors, and a need for better ways to develop and validate high-quality predictive models. Future research should refine the study design and study report, and continue to update and validate existing models. Secondly medical staff should develop and implement risk stratification strategies for acute exacerbations of COPD based on predicted risk classification results in order to reduce the frequency of acute exacerbations and to facilitate the rational allocation of medical resources.
ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.
Objective To investigate the relationship between peripheral blood circularRNA oxysterol binding protein-like 2 (circOSBPL2), circularRNA catenin beta 1 (circCTNNB1) and frequent acute exacerbations of patients with stable chronic obstructive pulmonary disease (COPD). Methods Patients with stable COPD admitted to the First Affiliated Hospital of Hebei North University between January 2021 and March 2023 were retrospective selected. Based on the time of acute exacerbations during the 1-year follow-up period, the included patients were divided into the frequent acute exacerbation group and the control group. The expression levels of circOSBPL2 and circCTNNB1 in peripheral blood and the clinical data of the two groups were compared. The influencing factors of frequent acute exacerbations were analyzed by binary logistic multivariate regression, and the predictive value of each indicator for frequent acute exacerbations was analyzed by receiver operator characteristic curve. Results A total of 109 patients were included. Among them, there were 42 cases in the frequent acute exacerbation group and 67 cases in the control group. The expression level of circOSBPL2 in peripheral blood and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score of patients in the frequent acute exacerbation group were higher than those in the control group (P<0.05), and the expression level of circCTNNB1 in peripheral blood and serum albumin levels were lower than those in the control group (P<0.05). There was no significant difference in other clinical data between the two groups (P>0.05). The results of binary logistic multiple regression analysis showed that circOSBPL2 and CAT score were risk factors for frequent acute exacerbations, and circCTNNB1 was protective a factor for frequent acute exacerbations (P<0.05). The receiver operator characteristic curve analysis results showed that the area under the curve predicted by the combination of circOSBPL2, circCTNNB1, and CAT scores was higher than that predicted by circOSBPL2, circCTNNB1, and CAT scores alone [0.948 (0.907, 0.989) vs. 0.811 (0.733, 0.889) vs. 0.833 (0.758, 0.907) vs. 0.738 (0.640, 0.835), P<0.05]. Conclusions The increase of circOSBPL2 expression and the decrease of circCTNNB1 expression in peripheral blood of stable chronic obstructive pulmonary disease patients are associated with frequent acute exacerbations. CircOSBPL2 and circCTNNB1 combined with CAT score have good predictive value for frequent acute exacerbations.
Objective To explore the clinical value of Wells score combined with thromboelastography (TEG) in rapid prediction of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 130 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine of Guangxi University of Science and Technology from January 2022 to March 2023 were selected as the study subjects. According to results of digital subtraction angiography (DSA) of the pulmonary artery, the patients were divided into a PE group (n=37) and a non-PE group (n=93). Both groups underwent Wells score analysis combined with TEG. Thromboelastographic parameters were comparing between the two groups, including Wells score, reaction time (R time), reaction time (K time), coagulation index (CI), and maximum amplitude (MA). The diagnostic value of different prediction models to diagnose AECOPD with PE was compared, including Wells score, thromboelogram and Wells score combined with TEG. Results The Wells score of the patients in the PE group was significantly higher than that in the non-PE group, and R time of the patients in the PE group was significantly lower than that in the non-PE group. The K time, CI, MA and other parameter levels of the patients in the PE group were significantly higher than those in the non-PE group (all P<0.05). The sensitivity, specificity, and area under ROC curve of the combination of Wells score and TEG prediction model in diagnosing AECOPD complicated with PE were greater than those of the Wells score alone prediction model (P<0.05). Conclusion The combination of Wells score and TEG has significant clinical value in quickly predicting AECOPD complicated with PE, and is worthy of clinical application and promotion.
Objective To evaluate the correlation between blood eosinophilia and clinical characteristics, readmission rate and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP, and CBM databases were searched until October 31, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the bias risk of the included studies. Meta-analysis was conducted by Rev Man v.5.4. Results Finally, 76 observational studies met the inclusion criteria, including 15 English literatures and 61 Chinese literatures. There were 8240 patients (34.20%) in the eosinophilia group (EOS≥2%) and 15854 cases (65.8%) in the eosinophil normal group (EOS<2%). Results of meta-analysis: (1) Inflammatory Index: eosinophilia group had lower C-reactive protein [MD=–8.44, 95%CI (–10.59, –6.29), P<0.05], and lower neutrophil to lymphocyte ratio [MD=–2.47, 95%CI (–3.13, –1.81), P<0.05]. (2) Hospitalization: eosinophilia group had shorter hospital stay [MD=–2.23, 95%CI (–2.64, –1.81), P<0.05] and lower in-hospital mortality [OR=0.41, 95%CI (0.31, 0.53), P<0.05], lower mechanical ventilation rate [OR=0.59, 95%CI (0.47, 0.75), P<0.05], lower hormone use rate [OR=0.91, 95%CI (0.85, 0.96), P<0.05]. (3) Follow-up results: eosinophilia group had a lower rate of readmission at 1 year [OR=0.78, 95%CI (0.66, 0.92), P<0.05] and a lower rate of death at 1 year [OR=0.78, 95%CI (0.62, 0.97), P<0.05]. Conclusions AECOPD patients with eosinophilia group were characterized by lower inflammatory indicators, shorter hospital stay, shorter in-hospital mortality, lower mechanical ventilation rate, lower hormone use rate, lower rate of acute exacerbation readmission, lower mortality rate and lower rate of follow-up after 1 year. This kind of patients with mild disease, good treatment effect, low risk of acute exacerbation.