ObjectiveTo explore the feasibility and clinical application value of low attenuation areas (LAA) scoring system in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsA total of 380 patients with AECOPD were included. Clinical data including general information, laboratory examinations and treatments during hospitalization were collected. According to the high-resolution computed CT (HRCT) imaging performance, the patients were divided into bronchitis phenotype and emphysema phenotype. The clinical data between these two groups were compared to analyze the differences between different phenotypes and the feasibility of LAA scoring system.ResultsIn patients of bronchitis phenotype, the levels of body mass index, C-reactive protein, interleukin-6, procalcitonin, neutrophil-to-lymphocyte ratio, and eosinophil counts on admission were higher than those of emphysema phenotype (P<0.05). Patients with emphysema phenotype had a higher proportion of male, a higher smoking index, higher cystatin C levels and lower bilirubin levels on admission (P<0.05), the rates of using mechanical ventilation and systemic glucocorticoids were higher as also (P<0.05). LAA scores had a positive correlation with the use of mechanical ventilation and systemic glucocorticoids and cystatin C levels, and a negative correlation with interleukin-6 levels (P<0.05).ConclusionsFor patients with AECOPD, using LAA scoring system to classify different phenotype through HRCT has relevant accuracy and clinical practicability. The LAA scoring system might help to evaluate the patient's condition and prognosis to a certain extent.
Objective To investigate the current situation of anxiety and depression in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and analyze the related influencing factors. Methods A questionnaire survey was conducted among AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University from August 2022 to October 2023. The survey included basic demographic information, anxiety and depression scores, quality of life and dyspnea symptoms in the AECOPD patients. The clinical data of patients in the electronic medical record system were also collected. According to the anxiety score or depression score, the patients were divided into an anxiety group and a non-anxiety group, or a depression group and a non-depression group. The indicators between two groups were compared and the influencing factors were analyzed. Results Among the 164 patients with AECOPD, 123 patients (75.0%) were complicated with anxiety, 125 patients (76.2%) were complicated with depression, and 105 patients (64.0%) were complicated with anxiety and depression. Education level, place of residence, monthly income, smoking index, and chronic obstructive pulmonary disease assessment test (CAT) score were associated with AECOPD and anxiety (P<0.05). Higher CAT score was an independent risk factor for anxiety in the patients with AECOPD. Residence, monthly income, smoking index, CAT score, modified British Medical Research Council (mMRC) dyspnea questionnaire rating, actual bicarbonate, neutrophilic granulocyte percentage (NEU%), lymphocyte percentage (LYM%), basophile percentage (BASO%), alkaline phosphatase, total carbon dioxide concentration, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were associated with AECOPD and depression (P<0.05). Among them, higher CAT score and PLR value were independent risk factors of AECOPD and depression. Conclusion Anxiety and depression have higher prevalence in AECOPD patients, and the influencing factors include quality of life, dyspnea symptoms, education level, place of residence, monthly income, smoking index, acid base balance, NEU%, LYM%, BASO%, NLR和PLR, etc.
ObjectiveTo systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease (AECOPD). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI, VIP, and WanFang Data from the date of their establishment to July 2016, to collect randomized controlled trials (RCTs) about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using RevMan 5.2 software. ResultsA total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate (RR=0.70, 95% CI 0.55 to 0.89, P=0.004), the rate of duration of antibiotic >10 days (RR=0.38, 95% CI 0.26 to 0.56, P<0.000 01) and the superinfection rate (RR=0.23, 95% CI 0.09 to 0.58, P=0.002) were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate (RR=0.98, 95% CI 0.91 to 1.06, P=0.61), hospital mortality (RR=0.84, 95% CI 0.52 to 1.73, P=0.43), and the rate of need for intensive care (RR=0.77, 95% CI 0.40 to 1.47, P=0.43). ConclusionProcalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.
Objective To investigate the application status of titrated oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by means of literature retrieving. Methods Database retrieving is taken on eight major domestic medical journals about the treatment for AECOPD patients during the period of January 2013 to December 2015. Results There were 70 articles involving the treatment of AECOPD in the eight major journals during 2013 to 2015. Oxygen therapy was not mentioned in 14 articles, oxygen therapy data were incomplete in 13 papers and relatively complete in 43 papers. None of the articals provided full description of oxygen therapy. The arterial blood gas of the patients was analyzed, and showed excessive or not enough on effect of oxygen treatment. Conclusion The clinicians did not pay enough attention to oxygen treatment for AECOPD patients, so treatment guideline and clinical pathway should be construed to standardize titrated oxygen therapy.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
ObjectiveTo analyze the effect of different nebulization methods in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring non-invasive ventilators (NIV). MethodsOne hundred and two patients with AECOPD were selected according to the standard, and randomly divided into a control group, a trial group I, and a trial group II according to the random number table. The patients in the control group received NIV intermittent oxygen-driven nebulization; the patients in the trial group I received NIV simultaneous oxygen-driven nebulization; and the patients in the trial group II received NIV simultaneous air-driven nebulization. The dynamic fluctuations of transcutaneous partial pressure of carbon dioxide (PtCO2), arterial blood gas indexes (PaCO2, PaO2, pH), vital signs and pulse oxygen saturation (SpO2) fluctuations were compared. ResultsPtCO2 at 15min of nebulization in the trial group II were lower than the other groups (P<0.05). PtCO2 at 15min of nebulization was higher than the other time points in the control group (P<0.05); there was no statistical difference of PtCO2 at different time points in the trial group I (P>0.05); PtCO2 gradually decreased with time in the trial group II (P<0.05). The difference before and after nebulization of PtCO2 (dPtCO2) was larger in trial group II than the other groups (P<0.05). PtCO2 at 0min and 5min after the end of nebulization in trial group II were lower than the other groups (P<0.05); there were no statistical differences of PtCO2 at 10min and 15min after the end of nebulization among three groups (P>0.05). There were statistical differences of the PtCO2 at each time point in the control group except for the PtCO2 at 10 min and 15min after the end of nebulization, all of which decreased with time; PtCO2 at each time points of nebulization decreased with time in the trial group I (P<0.05). PtCO2 only at 5min after the end of nebulization was lower than that at 0min after the end of nebulization in trial group II (P< 0.05), there were no statistical differences in other times (P>0.05). PaCO2, pH at the 4th day of treatment was lower than the pre-treatment in the control group (P<0.01); there were statistical differences of PaCO2 between the pre-treatment and the rest time points in the trial group I and group II (P<0.05). The number of abnormal fluctuations in vital signs and SpO2 during nebulization in three groups was not statistically different (P>0.05). ConclusionsThree groups can achieve good therapeutic effects. NIV intermittent oxygen-driven nebulization can make PtCO2 rise during nebulization; NIV simultaneous oxygen-driven nebulization can make PtCO2 remain stable during nebulization; NIV simultaneous air-driven nebulization can make PtCO2 fall during nebulization.
Objective To investigate the influence of pulmonary infection on noninvasive ventilation ( NIV) therapy in hypercapnic acute respiratory failure ( ARF) due to acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and evaluate the predictive value of simplified version of clinical pulmonary infection score ( CPIS) for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV wasevaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group ( 4. 0 ±2. 8, 3. 2 ±2. 4) were lower than those of the unsuccessful group ( 8. 0 ±2. 1, 7. 2 ±1. 8) significantly ( P =0. 006, 0. 007) . The area under ROC curve ( AUC) of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut oint of CPIS and simplified version of CPIS were 6 ( sensitivity of 78. 0% , specificity of 91. 2% ) and 5 ( sensitivity of 80. 0% , specificity of 91. 2% ) respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.
ObjectiveTo analyze the features and clinical significance of blood eosinophils (EOS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsThe general data, laboratory examination and treatment of patients with AECOPD admitted to this department from January 2014 to December 2016 were analyzed retrospectively. Based on the inclusion of treatment targets for blood EOS according to 2018GOLD, patients were divided into group A (EOS<100 cells/μL), group B (100 cells/μL≤EOS≤300 cells/μL), and group C (EOS>300 cells/μL) with two cut-off levels. The differences in general data, severity, and glucocorticoid use between group A, group B and group C were compared.ResultsA total of 515 patients with AECOPD were enrolled. 10.87% of patients had blood EOS>300 cells/μL, and 39.03% of patients had blood EOS≥100 cells/μL. Patients in group B and C were younger, with shorter disease duration, intensive care unit stay time, non-invasive mechanical ventilation use time. The time of glucocorticoid administration was significantly shortened, and the cumulative dose of venous glucocorticoid, hospitalization cost, and total drug cost were also lower than those of group A (all P<0.05).ConclusionsPatients in group B and C are younger, shorter in disease duration, lower in severity and more responsive to glucocorticoid therapy. Blood EOS can be used as a marker to guide glucocorticoid therapy in patients with AECOPD.
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.
Objective To assess the effectiveness and safety of moxifloxacin versus levofloxacin for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Such databases as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP were electronically searched, and the relevant conference proceedings were also hand-searched. The search time was up to July, 2011. Randomized controlled trials (RCTs) on moxifloxacin versus levofloxacin for AECOPD were included. Literature was screened according to inclusive and exclusive criteria, data were extracted, quality was assessed, and then meta-analysis was performed using RevMan 5.0. Results A total of 6 RCTs involving 482 patients with AECOPD were included. The results of meta-analysis showed that moxifloxacin group was significantly superior to levofloxacin group in the effective rate (OR=3.15, 95%CI 1.80 to 5.49, Plt;0.000 1). The bacterial clearance rate in moxifloxacin group was also higher than that in the levofloxacin group (OR=2.79, 95%CI 1.30 to 5.97, P=0.008). In addition, adverse effects of moxifloxacin group were less than levofloxacin (OR=0.48, 95%CI 0.24 to 0.98, P=0.04). Conclusion Based on current studies, moxifloxacin is superior to levofloxacin in improving effective rate and bacterial clearance rate, and in lowering side effects when treating AECOPD. Hence it is considerable to use moxifloxacin instead of levofloxacin in the treatment of AECOPD if necessary. Due to the limitation of both quantity and quality of included studies, this conclusion should be further confirmed with more high quality and large sample studies.