ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.
ObjectiveTo investigate the value of neutrophil/lymphocyte ratio (NLR) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers.MethodsRetrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed.ResultsThe level of NLR was higher in the group with pneumonia than that in the non-pneumonia group (P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level (P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid (P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days (P<0.05). The NLR value of the death group was higher than that of the survival group (P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727 (OR=4.112, 95% confidence interval 0.609 - 0.849, P=0.02).ConclusionsNLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.
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.
ObjectiveTo analyze the association between the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (syndrome of phlegm-heat obstructing lung) and clinical indicators related to COPD. MethodAECOPD in-patients and out-patients were enrolled from the Third People's Hospital of Chengdu from January 2013 to January 2014. The patients were grouped to Tanre Syndrome and non-Tanre Syndrome according to their clinical symptoms, signs and tongue, pulse. All patients underwent the following tests including routine blood test, erythrocyte sedimentation rate, lung function, blood gas analysis, C-reaction protein (CRP), procalcitonin (PCT) and other clinically relevant indicators. The association between AECOPD and clinically relevant indicators were analyzed by using SPSS 19.0 software. ResultsA total of 194 AECOPD patients were included, of which 88 patients were syndrome of phlegm-heat obstructing lung and 106 were non syndrome of phlegm-heat obstructing lung according to the traditional Chinese medicine (TCM) classifications. The results of single factor analysis showed that age (Z=-4.848, P=0.000) and course of disease (Z=-2.455, P=0.014) were associated with syndrome of phlegm-heat obstructing lung. While further logistic regression analysis showed that age (r=0.090, P=0.000) and the level of CRP (r=-0.008, P=0.000) were associated with syndrome of phlegm-heat obstructing lung. ConclusionSyndrome of phlegm-heat obstructing lung is the major clinical TCM syndrome of AECOPD. Syndrome of phlegm-heat obstructing lung is associated with age and level of CRP.
Objective To observe the genotype distribution of Haemophilus parainfluenzae from patients with acute exacerbations of chronic obstructive pulmonary disease ( AECOPD) and their effects on A549 cells. Methods 80 hospitalized patients with AECOPD in our hospital were enrolled. Haemophilus parainfluezae were collected by sputum culture and genotyped, then inoculated with cell line A549. IL-6 and IL-8 concentrations in the supernatant were detected and cell morphology was observed at different time points. Results The patients were divided into three groups according to their symptoms. 15 Haemophilus parainfuenzae strains were collected and the positive culture rate between type 1 and type 3 COPD patients were statistically different. The concentrations of IL-6 and IL-8 were both significantly higher than control and increased as time passed. 4 genotypes were got by random amplification of polymorphic DNA ( RAPD) . In RAPD Ⅲ group, the IL-8 concentration was higher at 12h and 24h than others. No morphologic change was found in the cells inoculated with Haemophilus parainfuenzae by microscope after fixing. Conclusions Positive culture rate of Haemophilus parainfuenzae was different in different COPD groups according to symptoms. Haemophilus parainfuenzae can stimulate a cytokine response in A549 cells, maybe one of the pathogens of AECOPD, especially the RAPDⅢ type. Haemophilus parainfuenzae is not an intracellular bacteria.
Objective To evaluate the influence of early mobilization on delirium and respiratory dynamics in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The study prospectively recruited 107 AECOPD patients who admitted between January 2014 and June 2015 and underwent mechanical ventilation.On basis of same routine treatment,the patients were randomly divided into a treatment group (54 cases)receiving regime of early mobilization,and a control group (53 cases)receiving routine sedation and analgesia treatment.The incidence of delirium,duration of delirium,time of mechanical ventilation,and ICU mortality were compared between two groups.The respiratory mechanical parameters including endogenous positive end expiratory pressure (PEEPi),airway resistance(Raw),static compliance(Cs),and dynamic compliance(Cd)before treatment,3 days and 5 days after treatment were also compared between two groups. Results Compared with the control group,the incidence of delirium decreased (59.3% vs. 77.4%),the duration of delirium [(1.8±1.1)d vs. (2.6±1.3)d] and mechanical ventilation[(6.2±3.4)d vs. (7.9±4.2)d] reduced in the treatment group with significant difference(P<0.05).There was no significant difference in respiratory mechanical parameters before treatment between two groups(P>0.05).While at 3 days and 5 days after treatment,PEEPi decreased [(6.23±2.83)cm H2O vs. (7.42±2.62)cm H2O,(4.46±2.20)cm H2O vs. (5.92±2.51)cm H2O],Raw decreased [(20.35±7.15)cmH2O·L-1·s-1 vs. (23.23±6.64)cm H2O·L-1·s-1,(16.00±5.41)cm H2O·L-1·s-1 vs. (19.02±6.37)cm H2O·L-1·s-1],Cd increased [(25.20±9.37)mL/cm H2O vs (21.75±7.38)mL/cm H2O,(27.46±5.45)mL/cm H2O vs. (24.40±6.68)mL/cm H2O] in the treatment group compared with the control group(P<0.05),and the difference in Cs was not significant(P>0.05).No complications such as slippage,physical injury,or malignant arrhythmia occurred in two groups.The mortality slightly decreased in the treatment group compared with the control group (5.6% vs 11.3%),but the difference was not statistically significant(P>0.05). Conclusions The incidence of delirium is high in mechanically ventilated patients with AECOPD.Early mobilization can reduce the incidence and duration of delirium,decrease the airway resistance,increase the dynamic lung compliance,relieve dynamic pulmonary hyperinflation and reduce PEEPi,so as to improve the respiratory function and shorten the time of mechanical ventilation.Therefore,early mobilization is an effective and safe regime for AECOPD patients underwent mechanical ventilation.
ObjectiveTo systematically review the clinical efficacy of low molecular weight heparin (LMWH) in treating patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). MethodsDatabases including PubMed, The Cochrane Library (Issue 10, 2013), EMbase, CBM, CNKI, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) about LMWH in treating acute exacerbation of COPD from the establishment to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Meta-analysis was then performed using RevMan 5.2 software. ResultsA total of 6 RCTs involving 501 patients were finally included. The results of meta-analysis showed that:compared with the control group, LMWH significantly improved levels of D-dimmer (MD=-0.28, 95%CI-0.50 to-0.05, P=0.02), reduced carbon dioxide partial pressure (PaCO2) (MD=-3.42, 95%CI-6.66 to-0.18, P=0.04), improved coagulation (PT) (MD=1.85, 95%CI 1.29 to 2.42, P < 0.000 01), and improved clinical symptoms and signs (RR=1.33, 95%CI 1.12 to 1.58, P=0.001), but it did not improve oxygen partial pressure (PaO2) (MD=0.28, 95%CI-3.04 to 3.61, P=0.87). During treatment, no severe adverse reaction occurred in both groups. ConclusionLMWH could significantly improve symptoms caused by acute exacerbation of COPD. Due to limited quantity and quality of the included studies, the above conclusion needs to be confirmed by conducting more high quality RCTs with larger sample size.
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.