Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Group Research Articles

Diagnostic Value of Galectin-3 in Exacerbations of Chronic Obstructive Pulmonary Disease.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by acute exacerbations. Systemic inflammation and oxidative stress play an important role in the pathogenesis of COPD. Exacerbations in COPD reduce the quality of life and are associated with rapid disease progression. Galectin-3 is a beta-galactoside-binding lectin of approximately 30 kDa with pro-inflammatory and pro-fibrotic properties. This study aims to analyze the efficacy of serum galectin-3 in predicting exacerbations in COPD patients. Materials and Methods: Baseline demographic and clinical characteristics of all patients were recorded and blood samples were collected. A total of 58 consecutive COPD patients, including 28 patients (19 male and 9 female) with stable COPD and 30 patients (23 male and 7 female) with acute exacerbation of COPD (AECOPD), were included in the study. Results: Serum galectin-3 levels were significantly higher in the AECOPD group compared to the stable COPD group. A logistic regression analysis revealed that increased galectin-3 levels and disease duration were independent predictors of COPD exacerbation (OR = 5.322, 95% CI: 1.178-24.052, p = 0.03; and OR = 1.297, 95% CI: 1.028-1.635, p = 0.028; respectively). Conclusions: The results of our study demonstrated that Galectin-3 was a strong and independent predictor of exacerbations in COPD patients.

Correlation of Coagulation Dysfunction with Infection and Hypercapnia in Acute Exacerbation of COPD Patients.

This study aims to explore the factors influencing the coagulation function of patients with chronic obstructive pulmonary disease (COPD) and its effects on thrombosis. A total of 155 COPD patients, including 118 patients with acute exacerbation of COPD (AECOPD) and 37 patients with stable COPD (SCOPD), were enrolled in this study. Meanwhile, 50 patients with gastrointestinal polyps found during physical examination and treated with surgery in the same period were enrolled as the control group. The basic data, routine blood tests, C-reactive protein (CRP), procalcitonin (PCT), and coagulation indexes of the three groups were collected, as well as arterial blood gas indexes of AECOPD patients. The differences in erythrocyte count and hemoglobin among groups were not statistically significant. Compared with the SCOPD group and control group, white blood cell (WBC), neutrophil percentage, PCT, CRP, prothrombin time (PT), and fibrinogen (FIB) in the AECOPD group increased significantly, while the international normalized ratio (INR) decreased (P < 0.05). The differences in activated partial thromboplastin time (APTT) and D-dimer among groups were not statistically significant (P > 0.05). Thrombin time (TT) in the AECOPD group was shorter than that of the control group, and PT was longer than that of the SCOPD group (P < 0.05). Five patients with AECOPD and one patient with SCOPD had venous thrombosis. The abnormal coagulation function in AECOPD patients is related to the degree of infection and hypercapnia, which may be a risk factor for thrombosis.

The Diagnostic and Assessment Value of Plasma Pentraxin 3 in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Pentraxin 3 (PTX3) is an acute-phase protein and an important inflammatory mediator. We hypothesized plasma PTX3 could be a valuable diagnostic biomarker in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this prospective controlled study, 458 COPD patients and 71 healthy controls from May 2019 to December 2020 in two hospitals were enrolled. COPD patients were divided into AECOPD group (n = 173) and stable COPD group (n = 285). AECOPD patients were subdivided into mild or moderate group (n = 43) and severe group (n = 130) based on severity. Plasma PTX3 levels were detected by ELISA. Plasma PTX3 levels were significantly higher in AECOPD (2.8 ng/mL) compared to stable COPD (0.87 ng/mL) and healthy controls (0.83 ng/mL). In the analysis of AECOPD subgroups, plasma PTX3 level of severe group (4.51 ng/mL) was significantly higher than that of mild or moderate group (1.25 ng/mL). Patients with respiratory failure had higher PTX3 than those without respiratory failure. No difference was observed between stable COPD patients and healthy controls. ROC analysis showed that plasma PTX3 had a considerable ability to distinguish AECOPD from stable COPD [AUC: 0.85, 95% CI (0.81-0.88), P < 0.0001; cut-off 1.25 ng/mL, sensitivity 77.5%, specificity 74%]. AUC of PTX3 was better than CRP regarding diagnosis of AECOPD. Combination of PTX3 and CRP was superior to either of them in diagnosing AECOPD. Plasma PTX3 levels were significantly higher in AECOPD than stable COPD. The level was associated with the severity of exacerbation. Plasma PTX3 has potential value as a biomarker to diagnose and evaluate AECOPD.

High-Flow Nasal Oxygen versus Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis of Randomized Controlled Trials.

High-flow nasal cannula (HFNC) can be used in stable chronic obstructive pulmonary disease (COPD) patients, but the effect of HFNC on clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still uncertain. We searched electronic literature databases for randomized controlled trials (RCTs) comparing HFNC with noninvasive ventilation (NIV) in hypercapnic patients with AECOPD. The primary endpoint of this meta-analysis was PaCO2, PaO2, and SpO2. The secondary outcomes were the respiratory rate, mortality, complications, and intubation rate. We included 7 RCTs with a total of 481 patients. There were no significant differences on measures of PaCO2 (MD = -0.42, 95%CI -3.60 to 2.75, Z = 0.26, and P = 0.79), PaO2 (MD = -1.36, 95%CI -4.69 to 1.97, Z = 0.80, and P = 0.42), and SpO2 (MD = -0.78, 95%CI -1.67 to 0.11, Z = 1.72, P = 0.08) between the HFNC group and the NIV group. There was no significant difference in measures of the mortality and intubation rate between the HFNC group (OR = 0.72, 95%CI 0.30 to 1.69, Z = 0.76, and P = 0.44) and the NIV group (OR = 2.38, 95%CI 0.49 to 11.50, Z = 1.08, and P = 0.28), respectively. But the respiratory rate in the HFNC group was lower than that in the NIV group (MD = -1.13, 95%CI -2.13 to -0.14, Z = 2.23, and P = 0.03), and fewer complications were found in the HFNC group (OR = 0.26, 95%CI 0.14 to 0.47, Z = 4.46, and P < 0.00001). NIV was noninferior to HFNC in decreasing PaCO2 and increasing PaO2 and SpO2. Similarly, the mortality and intubation rate was similar among the two groups. The respiratory rate and complications were inferior in the AECOPD group treated with HFNC.

Changes in peripheral blood TBNK lymphocyte subsets and their association with acute exacerbation of chronic obstructive pulmonary disease.

This study aimed to determine the changes in peripheral blood TBNK lymphocyte subsets in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and their relationship with the pathogenesis of AECOPD. A cross-sectional study of 1252 hospitalized patients in Zhejiang Hospital was conducted. There were 162 patients in the AECOPD group and 1090 in the non-chronic obstructive pulmonary disease (COPD) group. The proportions of peripheral blood T helper cells, cytotoxic T cells, total B cells, total natural killer (NK) cells, and total T cells in the two groups were determined, and the CD4/CD8 ratio was calculated. The proportions of men and total natural killer cells, and the mean age were significantly higher in the AECOPD group than in the non-COPD group. The T helper cell, total T cell, and CD4/CD8 ratios were significantly decreased in the AECOPD group. A multivariate logistic regression analysis showed that male sex, age, the total T cell ratio, and the CD4/CD8 ratio were significantly associated with the incidence of AECOPD. Cellular immune dysfunction in patients with AECOPD causes a decrease in total T lymphocytes and the CD4/CD8 ratio, which may be involved in the pathogenesis of AECOPD.

Red Cell Distribution Width and the Severity of Acute Exacerbration of Chronic Obstructive Pulmonary Disease - A Hospital Based Case Control Study

Abstract Background and Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the most common diseases in patients with having frequent hospitalization. The aim of this study is to find whether there is any relationship between red cell distribution width (RDW) with mortality in acute exacerbation of COPD. Materials and Methods: The hospital-based case–control study is conducted on hospitalized 50 patients with the diagnosis of acute exacerbation of COPD and 50 patients with stable period of COPD. Results: This was a hospital-based case–control study in the age group of above 30 years in hospitalized 50 patients with a primary and definite diagnosis of acute exacerbation of COPD and 50 participants in stable period of COPD conducted among admitted in the department of medicine. Maximum patients in both groups were found in the &gt;60 years age group. The mean age in acute exacerbations of COPD group was 64.62 ± 8.24 years and in stable COPD were 63.22 ± 9.18 years. Both groups were comparable. Maximum patients in both groups were male. The mean RDW significantly higher in acute exacerbation of COPD (17.60% ±5.70%) as compared to stable COPD patients (13.80% ±3.33%). The difference in both groups was found statistically significant. The mean corpuscular volume was significantly lower in acute exacerbation of COPD (82.04 ± 1.49) as compared to stable COPD patients (86.50 ± 1.87). The difference in both groups was found statistically significant. RDW was significantly higher in those patients who were died (19.50% ±0.70%) as compared to survived patients (17.52% ±5.61%). The difference in both groups was found to be statistically significant. 4.00% hospital mortality in acute exacerbation of COPD group compared with stable COPD patients. Conclusion: We have concluded that the mean RDW on the day of presenting the illness was significantly higher in acute exacerbation of COPD as compared to stable COPD. Those patients who had a high RDW during admission were associated with poor prognoses.

Predictive Value of CRP, PCT and ESR on Piperacillin-Tazobactam in Treating Chronic Obstructive Pulmonary Disease with Pneumonia.

The goal of this paper was to investigate the predictive value on the efficacy of C-reactive protein (CRP), procalcitonin (PCT), and erythrocyte sedimentation rate (ESR) on piperacillin-tazobactam in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. From January 2018 to May 2021, 52 AECOPD patients (AECOPD group) and 91 AECOPD patients with pneumonia (pneumonia group) were enrolled, and the levels of CRP, PCT, and ESR were compared. The pneumonia group was divided into a mild group and a severe group, and the correlation between the levels of CRP, PCT, and ESR and the severity of pneumonia was analyzed. The patients in the pneumonia group were treated with piperacillin and tazobactam, and the clinical efficacy of CRP, PCT, and ESR levels was analyzed. The pneumonia group, particularly the severe subtype, had higher CRP, PCT, and ESR than the AECOPD group. CRP, PCT, and ESR levels were related to the severity of pneumonia and were negatively associated with the efficacy of piperacillin and tazobactam. The AUC of the combined detection of CRP, PCT, and ESR levels was greater than 0.8 to evaluate the efficacy of piperacillin-tazobactam treatment. CRP ≥ 67.19 mg/L, PCT ≥ 1.73 ng/mL, and ESR ≥ 29.42 mm/hour were the related factors affecting the efficacy of piperacillin-tazobactam. CRP, PCT, and ESR levels are related to the severity of AECOPD complicated with pneumonia, and have value in evaluating the efficacy of piperacillin-tazobactam.

Evaluating the clinical role of fibrinogen, D-dimer, mean platelet volume in patients with acute exacerbation of COPD

BackgroundThere is limited research on clinical indicators for clinicians to judge the hypercoagulability of COPD patients. ObjectiveThe aim in this study was to evaluate the level changes of fibrinogen (FIB), d-dimer (D-D), and mean platelet volume (MPV) in plasma during the stable phase of chronic obstructive pulmonary disease (COPD), as compared with acute exacerbation of COPD (AECOPD). MethodsA total of 240 patients admitted with COPD in our hospital and 60 healthy people were enrolled in this prospective study using data from August 2016 to August 2017. Patients were allocated to AECOPD or stable COPD group. The levels of white blood cell (WBC) count, absolute neutrophil counts (NEU%), activated partial thromboplastin time (APTT), prothrombin time (PT), and hypoxia inducible factor-1(HIF-1) were detected. The MPV, D-D, and the FIB level were also determined and compared between groups. ResultsThe WBC count, NEU%, FIB, and D-D were significantly higher in the AECOPD group than in the stable COPD group and the healthy group (P < 0.05), while the MPV, APTT and PT was significantly lower in the AECOPD group than in the stable COPD group and the healthy group (P < 0.05). Additionally, MPV was significantly negatively correlated with WBC count (r=-0.798) and NEU% (r=-0.749) in the AECOPD group (P < 0.05); and the percentage of forced expiratory volume in one second (FEV1) in the predicted value was significantly negatively correlated with D-D (r=-0.891) and FIB (r=-0.656) (P <0.05). ConclusionWe demonstrated that, for patients hospitalized for exacerbation of COPD, MPV may indeed be a valid indicator of inflammation and a marker of thrombosis.

Elevated Peripheral Blood Eosinophils during Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Prevalence and clinical significance.

ObjectivesThis study aimed to evaluate the prevalence and clinical significance of elevated peripheral blood eosinophil (PBE) counts in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Oman. An elevated PBE count during AECOPD is a potential predictor of treatment responsiveness and future exacerbation risk.MethodsThis single-centre retrospective study included all patients with AECOPD who were admitted to Sultan Qaboos University Hospital, Muscat, Oman, between January 2017 and July 2019. The patients were classified as having eosinophilic or non-eosinophilic AECOPD based on blood eosinophil counts. An elevated eosinophil count was defined as a blood eosinophil count >0.3 × 109 cells/L on admission. The length of hospital stay, use of oral and inhaled steroids, number of readmissions in a year and use of mechanical ventilation on admission were compared between the eosinophilic and non-eosinophilic AECOPD groups.ResultsOf the 102 patients included in the study, 42.2% had eosinophilic AECOPD. The eosinophilic AECOPD group had a reduced length of hospital stay (P = 0.02) but an increased risk of readmission in a year (P = 0.04). Most patients in both groups were treated with inhaled and oral steroids. The need for mechanical ventilation did not differ between the groups.ConclusionEosinophilia is highly prevalent in patients with AECOPD and is associated with a reduced length of hospital stay but an increased risk of readmission in a year. It can be used as a surrogate marker to predict the health outcomes of patients with AECOPD and select treatment options.

Evaluating the Roles of sCD14 and sCD14-ST in Diagnosing COPD and Predicting an Acute Exacerbation of COPD

AimTo evaluate the roles of plasma soluble cluster of differentiation 14 (sCD14) and sCD14 subtype (sCD14-ST) in the diagnosis of chronic obstructive pulmonary disease (COPD) and in the prediction of an acute exacerbation of COPD (AECOPD).MethodsWe quantified the levels of white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin (IL)-6, IL-8, sCD14, and sCD14-ST in patients with COPD and healthy controls. The relationships between sCD14 or sCD14-ST and inflammatory markers were analyzed in each group. We used receiver operating characteristics (ROC) curves to evaluate the potential roles of sCD14 and sCD14-ST in the diagnosis of COPD and in predicting AECOPD.ResultsA total of 62 subjects were recruited, including 15 controls and 47 COPD patients, with the latter including 32 stable COPD and 15 AECOPD. WBC, IL-8, sCD14, and sCD14-ST were significantly higher in COPD than in the controls (all P < 0.05). WBC, CRP, ESR, IL-6, IL-8, sCD14, and sCD14-ST were higher in AECOPD than in the controls (all P < 0.05). In the COPD group, sCD14 levels were positively correlated with WBC, IL-8, and sCD14-ST (P < 0.05), and sCD14-ST levels were positively correlated with WBC and IL-8 (P < 0.05). In the AECOPD group, sCD14 was positively correlated with WBC, CRP, IL-8, and sCD14-ST (P < 0.05); sCD14-ST was positively correlated with WBC, IL-6, and IL-8 (P < 0.05). Discrimination between COPD and controls was tested by calculating areas under the ROC curve (AUCs) for sCD14 and sCD14-ST showing scores of 0.765 (95% CI 0.648–0.883) and 0.735 (95% CI 0.537–0.933) respectively. Similarly, discrimination between AECOPD and controls using sCD14 and sCD14-ST showed scores of 0.862 (95% CI 0.714–1.000) and 0.773 (95% CI 0.587–0.960), respectively.ConclusionOur study suggests that the inflammatory markers sCD14 and sCD14-ST might play an important diagnostic role in COPD and help predict AECOPD.

High-coverage lipidomics analysis reveals biomarkers for diagnosis of acute exacerbation of chronic obstructive pulmonary disease

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading cause of morbidity and mortality in COPD management. However, detecting the progression from the stable stage to acute exacerbation mainly depends on doctors’ judgment of clinical symptoms, and there is no biomarker that can be used for auxiliary clinical diagnosis. In this work, serum samples from COPD patients (n = 82) and healthy subjects (n = 29) were collected and analyzed. Patients with COPD were divided into stable COPD (SCOPD) and AECOPD groups, with the latter comprising subtypes 1 and 2. High-coverage lipidomics profiling of 913 lipids belonging to 19 subclasses was carried out by liquid chromatography–Q–Exactive orbitrap mass spectrometry. We performed 4 cross-comparisons to characterize metabolic disturbances associated with the progression of stable COPD to AECOPD—ie, SCOPD vs healthy subjects, AECOPD vs SCOPD, AECOPD subtype 1 vs SCOPD, and AECOPD subtype 2 vs SCOPD. We tentatively identified 86 lipids with differential abundance among groups, lipids that were altered from the stable stage of disease to AECOPD included sphingolipids, ether-containing glycerophospholipids, phosphatidylglycerols, and glycerol lipids. Three panels of lipid biomarkers specific to AECOPD, AECOPD subtypes 1 and 2 vs SCOPD yielded areas under the receiver operating characteristic curve of 0.788, 0.921 and 0.920, respectively, with sensitivity of 77.5%, 80.7% and 91.3%, respectively, and specificity of 75.8%, 97.0% and 87.9%, respectively. The result indicated differences in lipid metabolism may underlie AECOPD and its 2 subtypes and can serve as biomarkers for early diagnosis, and high-coverage lipidomics proved to be an accurate approach to profile the lipid metabolism in biological samples.

Serum Creatinine to Cystatin C Ratio is an Effective Indicator for Muscle Strength Decline in Men with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

PurposeThis study explored the value of the serum creatinine/cystatin C (Cr/CysC) ratio in diagnosing the reduction of muscle strength in men with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and MethodsIn this study, we enrolled 72 male patients with AECOPD and 32 male patients with stable chronic obstructive pulmonary disease (COPD). We compared clinical characteristics between the AECOPD and stable COPD groups. Then, we subdivided AECOPD patients into normal muscle strength and low muscle strength groups; we compared the clinical characteristics between these two groups. We analyzed the relationships of serum creatinine (Cr), cystatin C (CysC), and Cr/CysC ratio with clinical characteristics in male AECOPD patients. We also investigated whether the Cr/CysC ratio could aid in the diagnosis of muscle strength decline via receiver operating characteristic curve and binary logistic regression analysis.ResultsWe found that handgrip strength, Cr/CysC ratio, serum Cr, FEV1, FVC, and FEV1%pred were lower in AECOPD patients than in stable COPD patients. Among AECOPD patients, BMI, weight, FEV1, FVC, FEV1%pred, and Cr/CysC ratio were lower in the low muscle strength group than in the normal muscle strength group; there were more patients with ≥2 acute exacerbations within the past year in the low muscle strength group. The Cr/CysC ratio was correlated with handgrip strength, FEV1, FVC, FEV1%pred, BMI and weight. The area under curve for low handgrip strength was greater for the Cr/CysC ratio than for Cr. Binary logistic regression analysis showed that a Cr/CysC ratio <0.99 was a risk factor for decreased muscle strength in male patients with AECOPD.ConclusionThe Cr/CysC ratio is a useful predictor of muscle strength decline in male AECOPD patients, while a low Cr/CysC ratio is a risk factor for muscle strength decline in male patients with AECOPD.

Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study.

BackgroundVital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD).ObjectiveThis study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology.MethodsIn total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ≥85% for HR and ≥80% for RR, based on the device’s proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls.ResultsIn total, 84% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76%, SD 26%). There was greater adherence in the stable group than in the post-AECOPD group (≥5 weeks wear: 71.4% vs 45.7%; P=.02). For all 84 participants, the median HR signal quality was 90% (IQR 80%-94%) and the median RR signal quality was 93% (IQR 92%-95%). The median HR data quality was 81% (IQR 58%-91%), and the median RR data quality was 85% (IQR 77%-91%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=–0.49, P=.009; rs=–0.44, P=.02). In total, 36 (74%) participants in the Stable group and 21 (60%) participants in the AECOPD group accepted the technology, but 10 participants (12%) expressed concerns with wearing a device around their chest.ConclusionsThis wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context.

Clinical Value of FeNO for Pulmonary Hypertension Diagnosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Objective To investigate the clinical value of fractional exhaled nitric oxide (FeNO) in the diagnosis of pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods In this study, the medical records of AECOPD patients were retrospectively reviewed. The patients were divided into AECOPD and AECOPD + PH groups based on the absence or presence of PH. Moreover, FeNO and other indexes were compared between the two groups. The value of FeNO in diagnosing AECOPD with PH was determined using the ROC curve. Results A total of 83 patients were enrolled (56 in the AECOPD group and 27 in the AECOPD + PH group). The level of FeNO was significantly lower in the AECOPD + PH group than in the AECOPD group (P = 0.022). Moreover, FeNO level (25.22 ± 8.45 ppb) was higher in the mild PH subgroup than in the moderate (16.64 ± 5.67 ppb, P = 0.005) or severe (11.75 ± 2.36, P = 0.002) PH subgroups. FeNO level was positively correlated with C-reactive protein in AECOPD patients while negatively correlated with brain natriuretic peptide in the AECOPD + PH group. ROC analysis showed that the optimal cutoff value of FeNO in the diagnosis of AECOPD with PH was 24.5 ppb. Conclusion FeNO level at admission can act as an indicator for PH diagnosis in AECOPD patients.

Mortality outcomes associated with invasive aspergillosis among acute exacerbation of chronic obstructive pulmonary disease patient population

BackgroundLiterature regarding trends of mortality, and complications of aspergillosis infection among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is limited. MethodsData from the National Readmissions Database (NRD) that constitutes 49.1% of the stratified sample of all hospitals in the United States (US), representing more than 95% of the national population were analyzed for hospitalizations with aspergillosis among AECOPD. Predictors and trends related to aspergillosis in AECOPD were evaluated. A Linear p-trend was used to assess the trends. ResultsOut of the total 7,282,644 index hospitalizations for AECOPD (mean age 69.17 ± 12.04years, 55.3% females), 8209 (11.2/10,000) with primary diagnosis of invasive aspergillosis were recorded in the NRD for 2013–2018. Invasive aspergillosis was strongly associated with mortality (OR 4.47, 95%CI 4.02–4.97, p < 0.001) among AECOPD patients. Malignancy and organ transplant status were predominant predictors of developing aspergillosis among AECOPD patients. The IA-AECOPD group had higher rates of multi-organ manifestations including ACS (3.7% vs 0.44%; p-value0.001), AF (20% vs 18.4%; p-value0.001), PE (4.79% vs1.87%; p-value0.001), AKI (22.3% vs17.5%; p-value0.001), ICU admission (16.5% vs11.9%; p-value0.001), and MV (22.3% vs7.31%; p-value0.001) than the AECOPD group. The absolute yearly trend for mortality of aspergillosis was steady (linear p-trend 0.22) while the yearly rate of IA-AECOPD had decreased from 15/10,000 in 2013 to 9/10,000 in 2018 (linear p-trend 0.02). InterpretationAspergillosis was related with high mortality among AECOD hospitalizations. There has been a significant improvement in the yearly rates of aspergillosis while the mortality trend was steady among aspergillosis subgroups. Improved risk factor management through goal-directed approach may improve clinical outcomes.

Association between peripheral blood WBCs C3aR mRNA level and plasma C3a, C3aR, IL-1β concentrations and acute exacerbation of chronic obstructive pulmonary disease

BackgroundThe relationship between C3a-C3aR, IL-1β, and the acute exacerbation of chronic obstructive pulmonary disease is still unclear. This study aims to explore the expression levels of C3aR in peripheral blood WBCs and the concentrations of C3a, C3aR, and IL-1β in plasma in healthy controls and patients with chronic obstructive pulmonary disease (COPD). MethodsWBCs C3aR level in the peripheral blood, the concentrations of C3a, C3aR, and IL-1β in plasma were measured in 60 patients with acute exacerbation of COPD (AECOPD), 30 patients with stable COPD (SCOPD), and 30 healthy controls. The baseline characteristics and clinical data collected from enrolled patients, including age, gender, laboratory indicators, and lung function. We analyzed the correlation between C3a, C3aR, IL-1β, and lung function indicators (forced expiratory volume in the first second as a percentage of predicted value, FEV1%pred) in the AECOPD group. ResultsThe white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), and C-reactive protein (CRP) of patients in COPD were higher than in healthy controls (P < 0.05). The peripheral blood WBCs C3aR mRNA and plasma C3a, C3aR, and IL-1β in AECOPD were higher than in SCOPD and healthy controls (P < 0.05). The peripheral blood WBCs C3aR mRNA and plasma C3aR, and IL-1β in AECOPD combined with respiratory failure were higher than in the non-respiratory failure group (P < 0.05). The peripheral blood WBCs C3aR mRNA and plasma C3a, C3aR, and IL-1β in AECOPD with high-risk were higher than in the low-risk group (P < 0.05). The peripheral blood WBCs C3aR mRNA and plasma C3a, C3aR, and IL-1β in AECOPD were negatively correlated with FEV1pred%. The peripheral blood WBCs C3aR mRNA, the plasma C3a and C3aR in AECOPD were positively correlated with IL-1β. ConclusionThe peripheral blood WBCs C3aR mRNA and plasma C3a, C3aR, and IL-1β in COPD patients were significantly related to the risk of disease deterioration. The C3a-C3aR axis may be involved in airway inflammation in patients with COPD.

The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review.

BackgroundThe prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies.MethodsWe searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively.ResultsA total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97–23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06–5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51–4.00), higher heart rates (MD = 20.51, 95% CI: 4.95–36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01–4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80–2.23), WBC counts (MD = 1.42, 95% CI: 0.14–2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43–3.50).ConclusionsThe prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE.Prospero registration numberCRD42021226568.

Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia.

ABSTRACTBackgroundPatients with chronic obstructive pulmonary disease (COPD) often have coagulation abnormalities. However, the factors that lead to coagulation dysfunction in acute exacerbation of COPD (AECOPD) remain insufficiently explored. This study aimed to investigate the factors affecting coagulation status in patients with COPD and their influence on thrombosis.MethodsData of COPD patients, including 135 cases in acute exacerbation stage and 44 cases in stable stage from Nov 2016 to Nov 2019 in our hospital, were collected. Healthy people (n = 135) were enrolled as the controls. The coagulation parameters, blood gas indexes and blood routine examination results were collected and analyzed.ResultsWhite blood count (WBC), neutrophil count, neutrophil percentage (N%), platelet (PLT), prothrombin time (PT), international normalized ratio (INR), fibrinogen (FIB), and activated partial thromboplastin time (APTT) increased, plasma thrombin time (TT) decreased in AECOPD group compared with the control group. In AECOPD group, PT, APTT, and FIB were positively correlated with neutrophils and C‐reaction protein levels. PT was positively correlated with PCO2 and negatively with pH. Thrombosis was observed in five acute exacerbation and three stable stage COPD patients.ConclusionsPatients with AECOPD presented abnormal coagulation status, which was correlated to infection and hypercapnia and might be potentially the risk factor of thrombosis.

Effect of Aspirin and Statins on Pulmonary Function and Inflammation in Patients with AECOPD

Background: The influence of coronary atherosclerosis and related treatment drugs on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) development requires in-depth study. The study investigated the effect of coronary artery calcification (CAC) and drugs for CAC on the development of AECOPD. Methods: This retrospective clinical study recruited subjects with AECOPD from May 2017 to May 2019. All subjects performed spirometry and coronary computed tomography (CT), and were divided into three groups according to whether coronary CT revealed CAC and whether they had received oral aspirin and statins: AECOPD group, AECOPD[Formula: see text]CAC nonmedication and AECOPD[Formula: see text]CAC medication. The t-test and nonparametric test were used for analyzing the lung function, arterial blood gas, routine blood and lipid between groups. Results: Compared with the AECOPD group, Lym% were significantly higher ([Formula: see text]) in both the AECOPD[Formula: see text]CAC nonmedication and the AECOPD[Formula: see text]CAC medication. The AECOPD[Formula: see text]CAC medication group also had significantly higher PaO2 ([Formula: see text]). WBC, Neu, and Neu% in the AECOPD[Formula: see text]CAC medication group were significantly lower ([Formula: see text]) compared to the AECOPD group. Conclusions: Aspirin and statins for the treatment of cardiovascular diseases may be linked to improving lung function, normalizing blood gas levels, and reducing inflammation in patients with AECOPD and CAC. Further, randomized controlled trials are needed to explore this topic.

Lactate dehydrogenase isoenzymes in patients with acute exacerbation of chronic obstructive pulmonary disease: An exploratory cross-sectional study

We aimed to evaluate differences in serum lactate dehydrogenase (LDH) isoenzymes between patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and other lower respiratory tract infections (LRTIs). Based on self-reported COPD diagnosis, 71 participants were divided into AECOPD (n = 38, 29 males, mean age 70.5 years) and LRTI (n = 33, 12 males, mean age 70.4 years) groups. Information on demographics, comorbidities, and COPD severity markers, as well as arterial blood gases and laboratory data were collected, while serum LDH electrophoresis was performed to examine the LDH isoenzymes. Adjusting for sex, age, comorbidities, degree of hypoxemia, inflammation markers, muscle and myocardial enzymes, and total serum LDH, the mean differences (95 % confidence intervals) in the ratios of serum LDH isoenzymes to total serum LDH between groups (LDHxAECOPD − LDHxLRTI) were statistically significant for LDH1 [4.9 (1.4 to 8.3)], LDH2 [3.0 (0.1 to 5.8)], LDH3 [−4.3 (−6.3 to −2.3)], and LDH4 [−3.2 (−4.9 to −1.5)]. A sum of LDH3 and LDH4 ratios below 29 % had the highest discriminative ability to classify a subject in the AECOPD group (AUC 0.841, sensitivity 76 %, specificity 87 %). Aerobic metabolic adaptive mechanisms in respiratory muscles during AECOPD could explain the above differences.