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Complexity in clinical diagnoses of acute exacerbation of chronic obstructive pulmonary disease.
Pratt, Alexandre J; Purssell, Andrew; Zhang, Tinghua; Luks, Vanessa P J; Bauza, Xavier; Mulpuru, Sunita; Kirby, Miranda; Aaron, Shawn D; Cowan, Juthaporn.
Afiliação
  • Pratt AJ; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Purssell A; Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Zhang T; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Luks VPJ; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Bauza X; Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Mulpuru S; Department of Physics, Toronto Metropolitan University, Ottawa, ON, Canada.
  • Kirby M; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Aaron SD; Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Cowan J; Department of Physics, Toronto Metropolitan University, Ottawa, ON, Canada.
BMC Pulm Med ; 23(1): 298, 2023 Aug 14.
Article em En | MEDLINE | ID: mdl-37580731
BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently. METHODS: To identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea. RESULTS: Three hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68-6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 - 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 - 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 - 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 - 0.25) suggested against the diagnosis of AECOPD alone. CONCLUSION: The study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans Idioma: En Revista: BMC Pulm Med Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans Idioma: En Revista: BMC Pulm Med Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá