RESUMO
BACKGROUND: Among patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. METHODS: We analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. RESULTS: Among the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30-1.38; P=0.26). CONCLUSIONS: Among patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Embolia Pulmonar , Humanos , Angiografia/métodos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Embolia Pulmonar/complicaçõesRESUMO
Antecedentes: El ensayo clínico SLICE no demostró un beneficio clínico de la búsqueda activa de la tromboembolia de pulmón (TEP) en pacientes que requirieron ingreso por agudización de su EPOC. El objetivo de este subanálisis fue determinar la frecuencia y el significado pronóstico del hallazgo de un diagnóstico alternativo a la TEP en la tomografía computarizada de tórax (TC) realizada a pacientes hospitalizados por EPOC agudizada. Métodos: Analizamos los pacientes del grupo intervención de SLICE que recibieron una TC con resultado negativo para TEP. Evaluamos mediante el uso de regresión logística multivariable la asociación entre un diagnóstico alternativo y el evento primario compuesto de reingreso por EPOC y la mortalidad por cualquier causa en los primeros 90 días después de la aleatorización. Resultados: Este análisis incluyó a 175 pacientes del grupo intervención que recibieron una TC con un resultado negativo para TEP. De ellos, 84 (48,0%) fueron diagnosticados de infección bronquial aguda, 13 (7,4%) de cáncer de pulmón, 10 (5,7%) de insuficiencia cardiaca, 8 (4,6%) de neumonía, 18 (10,3%) de otros diagnósticos, y en 42 (24,0%) pacientes la TC fue normal. En el análisis multivariable, un diagnóstico alternativo no se asoció de manera significativa con el evento primario (odds ratio: 0,64; IC 95%: 0,30-1,38; P=0,26). Conclusiones: Entre los pacientes que requieren ingreso por agudización de EPOC, la TC ofrece un diagnóstico alternativo a la TEP en el 76% de las ocasiones. El tratamiento específico de estas patologías no se asocia a un mejor pronóstico durante el seguimiento. (AU)
Background: Among patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. Methods: We analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. Results: Among the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30-1.38; P=0.26). Conclusions: Among patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization. (AU)
Assuntos
Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Tomografia , 28599 , Análise Multivariada , Tomografia/mortalidadeRESUMO
Background: Among patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. Methods: We analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. Results: Among the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30-1.38; P=0.26). Conclusions: Among patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization. (AU)
Antecedentes: El ensayo clínico SLICE no demostró un beneficio clínico de la búsqueda activa de la tromboembolia de pulmón (TEP) en pacientes que requirieron ingreso por agudización de su EPOC. El objetivo de este subanálisis fue determinar la frecuencia y el significado pronóstico del hallazgo de un diagnóstico alternativo a la TEP en la tomografía computarizada de tórax (TC) realizada a pacientes hospitalizados por EPOC agudizada. Métodos: Analizamos los pacientes del grupo intervención de SLICE que recibieron una TC con resultado negativo para TEP. Evaluamos mediante el uso de regresión logística multivariable la asociación entre un diagnóstico alternativo y el evento primario compuesto de reingreso por EPOC y la mortalidad por cualquier causa en los primeros 90 días después de la aleatorización. Resultados: Este análisis incluyó a 175 pacientes del grupo intervención que recibieron una TC con un resultado negativo para TEP. De ellos, 84 (48,0%) fueron diagnosticados de infección bronquial aguda, 13 (7,4%) de cáncer de pulmón, 10 (5,7%) de insuficiencia cardiaca, 8 (4,6%) de neumonía, 18 (10,3%) de otros diagnósticos, y en 42 (24,0%) pacientes la TC fue normal. En el análisis multivariable, un diagnóstico alternativo no se asoció de manera significativa con el evento primario (odds ratio: 0,64; IC 95%: 0,30-1,38; P=0,26). Conclusiones: Entre los pacientes que requieren ingreso por agudización de EPOC, la TC ofrece un diagnóstico alternativo a la TEP en el 76% de las ocasiones. El tratamiento específico de estas patologías no se asocia a un mejor pronóstico durante el seguimiento. (AU)
Assuntos
Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Tomografia , 28599 , Análise Multivariada , Tomografia/mortalidadeRESUMO
BACKGROUND: There is considerable variation in disease behavior among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19). Genomewide association analysis may allow for the identification of potential genetic factors involved in the development of Covid-19. METHODS: We conducted a genomewide association study involving 1980 patients with Covid-19 and severe disease (defined as respiratory failure) at seven hospitals in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, we analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case-control panels. RESULTS: We detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genomewide level (P<5×10-8) in the meta-analysis of the two case-control panels (odds ratio, 1.77; 95% confidence interval [CI], 1.48 to 2.11; P = 1.15×10-10; and odds ratio, 1.32; 95% CI, 1.20 to 1.47; P = 4.95×10-8, respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group-specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75; P = 1.48×10-4) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79; P = 1.06×10-5). CONCLUSIONS: We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.).
