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1.
JAMA ; 323(5): 455-465, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016309

RESUMO

Importance: The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. Objective: To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia. Data Sources: Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019. Study Selection: Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included. Data Extraction and Synthesis: Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies. Main Outcomes and Measures: Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up. Results: A total of 21 RCTs and 12 observational studies evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], -5.53% [95% CI, -10.29% to -0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P = .003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, -35.26% [95% CI, -49.39% to -21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P < .001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, -8.02% [95% CI, -14.77% to -1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P = .02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P = .47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, -0.06 to 0.39]; P = .15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P < .001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, -11.99% [95% CI, -24.77% to 0.79%]; OR, 0.56 [95% CI, 0.29-1.08]; P = .49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P = .84; 6 studies; 414 patients). Conclusions and Relevance: In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.


Assuntos
Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/métodos , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Hipercapnia/etiologia , Ventilação não Invasiva/instrumentação , Respiração com Pressão Positiva/instrumentação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Respiração Artificial/instrumentação , Resultado do Tratamento
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(12): 895-900, 2019 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-31826532

RESUMO

Objective: To identify the independent risk factors that predict one-year mortality and long-term mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A retrospective review of medical records and long-term follow-up were performed for inpatients with the first diagnosis of AECOPD at Beijing Chaoyang Hospital between January 2013 and December 2014. The follow-up was completed on March 1, 2018. Cox regression analysis was used to determine the independent risk factors for all-cause mortality of AECOPD patients. Results: A total of 890 AECOPD patients were enrolled. The average follow-up was 41 months (range 1-62). One-year mortality was 8.4% (75/890) and long-term mortality was 37.2% (331/890). In both scenarios, the main cause of death was respiratory disorders, and the next ones were cardiovascular and tumor disorders. The risk factors independently associated with one-year mortality included body mass index (HR 0.891, 95%CI 0.838-0.947, P<0.01), length of hospitalization (HR 1.031, 95%CI 1.019-1.042, P<0.01), lymphocyte count (HR 0.295, 95%CI 0.160-0.542, P<0.01), albumin (HR 0.935, 95%CI 0.880-0.994, P=0.031), atrial fibrillation (HR 2.220, 95%CI 1.038-4.747, P=0.040), and lung cancer (HR 5.865, 95%CI 2.608-13.192, P<0.01). The risk factors independently associated with long-term mortality included age (HR 1.046, 95%CI 1.031-1.062, P<0.001), body mass index (HR 0.939, 95%CI 0.914-0.964, P<0.01), length of hospitalization (HR 1.028, 95%CI 1.019-1.038, P<0.01), albumin (HR 0.957, 95%CI 0.929-0.986, P<0.01), partial pressure of carbon dioxide (HR 1.019, 95%CI 1.009-1.028, P<0.01), heart failure (HR 1.538, 95%CI 1.180-2.005, P=0.001), lung cancer (HR 3.443, 95%CI 2.033-5.830, P<0.01). However, blood eosinophil count (≥300 cells/µl) was not independently associated with one-year mortality (HR 0.892, 95%CI 0.309-2.579, P=0.834) and long-term mortality of COPD patients (HR 1.007, 95%CI 0.682-1.486, P=0.973). Conclusion: Old age, poor nutritional status, long length of hospitalization, cardiovascular disorders, lung cancer, low lymphocyte count and hypercapnia were independent risk factors for mortality of AECOPD patients.


Assuntos
Hospitalização , Doença Pulmonar Obstrutiva Crônica/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Causas de Morte , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
3.
J Surg Oncol ; 120(8): 1486-1496, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31602661

RESUMO

BACKGROUND AND OBJECTIVES: To investigate non-lung cancer specific mortality between stage IA non-small cell lung cancer (NSCLC) tumors less than and equal to 2 cm treated with lobectomy and sublobectomy. METHODS: Surveillance, epidemiology, and end results database was queried for patients who underwent lobectomy and sublobectomy. Propensity score matching (PSM) was used to achieve balance in clinicopathological characteristics. We used Fine-and-Gray hazard functions to analyze cause-specific mortality and risk factors. Standardized mortality ratios were calculated to describe cause specific mortality relative to the general population. RESULTS: After PSM, 3,844 patients underwent lobectomy and 1,922 patients underwent sublobectomy. Three leading causes of non-lung cancer mortality were cardiovascular disease (CVD), chronic obstructive pulmonary diseases (COPD), and other cancers. The 5-year cumulative non-lung cancer mortality of lobectomy and sublobectomy groups were 11.4% and 14.0%, respectively (P = .090). Multivariate analyses revealed that age, sex, histology, tumor size, and marital status (P < .01) were independent predictors of non-lung cancer specific mortality. In both groups, risks of CVD specific mortality were comparable to that in the general population, whereas the risk of COPD specific mortality was higher relative to the general population. CONCLUSIONS: As a significant competing event, non-lung cancer specific mortality is comparable between stage IA NSCLC tumors less than equal to 2 cm treated with lobectomy and sublobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Adulto , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Estado Civil , Análise por Pareamento , Pessoa de Meia-Idade , Análise Multivariada , Pontuação de Propensão , Programa de SEER , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
4.
PLoS Genet ; 15(10): e1008405, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31647808

RESUMO

Obesity traits are causally implicated with risk of cardiometabolic diseases. It remains unclear whether there are similar causal effects of obesity traits on other non-communicable diseases. Also, it is largely unexplored whether there are any sex-specific differences in the causal effects of obesity traits on cardiometabolic diseases and other leading causes of death. We constructed sex-specific genetic risk scores (GRS) for three obesity traits; body mass index (BMI), waist-hip ratio (WHR), and WHR adjusted for BMI, including 565, 324, and 337 genetic variants, respectively. These GRSs were then used as instrumental variables to assess associations between the obesity traits and leading causes of mortality in the UK Biobank using Mendelian randomization. We also investigated associations with potential mediators, including smoking, glycemic and blood pressure traits. Sex-differences were subsequently assessed by Cochran's Q-test (Phet). A Mendelian randomization analysis of 228,466 women and 195,041 men showed that obesity causes coronary artery disease, stroke (particularly ischemic), chronic obstructive pulmonary disease, lung cancer, type 2 and 1 diabetes mellitus, non-alcoholic fatty liver disease, chronic liver disease, and acute and chronic renal failure. Higher BMI led to higher risk of type 2 diabetes in women than in men (Phet = 1.4×10-5). Waist-hip-ratio led to a higher risk of chronic obstructive pulmonary disease (Phet = 3.7×10-6) and higher risk of chronic renal failure (Phet = 1.0×10-4) in men than women. Obesity traits have an etiological role in the majority of the leading global causes of death. Sex differences exist in the effects of obesity traits on risk of type 2 diabetes, chronic obstructive pulmonary disease, and renal failure, which may have downstream implications for public health.


Assuntos
Causas de Morte , Doença da Artéria Coronariana/genética , Diabetes Mellitus Tipo 2/genética , Obesidade/genética , Doença Pulmonar Obstrutiva Crônica/genética , Adiposidade/genética , Idoso , Pressão Sanguínea/genética , Índice de Massa Corporal , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/patologia , Feminino , Estudo de Associação Genômica Ampla , Humanos , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Neoplasias , Obesidade/complicações , Obesidade/mortalidade , Obesidade/patologia , Polimorfismo de Nucleotídeo Único , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/patologia , Fatores de Risco , Acidente Vascular Cerebral , Relação Cintura-Quadril
5.
Environ Pollut ; 255(Pt 1): 113173, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521993

RESUMO

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 µm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 µm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 µg/m3 (UI: 19.03-24.9) and 35.4 µg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China , Exposição Ambiental/estatística & dados numéricos , Humanos , Irã (Geográfico) , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Isquemia Miocárdica/induzido quimicamente , Isquemia Miocárdica/mortalidade , Material Particulado/análise , Saúde Pública , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/mortalidade , Infecções Respiratórias/induzido quimicamente , Infecções Respiratórias/mortalidade , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/mortalidade
6.
Tuberk Toraks ; 67(2): 83-91, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414638

RESUMO

Introduction: The goals of chronic obstructive pulmonary disease (COPD) treatment are to relieve dyspnea, increase exercise capacity, and improve quality of life. The relation of exercise capacity, dyspnea level, and quality of life with long-term mortality is unclear. Aim of the study was to assess the effect of exercise capacity, dyspnea level and quality of life on long-term mortality risk in patients with COPD. Materials and Methods: Dyspnea level was assessed using the modified Medical Research Council (mMRC), Borg and Baseline Dyspnea Index (BDI) and Body Obstruction Dyspnea Exercise (BODE), health-related quality of life with St. George's Respiratory Questionnaire, and exercise capacity with the 6-minute walking test (6MWT) and cardiopulmonary exercise test. At the end of 8-year follow-up period, the relation between these tests and mortality was examined. Result: A total of 42 patients with stable COPD were included in the study. Sixteen patients died during the approximately 8-year follow-up period. Univariate analysis revealed that VO2 peak [HR: 1.845; CI: (1.336-2.55); p<0.001], BODE index [HR: 0.787; CI: (0.703-0.880); p<0.001], and SGRQ [HR: 1.073; CI: (1.028-1.119); p= 0.001] were significantly correlated to mortality risk. Multivariate Cox regression analysis revealed VO2 peak [HR: 1.031; CI: (0.683-1.120); p= 0.01] as the single significant predictor of mortality. VO2 peak less than 22.5 had a sensitivity of 82%, specificity of 80%, and area under the curve of 0.142 [95% CI: (0.027-0.257); p< 0.001] for mortality risk with ROC analysis. Conclusions: Cardiopulmonary disturbances during maximal exercise may be an important indicator of mortality risk.


Assuntos
Dispneia/fisiopatologia , Tolerância ao Exercício/fisiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Idoso , Análise de Variância , Exercício , Teste de Esforço , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Curva ROC , Sensibilidade e Especificidade , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 98(32): e16775, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393400

RESUMO

BACKGROUND: The benefit of a procalcitonin (PCT)-guided antibiotic strategy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain. OBJECTIVES: This updated meta-analysis was performed to reevaluate the therapeutic potential of PCT-guided antibiotic therapy in AECOPD. DATA SOURCES: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to February 2019 to identify randomized controlled trials (RCTs) investigating the role of PCT-guided antibiotic strategies in treating adult patients with AECOPD. Relative risk (RR) or mean differences (MD) with accompanying 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS: Eight RCTs with a total of 1376 participants were included. The results suggested that a PCT-guided antibiotic strategy reduced antibiotic prescriptions (RR: 0.55; 95% CI: 0.39-0.76; P = .0003). However, antibiotic exposure duration (MD: -1.34; 95% CI: -2.83-0.16; P = .08), antibiotic use after discharge (RR: 1.61; 95% CI: 0.61-4.23; P = .34), clinical success (RR: 1.02; 95% CI: 0.96-1.08; P = .47), all-cause mortality (RR: 1.05; 95% CI: 0.72-1.55; P = .79), exacerbation at follow-up (RR: 0.97; 95% CI: 0.80-1.18; P = .78), readmission at follow-up (RR: 1.12; 95% CI: 0.82-1.53; P = .49), length of hospital stay (MD: -0.36; 95% CI: -1.36-0.64; P = .48), and adverse events (RR: 1.33; 95% CI: 0.79-2.23; P = .28) were similar in both groups. IMPLICATIONS OF KEY FINDINGS: A PCT-guided antibiotic strategy is associated with fewer antibiotic prescriptions, and has similar efficacy and safety compared with standard antibiotic therapy in AECOPD patients.


Assuntos
Antibacterianos/uso terapêutico , Pró-Calcitonina/sangue , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Protocolos Clínicos , Esquema de Medicação , Uso de Medicamentos , Humanos , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
BMC Pulm Med ; 19(1): 131, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319839

RESUMO

BACKGROUND: Noninvasive ventilation (NIV) reduces the rate of endotracheal intubation (ETI) and overall mortality in severe acute exacerbation of COPD (AECOPD) with acute respiratory failure and is increasingly applied in respiratory intermediate care units. However, inadequate patient selection and incorrect management of NIV increase mortality. We aimed to identify factors that predict the outcome of NIV in AECOPD. Also, we looked for factors that influence ventilator settings and duration. METHODS: A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2016 and 2017. Age, BMI, lung function, arterial pH and pCO2 at admission (t0), at 1-2 h (t1) and 4-6 h (t2) after admission, creatinine clearance, echocardiographic data (that defined left heart dysfunction), mean inspiratory pressure during the first 72 h (mIPAP-72 h) and hours of NIV during the first 72 h (dNIV-72 h) were recorded. Main outcome was NIV failure (i.e., ETI or in-hospital death). Secondary outcomes were in-hospital mortality, length of stay (LOS), duration of NIV (days), mIPAP-72 h, and dNIV-72 h. RESULTS: We included 89 patients (45 male, mean age 67.6 years) with AECOPD that required NIV. NIV failure was 12.4%, and in-hospital mortality was 11.2%. NIV failure was correlated with days of NIV, LOS, in-hospital mortality (p < 0.01), and kidney dysfunction (p < 0.05). In-hospital mortality was strongly associated with days of NIV (OR 1.27, 95%CI: 1.07-1.5, p < 0.01) and with FEV1 (p < 0.05). All other investigated parameters (including left heart dysfunction, dNIV-72 h, mIPAP-72 h, pH, etc.) did not influence NIV failure or mortality. dNIV-72 h and days of NIV were independent predictors of LOS (p < 0.01). Regarding the secondary outcomes, left heart dysfunction and pH at 1-2 h independently predicted NIV duration (dNIV-72 h, p < 0.01), while BMI and baseline pCO2 predicted NIV settings (mIPAP-72 h, p < 0.01). CONCLUSION: In-hospital mortality and NIV failure were not influenced by BMI, left heart dysfunction, age, nor by arterial blood gas values in the first 6 h of NIV. Patients with severe acidosis and left heart dysfunction required prolonged use of NIV. BMI and pCO2 levels influence the NIV settings in AECOPD regardless of lung function.


Assuntos
Mortalidade Hospitalar , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Gasometria , Progressão da Doença , Feminino , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Análise de Regressão , Unidades de Cuidados Respiratórios , Insuficiência Respiratória/mortalidade , Romênia/epidemiologia
9.
Braz J Cardiovasc Surg ; 34(3): 279-284, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310465

RESUMO

OBJECTIVE: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. METHODS: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). RESULTS: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). CONCLUSION: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.


Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/métodos , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/cirurgia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/cirurgia , Valores de Referência , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/cirurgia , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento
10.
Ther Adv Respir Dis ; 13: 1753466619860058, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291820

RESUMO

BACKGROUND: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. METHODS: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC

Assuntos
Obstrução das Vias Respiratórias/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Ansiedade/epidemiologia , Doenças Cardiovasculares/mortalidade , Depressão/epidemiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Fatores Sexuais , Capacidade Vital
11.
Artigo em Inglês | MEDLINE | ID: mdl-31190781

RESUMO

Purpose: Clinically important deterioration (CID) in chronic obstructive pulmonary disease (COPD) is a novel composite endpoint that assesses disease stability. The association between short-term CID and future economic and quality of life (QoL) outcomes has not been previously assessed. This analysis considers 3-year data from the TOwards a Revolution in COPD Health (TORCH) study, to examine this question. Patients and methods: This post hoc analysis of TORCH (NCT00268216) compared costs and utilities at 3 years among patients without CID (CID-) and with CID (CID+) at 24 weeks. A positive CID status was defined as either: a deterioration in forced expiratory volume in 1 second (FEV1) of ≥100 mL from baseline; or a ≥4-unit increase from baseline in St George's Respiratory Questionnaire (SGRQ) total score; or the incidence of a moderate/severe exacerbation. Patients from all treatment arms were included. Utility change was based on the EQ-5D utility index. Costs were based on healthcare resource utilization from 24 weeks to end of follow-up combined with unit costs for the UK (2016 GBP), and reported as per patient per year (PPPY). Adjusted estimates were generated controlling for baseline characteristics, treatment assignment, and number of CID criteria met. Results: Overall, 3,769 patients completed the study and were included in the analysis (stable CID- patients, n=1,832; unstable CID+ patients, n=1,937). At the end of follow-up, CID- patients had higher mean (95% confidence interval [CI]) utility scores than CID+ patients (0.752 [0.738, 0.765] vs 0.697 [0.685, 0.71]; difference +0.054; P<0.001), and lower costs PPPY (£538 vs £916; difference: £378 [95% CI: £244, £521]; P<0.001). The cost differential was primarily driven by the difference in general hospital ward days (P=0.003). Conclusion: This study demonstrated that achieving early stability in COPD by preventing short-term CID is associated with better preservation of future QoL alongside reduced healthcare service costs.


Assuntos
Broncodilatadores/economia , Broncodilatadores/uso terapêutico , Combinação Fluticasona-Salmeterol/economia , Combinação Fluticasona-Salmeterol/uso terapêutico , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Custos de Cuidados de Saúde , Pulmão/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Redução de Custos , Análise Custo-Benefício , Progressão da Doença , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-31190783

RESUMO

Introduction: There has been an increase in interest in the peripheral blood eosinophil count as a biomarker in COPD. Few studies have examined the eosinophil count in patients attending the emergency department (ED) with acute exacerbations of COPD (AECOPD). We investigated the relationship between the blood eosinophil and other variables collected routinely at ED presentation and outcomes. Methods: Retrospective case note review of patients attending the ED with an AECOPD over 18 months. Demographic, clinical and pharmacological data were analyzed at the time of presentation, and clinical outcomes relating to hospital admission, length of hospital stay and mortality were investigated. Results: There were 743 AECOPD index events in 537 patients. Over half (57%) of all attendees were admitted to hospital. They were older, reported an increased number of exacerbations and higher levels of total leukocytes and neutrophils. Length of stay was shorter in patients with a blood eosinophil count ≥2% compared to <2% (median (IQR) 3 days (1-7) vs 4 days (2-8) respectively, p<0.05). Length of stay correlated with peripheral blood neutrophils (r=0.12, p=0.021), peripheral blood absolute and relative eosinophils (r=-0.12, p=0.024 and r=-0.11, p=0.035, respectively) and CRP (r=0.16, p=0.027). Non-eosinophilic AECOPD were associated with an increased risk of mortality during an exacerbation (χ 2 5.9, OR 3.08, 95% CI 1.19-7.96, p=0.015). Conclusion: In exacerbations of COPD presenting to ED, a higher blood eosinophil count is associated with a shorter length of stay and reduced mortality.


Assuntos
Serviço Hospitalar de Emergência , Eosinófilos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Tempo de Internação , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
13.
Int J Chron Obstruct Pulmon Dis ; 14: 995-1008, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190785

RESUMO

Purpose: Assess the clinical and economic consequences associated with an early versus late diagnosis in patients with COPD. Patients and methods: In a retrospective, observational cohort study, electronic medical record data (2000-2014) were collected from Swedish primary care patients with COPD. COPD indicators (pneumonia, other respiratory diseases, oral corticosteroids, antibiotics for respiratory infections, prescribed drugs for respiratory symptoms, lung function measurement) registered prior to diagnosis were applied to categorize patients into those receiving early (2 or less indicators) or late diagnosis (3 or more indicators registered >90 days preceding a COPD diagnosis). Outcome measures included annual rate of and time to first exacerbation, mortality risk, prevalence of comorbidities and health care utilization. Results: More patients with late diagnosis (n=8827) than with early diagnosis (n=3870) had a recent comorbid diagnosis of asthma (22.0% vs 3.9%; P<0.0001). Compared with early diagnosis, patients with late diagnosis had a higher exacerbation rate (hazard ratio [HR] 1.89, 95% confidence interval [CI]: 1.83-1.96; P<0.0001) and shorter time to first exacerbation (HR 1.61, 95% CI: 1.54-1.69; P<0.0001). Mortality was not different between groups overall but higher for late versus early diagnosis, after excluding patients with past asthma diagnosis (HR 1.10, 95% CI: 1.02-1.18; P=0.0095). Late diagnosis was also associated with higher direct costs than early diagnosis. Conclusion: Late COPD diagnosis is associated with higher exacerbation rate and increased comorbidities and costs compared with early diagnosis. The study highlights the need for accurate diagnosis of COPD in primary care in order to reduce exacerbations and the economic burden of COPD.


Assuntos
Custos de Cuidados de Saúde , Atenção Primária à Saúde/economia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Idoso , Comorbidade , Progressão da Doença , Diagnóstico Precoce , Registros Eletrônicos de Saúde , Feminino , Nível de Saúde , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Fatores de Tempo
14.
Int J Chron Obstruct Pulmon Dis ; 14: 1053-1061, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190790

RESUMO

Objectives: COPD is the fourth-leading cause of mortality worldwide. Prolonged QTc has been found to be a long-term negative prognostic factor in ambulatory COPD patients. The aim of this study was to evaluate the extent of prolonged-QTc syndrome in COPD patients upon admission to an internal medicine department, its relationship to hypomagnesemia, hypokalemia, and hypocalcemia, and the effect of COPD treatment on mortality during hospital stay. Methods: This prospective cohort study evaluated COPD patients hospitalized in an internal medicine department. The study evaluated QTc, electrolyte levels, and known risk factors during hospitalization of COPD patients. Results: A total of 67 patients were recruited. The median QTc interval was 0.441 seconds and 0.434 seconds on days 0 and 3, respectively. Prolonged QTc was noted in 35.8% of patients on admission and 37.3% on day 3 of hospitalization. The median QTc in the prolonged-QTc group on admission was 0.471 seconds and in the normal-QTc group 0.430 seconds. There was no significant difference in age, sex, electrolyte levels, renal function tests, or blood gases on admission between the two groups. Mortality during the hospital stay was significantly higher in the prolonged-QTc group (3 deaths, 12%) than in the normal QTc group (no deaths) (P=0.04). A subanalysis was performed, removing known causes for prolonged QTc. We found no differences in age, electrolytes, or renal functions. There was a small but significant difference in bicarbonate levels. Conclusion: Our findings demonstrated that there was no correlation between QTc prolongation in hospitalized COPD patients and electrolyte levels, comorbidities, or relevant medications. A higher rate of mortality was noted in patients with prolonged QTc in comparison to normal QTc. As such, it is suggested that prolonged QTc could serve as a negative prognostic factor for mortality during hospitalization in COPD patients.


Assuntos
Hospitalização , Síndrome do QT Longo/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Desequilíbrio Hidroeletrolítico/mortalidade , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Cálcio/sangue , Causas de Morte , Progressão da Doença , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Mortalidade Hospitalar , Humanos , Hipocalcemia/sangue , Hipocalcemia/mortalidade , Hipopotassemia/sangue , Hipopotassemia/mortalidade , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/diagnóstico
15.
Lakartidningen ; 1162019 May 28.
Artigo em Sueco | MEDLINE | ID: mdl-31192398

RESUMO

Lung volume reduction using endobronchial one-way valves (EBV) have been introduced as a new treatment for end-stage COPD and emphysema. They cause the lung parenchyma distal to the valve to collapse by causing an atelectasis. Nine randomized controlled trials (RCTs) studying the effects of insertion of EBVs in patients with severe emphysema were identified. In two of the RCTs both lungs were treated whereas in seven a unilateral approach was used. In comparison with optimal medical therapy, unilateral placement of EBVs resulted in clinically and statistically significant improvements in lung function, quality of life, and physical capacity in patients with heterogeneous or homogeneous emphysema. There were no significant differences in mortality. The frequency of serious complications and adverse events, especially pneumothorax, was higher. Bilateral EBV treatment did not show corresponding improvements in the outcome variables.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Idoso , Broncoscopia/efeitos adversos , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Teste de Caminhada
16.
JAMA ; 321(24): 2438-2447, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31237643

RESUMO

Importance: According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial. Objective: To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting COPD-related hospitalization and mortality. Design, Setting, and Participants: The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016. Exposures: Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN). Main Outcomes and Measures: The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach. Results: Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95% CI, -0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models. Conclusions and Relevance: Defining airflow obstruction as FEV1:FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD.


Assuntos
Volume Expiratório Forçado , Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Capacidade Vital , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/mortalidade , Medição de Risco/métodos
17.
Int J Chron Obstruct Pulmon Dis ; 14: 1229-1237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239658

RESUMO

Background: High-flow nasal cannula (HFNC) oxygen therapy in acute hypoxic respiratory failure is becoming increasingly popular. However, evidence to support the use of HFNC in acute respiratory failure (ARF) with hypercapnia is limited. Methods: Chronic obstructive pulmonary disease (COPD) patients with moderate hypercapnic ARF (arterial blood gas pH 7.25-7.35, PaCO2>50 mmHg) who received HFNC or non-invasive ventilation (NIV) in the intensive care uint from April 2016 to March 2018 were analyzed retrospectively. The endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa), and 28-day mortality. Results: Eighty-two COPD patients (39 in the HFNC group and 43 in the NIV group) were enrolled in this study. The mean age was 71.8±8.2 and 54 patients (65.9%) were male. The treatment failed in 11 out of 39 patients with HFNC (28.2%) and in 17 of 43 patients with NIV (39.5%) (P=0.268). No significant differences were found for 28-day mortality (15.4% in the HFNC group and 14% in the NIV group, P=0.824). During the first 24 hrs of treatment, the number of nursing airway care interventions in the HFNC group was significantly less than in the NIV group, while the duration of device application was significantly longer in the HFNC group (all P<0.05). Skin breakdown was significantly more common in the NIV group (20.9% vs 5.1%, P<0.05). Conclusion: Among COPD patients with moderate hypercarbic ARF, the use of HFNC compared with NIV did not result in increased rates of treatment failure, while there were fewer nursing interventions and skin breakdown episodes reported in the HFNC group.


Assuntos
Cânula , Hipercapnia/terapia , Pulmão/fisiopatologia , Ventilação não Invasiva , Oxigenoterapia/instrumentação , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Administração Intranasal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercapnia/diagnóstico , Hipercapnia/mortalidade , Hipercapnia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/mortalidade , Oxigenoterapia/efeitos adversos , Oxigenoterapia/mortalidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
18.
Lancet ; 394(10204): 1145-1158, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31248666

RESUMO

BACKGROUND: Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. METHODS: We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). FINDINGS: Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). INTERPRETATION: China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. FUNDING: China National Key Research and Development Program and Bill & Melinda Gates Foundation.


Assuntos
Carga Global da Doença , Morbidade , Mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/estatística & dados numéricos , Causas de Morte , Criança , Pré-Escolar , China/epidemiologia , Dieta/estatística & dados numéricos , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/mortalidade , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Material Particulado , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Adulto Jovem
19.
Int J Chron Obstruct Pulmon Dis ; 14: 1159-1165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213795

RESUMO

Objective: The aim of this study was to investigate the outcomes of patients with COPD after laparoscopic cholecystectomy (LC). Patients and methods: All COPD patients who underwent LC from 2000 to 2010 were identified from the Taiwanese National Health Insurance Research Database. The outcomes of hospital stay, intensive care unit (ICU) stay, and use of mechanical ventilation and life support measures in COPD and non-COPD populations were compared. Results: A total of 3,954 COPD patients who underwent LC were enrolled in our study. There were significant differences in the hospitalization period, ICU stay, and use of mechanical ventilation and life support measures between the COPD and non-COPD populations. The mean hospital stay, ICU stay and number of mechanical ventilation days in the COPD and non-COPD groups were 7.81 vs 6.01 days, 5.5 vs 4.5 days and 6.40 vs 4.74 days, respectively. The use of life support measures, including vasopressors and hemodialysis, and the rates of hospital mortality, acute respiratory failure and pneumonia were also increased in COPD patients compared with those in non-COPD patients. Conclusion: COPD increased the risk of mortality, lengths of hospital and ICU stays, ventilator days and poor outcomes after LC in this study.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/mortalidade , Bases de Dados Factuais , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/mortalidade , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Pneumonia/mortalidade , Pneumonia/terapia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taiwan , Fatores de Tempo , Resultado do Tratamento
20.
Rev. patol. respir ; 22(2): 47-52, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-FGT-2139

RESUMO

Objetivo. El objetivo de este estudio es evaluar la mortalidad y los factores pronósticos de una población de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de fenotipo exacerbador. Material y métodos. Seguimos a una cohorte de pacientes con EPOC y dos exacerbaciones graves del área del Hospital General Universitario Gregorio Marañón (HGUGM) durante un año. Registramos: índice de comorbilidad de Charlson, índice CODEX, edad, índice de masa corporal (IMC), hábito tabáquico mediante el índice paquetes-año (IPA), COPD Assessment Test (CAT), volumen espiratorio forzado el primer segundo (FEV1), escala modificada de disnea mMRC (Modified Medical Research Council Dyspnea Scale) y tratamiento tras la segunda exacerbación y valoramos su relación con la mortalidad al año. Resultados. Incluimos a 131 pacientes con una edad media de 75,3 años. Fallecieron 43 pacientes (32,08%) al año de seguimiento. La disnea según la escala mMRC, la edad, la puntuación según el índice CODEX y la puntuación según el índice de comorbilidad de Charlson se relacionaron significativamente con la mortalidad. Desglosando este último se concluye que el antecedente de insuficiencia cardíaca y de neoplasia se relaciona significativamente con la mortalidad. Conclusiones. Tanto la puntuación del índice CODEX como del índice de comorbilidad de Charlson, la edad avanzada y el grado de disnea según la escala mMRC son útiles en la predicción de la mortalidad de pacientes con EPOC frágil en el área del HGUGM


Objective. The main objective is to assess the mortality and prognositic factors in the population of patients with exacerbation phenotype of chronic obstructive pulmonary disease (COPD). Material and method. A cohort of patients with exacerbation phenotype of COPD (two severe exacerbations requiring hospital admission at Hospital General Universitario Gregorio Marañón (HGUGM) was followed for a year. Charlson comorbidity index, CODEX index, age, body mass index, Cigarette index, COPD Assessment Test (CAT), forced expiratory volume in 1 second (FEV1), Modified Medical Research Council Dyspnea Scale (mMRC) were calculated as well as treatments and its relationship with mortality on a prospective basis after the discharge of the second exacerbation. Results. 131 patients were included which mean age is 75.3 years. 43 patients died after a year of monitoring (32.08%). Dyspnea (mMRC), age, the score according to Charlson comorbidity index and the score according to CODEX index were related to mortality as a prognostic factor. Furthermore, antecedents of heart failure and neoplasia were significantly related to mortality. Conclusions. Both the score according to CODEX index and the score according to Charlson comorbidity index, age and grade from dyspnea scale mMRC are useful as a prognostic factor of the population of pacients with fragile COPD in HGUGM area


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica/mortalidade , Índice de Gravidade de Doença , Análise de Sobrevida , Seguimentos , Estudos de Coortes , Prognóstico , Fenótipo , Fatores de Risco
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