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1.
BMC Pulm Med ; 21(1): 74, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653314

RESUMO

BACKGROUND: Blood eosinophil count may predict treatment response in patients with chronic obstructive pulmonary disease (COPD) during acute exacerbations (AE). However, the ability and thresholds of blood eosinophil counts in stable status to predict eosinophilic AECOPD have not been completely investigated. METHODS: This was a retrospective multicenter study performed January 2010 to December 2014. COPD subjects hospitalized with exacerbations, were included. Blood samples were obtained at the time of AE and stable disease at outpatient clinic before or after admission. We identified a blood eosinophil count cut-off point at stable COPD, either taken as a percentage or as absolute value, for identification of eosinophilic exacerbation. RESULTS: There was significant positive correlation of eosinophil counts between stable COPD and AECOPD. The best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation based on blood eosinophil count ≥ 2% was 300 cells/µL (area under the ROC curve [AUC] 0.614, P = 0.001, 39% sensitivity, 83.8% specificity). When the eosinophilic COPD exacerbation was based on blood eosinophil count ≥ 300 cells/µL, the best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation was also 300 cells/uL (AUC 0.634, P = 0.046, 45.8% sensitivity, 80.9% specificity). CONCLUSIONS: We demonstrated association between blood eosinophil counts at stable COPD and those with AECOPD. The thresholds of blood counts at stable COPD to predict eosinophilic exacerbations was 300 cells/µL. Further and prospective studies in other populations should validate our results.


Assuntos
Eosinofilia/sangue , Eosinófilos , Doença Pulmonar Obstrutiva Crônica/sangue , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Eosinofilia/complicações , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(10): e25010, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725881

RESUMO

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is still a constant threat to people's health. We aimed to identify the relationship between increased red cell distribution width (RDW) on admission and length of hospitalization in acute exacerbation of chronic obstructive pulmonary disease patients (AECOPD).Patients with AECOPD were recruited and divided into 3 groups based on RDW tertiles.Two hundred eighty six patients with AECOPD admitted to our department during January 1, 2017 and June 30, 2019 were enrolled in the study. According to the RDW tertiles (≤12.8%, 12.9% to 13.6%, >13.6%), the patients were divided into 3 groups. Length of stay was significantly related to RDW (P < .001) in AECOPD patients. Correlation analysis indicated that RDW was negatively associated with FEV1% predicted (r = -0.142, P = .016). However, RDW was positively associated with prolonged of stay (r = 0.298, P < .001) in AECOPD patients. Multivariate regression analysis discovered that RDW was independently associated with the length of hospitalization (P = .001). Receiver operating characteristic (ROC) curve showed that RDW was a good predictor of prolonged hospital stay in AECOPD patients, and the area under the curve (AUC) was 0.818 (95% CI: 0.769-0.868). The highest sensitivity to predict prolonged hospital stay was 83.8% and the specificity was 71.6% with the cut-off 13.35%.In conclusion, prolonged hospital stay in AECOPD patients was closely associated with increased RDW. Elevated RDW may be an independent predictor for prolonged hospitalization in AECOPD patients.


Assuntos
Índices de Eritrócitos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Exacerbação dos Sintomas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
BMC Pulm Med ; 20(1): 269, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066765

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has spread to almost 100 countries, infected over 31 M patients and resulted in 961 K deaths worldwide as of 21st September 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute respiratory distress syndrome (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum levels of cytokines. The pathogenesis of the respiratory failure in COVID-19 is yet unknown, but diffuse alveolar damage with interstitial thickening leading to compromised gas exchange is a plausible mechanism. Hypoxia is seen in the COVID-19 patients, however, patients present with a distinct phenotype. Intracellular levels of nitric oxide (NO) play an important role in the vasodilation of small vessels. To elucidate the intracellular levels of NO inside of RBCs in COVID-19 patients compared with that of healthy control subjects. METHODS: We recruited 14 COVID-19 infected cases who had pulmonary involvement of their disease, 4 non-COVID-19 healthy controls (without pulmonary involvement and were not hypoxic) and 2 hypoxic non-COVID-19 patients subjects who presented at the Masih Daneshvari Hospital of Tehran, Iran between March-May 2020. Whole blood samples were harvested from patients and intracellular NO levels in 1 × 106 red blood cells (RBC) was measured by DAF staining using flow cytometry (FACS Calibour, BD, CA, USA). RESULTS: The Mean florescent of intensity for NO was significantly enhanced in COVID-19 patients compared with healthy control subjects (P ≤ 0.05). As a further control for whether hypoxia induced this higher intracellular NO, we evaluated the levels of NO inside RBC of hypoxic patients. No significant differences in NO levels were seen between the hypoxic and non-hypoxic control group. CONCLUSIONS: This pilot study demonstrates increased levels of intracellular NO in RBCs from COVID-19 patients. Future multi-centre studies should examine whether this is seen in a larger number of COVID-19 patients and whether NO therapy may be of use in these severe COVID-19 patients.


Assuntos
Dióxido de Carbono/metabolismo , Infecções por Coronavirus/metabolismo , Eritrócitos/metabolismo , Hipóxia/metabolismo , Óxido Nítrico/metabolismo , Oxigênio/metabolismo , Pneumonia Viral/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Betacoronavirus , Gasometria , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Feminino , Citometria de Fluxo , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pressão Parcial , Projetos Piloto , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/metabolismo , Vasodilatação , Adulto Jovem
5.
BMC Pulm Med ; 20(1): 237, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894108

RESUMO

BACKGROUND: This study aimed to evaluate whether the Homocysteine (Hcy) level was elevated in chronic obstructive pulmonary disease (COPD) patients and its correlation with the occurrence and acute progression of COPD. METHODS: From November 2014 to November 2015, COPD patients were enrolled from Beijing Chao-yang Hospital, and the the biological and clinical data were collected. These patients were tested in the non-acute exacerbation period and the acute exacerbation period, so they were defined as AECOPD group and Non-AECOPD group. Besides, 50 healthy subjects were recruited and defined as control group. Total plasma Hcy levels (antibodies-online, USA) were determined by enzyme-linked immunosorbent assay. Correlation analysis was used to analyze the correlation between serum Hcy level and ventilatory function. Using ROC curve, the diagnostic value of Hcy for the occurrence and acute progression of COPD was explored. RESULTS: In this study, we found that Hcy levels in the Non-AECOPD group or the AECOPD group were significantly higher than those in the control group (P < 0.001). Meanwhile, compared with the Non-AECOPD group, the Hcy level in the AECOPD group was significantly higher (P < 0.001). In addition, according to the classification of GOLD grade, there was significant difference in the Hcy level among different GOLD grade groups (P < 0.001). The correlation analysis showed that in the AECOPD group and the Non-AECOPD group, Hcy levels presented a negative correlation with FEV1(r < 0). Meanwhile, FEV1% was also negatively correlated with Hcy level (r < 0). ROC curve analysis showed that when the cutoff value was set to 10.8 µg/ml, the specificity, sensitivity and AUC were the best, which were 0.980, 0.800, and 0.945, respectively. Besides, our results showed that when the cutoff value was set to 14.0 µg / ml, the specificity, sensitivity and AUC were the best, which were 0.846, 0.680, and 0.802, respectively. In addition, compared with the prediction of acute progression of COPD, when Hcy level predicted the occurrence of COPD, its specificity (0.980 vs. 0.846, P < 0.001) and sensitivity (0.800 vs. 0.680, P < 0.001) were significantly higher. CONCLUSION: Hcy level is positively correlated with the severity of COPD patients, which has predictive value for the occurrence of COPD and acute progression.


Assuntos
Progressão da Doença , Homocisteína/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Aguda , Idoso , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
6.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883943

RESUMO

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(33): e21550, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872002

RESUMO

To study the relationship between neutrophil to lymphocyte ratio (NLR) and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD).235 patients with COPD were selected as the study subjects. Complete blood count, C reactive protein (CRP), pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council, the COPD assessment test, and clinical COPD questionnaire were tested. Heart rate, oxygen saturation, and Borg scale were tested before or after 6MWD test.By the median of NLR, the subjects were divided into 2 groups, NLR ≥4.5 group and NLR <4.5 group. The white blood cell count (WBC), CRP and deoxygenation saturation in the NLR ≥4.5 group were higher than those in the NLR <4.5 group, while the age, body mass index (BMI), 6MWD, and heart rate variation were lower than those in the NLR <4.5 group. CRP, WBC, and deoxygenation saturation had positive effects on NLR, BMI, 6MWT, and heart rate variation had negative effects on NLR. The Pearson correlation analysis showed NLR was positively correlated with WBC, CRP, BMI index, 6MWT, and deoxygenation saturation, while it was negatively correlated with BMI and heart rate variation.NLR might associate with exercise tolerance and cardiorespiratory reserve of COPD patients, and could be used as an indicator of muscle function in COPD patients.


Assuntos
Tolerância ao Exercício , Linfócitos/metabolismo , Neutrófilos/metabolismo , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Inquéritos e Questionários , Teste de Caminhada
8.
Arch. bronconeumol. (Ed. impr.) ; 56(9): 571-577, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198501

RESUMO

INTRODUCCIÓN: Existe subdiagnóstico del déficit grave de alfa-1 antitripsina (DAAT) a pesar de la recomendación de realizar la determinación de AAT en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). OBJETIVO: Estimar la prevalencia de DAAT en pacientes con EPOC ajustada a la población del estudio de prevalencia de EPOC en la Argentina (EPOC.AR). MATERIAL Y MÉTODOS: Estudio prospectivo multicéntrico de corte transversal en población ≥ 30 años de edad con diagnóstico de EPOC. Cuantificación de AAT por toma de sangre capilar en gota seca y posterior genotipificación en aquellos sujetos con concentraciones < 1,5 mg/dl en sangre capilar en gota seca (< 80 mg/dl sérica). Se definió DAAT como la detección de las variantes ZZ o SZ por genotipificación. Se tomó la población del estudio EPOC.AR para calcular la prevalencia local ajustada. RESULTADOS: Se incluyeron 3.254 pacientes (544 con AAT < 80 mg/dl) con diagnóstico espirométrico de EPOC. La prevalencia de DAAT en la población total del estudio fue de 1,29% (IC 95% 0,93-1,74), de los cuales un 0,92% (IC 95% 0,62-1,31) fueron Pi*ZZ y un 0,37% (IC 95% 0,19-0,64) Pi*SZ. La prevalencia ajustada de DAAT en pacientes con EPOC (≥ 40 años) fue de 0,83% (IC 95% 0,23-2,08). Encontramos asociación negativa de DAAT con la edad (OR 0,94; IC 95% 0,90-0,98; p = 0,006), el consumo de tabaco (OR 0,98; IC 95% 0,96-0,99; p = 0,009) y el VEF1% (OR 0,95; IC 95% 0,91-0,99; p = 0,015). CONCLUSIONES: Se estima que la prevalencia de DAAT en la población adulta con EPOC en Argentina es del 0,83%, lo cual podría representar 17.000 casos en nuestro país


INTRODUCTION: Alpha-1 antitrypsin deficiency (AATD) is still underdiagnosed, despite the recommendation to determine AAT in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To estimate the prevalence of AATD in COPD patients adjusted according to the population of the COPD prevalence study in Argentina (EPOC.AR). MATERIAL AND METHODS: This was a multicenter prospective cross-sectional study of a population aged ≥ 30 years of age diagnosed with COPD, involving AAT quantification in dry blood spot and subsequent genotyping in subjects with < 1.5 mg/dL AAT in dry blood spot (< 80 mg/dL in serum). AAT was defined as the detection of variants ZZ or SZ on genotyping. The EPOC.AR study population was used to calculate local adjusted prevalence. RESULTS: We included 3,254 patients (544 with AAT < 80 mg/dL) with a spirometric diagnosis of COPD. The prevalence of AATD in the total study population was 1.29% (95% CI 0.93-1.74), of which 0.92% (95% CI 0.62-1.31) were Pi*ZZ and 0.37% (95% CI 0.19-0.64) Pi*SZ. The adjusted prevalence of AATD in COPD patients ≥ 40 years of age was 0.83% (95% CI 0.23-2.08). We found that AATD was negatively associated with age (OR 0.94; 95% CI 0.90-0.98; P = .006), smoking habit (OR 0.98; 95% CI 0.96-0.99; P = .009), and FEV1% (OR 0.95; 95% CI 0.91-0.99; P = .015). CONCLUSIONS: The prevalence of AATD in the adult population with COPD in Argentina is estimated to be 0.83%, which could represent 17,000 cases in our country


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Pulmonar Obstrutiva Crônica/sangue , alfa 1-Antiquimotripsina/sangue , Índice de Gravidade de Doença , Biomarcadores/sangue , Estudos Transversais , Estudos Prospectivos , Prevalência
9.
Medicine (Baltimore) ; 99(29): e21152, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702869

RESUMO

BACKGROUND: The use of antibiotics in the acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Serum C-reactive protein (CRP), a sensitive biomarker for systemic inflammation and tissue damage, is a good indicator of lower respiratory tract bacterial infection. However, due to the small sample size of the existing studies, the clinical value of CRP in guiding the use of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotics is insufficient. The aim of this study was to evaluate the value of CRP-guided treatment strategies for AECOPD patients. METHODS: This review summarizes and meta-analyses randomized controlled trials (RCTs) of CRP guiding antibiotic prescribing for COPD exacerbations. RCTs compare either usual-care or the GOLD strategy have been included. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data. The methodologic quality of RCTs has been assessed using the Cochrane risk assessment tool. All trials included are analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software, and GRADE pro GDT web solution are used for data synthesis and analysis. RESULTS: This review evaluates the effects of CRP testing on the antibiotic use, CCQ, EQ-5D utility scores and adverse events in patients with COPD exacerbations. CONCLUSION: This review provides clear evidence that CRP testing can reduce the use of antibiotics in patients with AECOPD without causing harm.


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Protocolos Clínicos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antibacterianos/administração & dosagem , Biomarcadores/análise , Biomarcadores/sangue , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Metanálise como Assunto , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Revisões Sistemáticas como Assunto
11.
Niger J Clin Pract ; 23(6): 817-824, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525117

RESUMO

Background: The Global Initiative classification (GOLD) for chronic obstructive pulmonary disease (COPD), which relies on the practical issues of treatment of this complex and heterogeneous disease, may not be reliable in predicting disease severity and prognosis as the term of inflammation is excluded from the definition. Aim: The aim of this study was to determine systemic inflammatory markers in GOLD ABCD groups and to compare these parameters according to clinical and functional features. Methods: The study included 60 COPD patients and 59 healthy subjects. Comparisons were made with the pulmonary function test, transthoracic echocardiography and the six-minute walk test (6MWT). The COPD assessment test (CAT), modified Medical Research Council (mMRC), and index scores of body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) were recorded. The systemic inflammatory state was assessed using C-reactive protein, fibrinogen, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8 and IL-18. Results: The levels of all serum inflammatory markers were higher in the COPD group than in the control group. TNF-α and IL-6 were significantly higher in the symptomatic groups (B and D) than in the less symptomatic groups (A and C) (P < 0.05). Spirometric parameters were more severe in Group D, followed by groups C, B and A, respectively. The 6MWT and the BODE scores were worst in Group D, followed by groups B, C and A. Conclusion: The results suggest that bronchodilator treatment alone might be insufficient in Group B patients, as the systemic inflammatory markers in addition to exercise capacity and mortality predictors were at the worst level in Groups D and B.


Assuntos
Biomarcadores/sangue , Mediadores da Inflamação/sangue , Inflamação/sangue , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Idoso , Índice de Massa Corporal , Proteína C-Reativa , Estudos de Casos e Controles , Estudos Transversais , Dispneia/fisiopatologia , Ecocardiografia , Tolerância ao Exercício , Feminino , Humanos , Inflamação/imunologia , Interleucina-6/sangue , Interleucina-8/sangue , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/imunologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Índice de Gravidade de Doença , Espirometria , Fator de Necrose Tumoral alfa/sangue , Teste de Caminhada
12.
Clin Microbiol Infect ; 26(10): 1380-1385, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32593742

RESUMO

OBJECTIVES: The aim was to determine the clinical characteristics of COVID-19 patients because the SARS-CoV-2 virus continues to circulate in the population. METHODS: This is a retrospective, multicentre, cohort study. Adult COVID-19 cases from four hospitals in Zhejiang were enrolled and clustered into three groups based on epidemiological history. First-generation patients had a travel history to Hubei within 14 days before disease onset; second-generation patients had a contact history with first-generation patients; third-generation patients had a contact history with second-generation patients. Demographic, clinical characteristics, clinical outcomes and duration of viral shedding were analysed. RESULTS: A total of 171 patients were enrolled, with 83, 44 and 44 patients in the first-, second-, and third-generation, respectively. Compared with the first and second generations, third-generation patients were older (61.3 vs. 48.3 and 44.0 years, p < 0.001) and had more coexisting conditions (56.8% vs. 36.1% and 27.3%, p 0.013). At 7 ± 1 days from illness onset, third-generation patients had lower lymphocyte (0.6 vs. 0.8 and 0.8 × 109/L, p 0.007), higher C-reactive protein (29.7 vs. 17.1 and 13.8 mg/L, p 0.018) and D-dimer (1066 vs. 412.5 and 549 µg/L, p 0.002) and more lesions involving the pulmonary lobes (lobes ≥5, 81.8% vs. 53.0% and 34.1%, p < 0.001). The proportions of third-generation patients developing severe illness (72.7% vs. 32.5% and 27.3%, p < 0.001), critical illness (38.6% vs. 10.8% and 6.8%, p < 0.001) and receiving endotracheal intubation (20.5% vs. 3.6% and 2.3%, p 0.002) were higher than in the other two groups. DISCUSSION: Third-generation patients were older, had more underlying comorbidities and had a higher proportion of severe or critical illness than first- and second-generation patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , China/epidemiologia , Comorbidade , Busca de Comunicante , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Interleucina-6/sangue , Intubação Intratraqueal , Linfócitos/patologia , Linfócitos/virologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Viagem/estatística & dados numéricos , Eliminação de Partículas Virais
13.
J Steroid Biochem Mol Biol ; 201: 105687, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360596

RESUMO

The increasing use of vitamin D supplements has stimulated interest in identifying factors that may modify the effect of supplementation on circulating 25-hydroxyvitamin D (25(OH)D) concentrations. Such information is of potential interest to researchers, clinicians and patients when deciding on bolus dose of vitamin D supplementation. We carried out a large randomized controlled trial of 5110 adults aged 50-84 years, of European/Other (84%), Polynesian (11%) and Asian (5%) ethnicity, to whom we gave a standard dose of vitamin D3 supplements (200,000 IU initially, then 100,000 IU monthly) which was taken with high adherence. All participants provided a baseline blood sample, and follow-up blood samples were collected at 6 months and annually for 3 years in a random sample of 441 participants, and also at 2 years in 413 participants enrolled in a bone density sub-study. Serum 25(OH)D was measured by LC/MSMS. Mixed model analyses were carried out on all 854 participants providing follow-up blood samples in multivariable models that included age, sex, ethnicity, body mass index (kg/m2), tobacco smoking, alcohol intake, physical activity, sun exposure, season, medical prescription of high-dose vitamin D3 (Cal.D.Forte tablets), asthma/COPD and the study treatment (vitamin D or placebo). The adjusted mean difference in 25(OH)D in the follow-up points between vitamin D supplementation and placebo groups was inversely related (all p for interaction <0.05) to baseline 25(OH)D, BMI, and hours of sun exposure, and higher in females, elders, and those with high frequency of alcohol, medical prescription of vitamin D, and asthma/COPD. The mean difference was not significantly related to ethnicity (p = 0.12), tobacco (p = 0.34), and vigorous activity (p = 0.33). In summary, these data show that vitamin D status, BMI, sun exposure hours, sex and asthma/COPD modify the 25(OH)D response to vitamin D supplementation. By contrast, ethnicity, tobacco smoking, and vigorous activity do not.


Assuntos
Suplementos Nutricionais , Vitamina D/análogos & derivados , Vitaminas/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Asma/sangue , Índice de Massa Corporal , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Caracteres Sexuais , Luz Solar , Vitamina D/administração & dosagem , Vitamina D/sangue , Vitaminas/sangue
14.
J Ayub Med Coll Abbottabad ; 32(1): 3-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468745

RESUMO

Background: Chronic Obstructive Pulmonary Disease (COPD) is the leading cause of morbidity and mortality across the globe. Currently, there is a dearth of biomarkers which can accurately diagnose and evaluate the prognosis of the disease. Systemic Surfactant Protein- A (SP-A) levels are generally higher in smokers compared to non-smokers as well as elevated in COPD patients as compared to controls. The objective of the study was to estimate and compare plasma surfactant protein-A levels in male and female COPD patients and healthy subjects and to evaluate the role of SP-A as a possible bio-marker for COPD patients. Methods: A Comparative study, conducted at the department of Physiology & Cell Biology, University of Health Sciences, Lahore between August 2013 and April 2015. A total of 84 subjects of both sexes between 30-80 years of age were included in this study. Subjects were taken from local community and were divided into four groups (A- D). COPD was diagnosed on the basis of relevant history and spirometry showing post bronchodilator FEV1/FVC <0.70. Results: Plasma SP-A levels were not different between controls and COPD patients and between male and female COPD patients. However, SP-A levels were directly correlated with cotinine levels (r= 0.503, p=0.001). Female patients were usually more symptomatic than males and developed COPD at an earlier age compared with male patients. Conclusion: Plasma SP-A levels were not significantly different between groups. Plasma cotinine levels (an indication of the tobacco use) were positively correlated with plasma SP-A levels in study subjects. Female patients developed COPD at an early age compared to male counterparts with similar tobacco exposure.


Assuntos
Doença Pulmonar Obstrutiva Crônica/sangue , Proteína A Associada a Surfactante Pulmonar/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Fatores Sexuais , Espirometria , Tensoativos
15.
Phys Ther ; 100(8): 1249-1259, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32329780

RESUMO

OBJECTIVE: The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD). METHODS: A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated. RESULTS: Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = -18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively. CONCLUSION: In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity. IMPACT STATEMENT: The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance.


Assuntos
Dispneia/terapia , Tolerância ao Exercício/fisiologia , Exercício Físico , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Doença Crônica , Intervalos de Confiança , Dispneia/sangue , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Força Muscular , Ventilação não Invasiva , Oxigênio/administração & dosagem , Satisfação do Paciente , Doença Pulmonar Obstrutiva Crônica/sangue , Método Simples-Cego , Teste de Caminhada
16.
Niger J Clin Pract ; 23(4): 450-455, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32246649

RESUMO

Objective: The role of monocytes and high-density lipoprotein (HDL) levels in the pathophysiology of cardiovascular disease (CVD) is well known. However, the relationship between monocytes to HDL-cholesterol ratio (MHR) and CVD in chronic obstructive pulmonary disease (COPD) patients has not been investigated previously. We, therefore, aimed to investigate the predictor role of MHR in the development of CVD in subjects with COPD. Methods: 185 COPD patients and 89 control subjects were enrolled. Demographic data and laboratory parameters were recorded and MHR was calculated for all participants. CVDs were defined if hypertension, ischemic heart disease, congestive heart failure, or stroke present. MHR levels were compared between the two groups in terms of CVD. Receiver operating characteristic analysis was used to determine the MHR cutoff value that predicts CVD in COPD patients. Results: We found positive correlation between MHR and COPD (r = 0.24, P = 0.001). However, there was no statically significant association between MHR and severity of COPD defined by the Global Initiative for Chronic Obstructive Lung Disease criteria (P = 0.78). MHR was significantly higher in COPD patients with CVD compared to without CVD (P = 0.007). In subgroups' analysis, COPD patients with CVD, MHR was significantly higher in COPD patients with ischemic heart diseases (P < 0001). Similarly, MHR was higher in subjects with CVD compared to the subjects without CVD, but it was not statistically significant (P = 0.68). In the ROC analysis, the MHR cutoff value that predicts CVD in COPD patients was found to be 12.50 (sensitivity of 64.9% and specificity of 65.4%) (area under the receiver operating characteristic curve [AUC] = 0.73, P = 0.001). Conclusion: MHR is significantly associated with CVD in COPD patients. Further prospective studies are warranted to elucidate the predictive value of MHR in COPD patients.


Assuntos
Doenças Cardiovasculares/sangue , HDL-Colesterol/sangue , Monócitos/metabolismo , Doença Pulmonar Obstrutiva Crônica/sangue , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/complicações , Curva ROC
17.
Gene ; 744: 144633, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32240778

RESUMO

BACKGROUND: Several studies have examined the association between transforming growth factor-ß (TGF-ß) genetic polymorphisms and chronic obstructive pulmonary disease (COPD) risk, but the results remained inconclusive and controversial. AIMS: We aimed to examine the correlation between TGF-ß genetic polymorphisms and COPD risk through a comprehensive meta-analysis. Additionally, changes in circulating TGF-ß concentrations across genotypes of TGF-ß genetic polymorphisms were analyzed. METHODS: Literature search, quality assessment, and data extraction were completed independently and in duplicate. Data are expressed in odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS: A total of 12 articles, involving 14 independent studies and 7 170 participants, were meta-analyzed for the correlation of five polymorphisms (rs2241712, rs1800469, rs1982073, rs6957, and rs2241718) in TGF-ß gene with COPD risk. Under the allele model, no statistical significance was observed for all polymorphisms associated with COPD risk. Subsidiary analyses indicated that country, COPD stage, and diagnosis of COPD were potential sources of between-study heterogeneity. Filled full plots revealed no missing studies for all studied polymorphisms, except rs1982073. Genotype-phenotype analyses showed that carriers of rs1800469 CT genotype had significantly higher concentrations of circulating TGF-ß than those with CC genotype in COPD patients (WMD: 0.28 pg/ml, 95% CI: 0.01 to 0.56). CONCLUSION: Our findings failed to support the candidacy of TGF-ß gene in the development of COPD, whereas the contribution of TGF-ß gene to COPD might be ethnicity- and stage-dependent.


Assuntos
Doença Pulmonar Obstrutiva Crônica/genética , Fator de Crescimento Transformador beta1/genética , Correlação de Dados , Genótipo , Humanos , Polimorfismo Genético , Doença Pulmonar Obstrutiva Crônica/sangue , Fatores de Risco , Fator de Crescimento Transformador beta1/sangue
18.
Sci Rep ; 10(1): 4320, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152402

RESUMO

A flow cytometry-based method was developed to quantify in vivo circulating neutrophil extracellular trap (NET) levels in plasma and compare them in patients with different chronic inflammatory lung diseases. Seventeen asthmatic and 11 control children, 12 adult controls, 46 asthmatic, 6 COPD and 6 adult patients with asthma-COPD overlap syndrome (ACOS) were recruited in the study. The presence of NETs in unstimulated cell-free plasma was confirmed and visualized by confocal laser-scanning microscopy. No significant differences were found in plasma NET levels between children and adults, children with or without asthma and adults with or without asthma, COPD or ACOS. When asthmatic patients were stratified according to their disease severity the average plasma NET level was significantly higher in asthmatic patients with more serious symptoms (adjusted p = 0.027). Patients with poorer pulmonary functions had higher plasma NET levels which negatively correlated with the FEV1 values (r = -0.39, p = 0.002). Patients who were medicated daily with inhaled corticosteroids (ICS) had significantly lower average plasma NET level than patients who did not or just occasionally used ICS (p = 0.027). If further studies confirm the NET-lowering effect of ICS in the circulation, it can be utilized in diseases where NETosis contributes to the pathogenesis.


Assuntos
Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/patologia , Armadilhas Extracelulares/metabolismo , Doença Pulmonar Obstrutiva Crônica/patologia , Índice de Gravidade de Doença , Administração por Inalação , Adulto , Idoso , Asma/sangue , Asma/tratamento farmacológico , Estudos de Casos e Controles , Criança , Armadilhas Extracelulares/efeitos dos fármacos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
19.
J Med Virol ; 92(7): 791-796, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32181911

RESUMO

The role of clinical laboratory data in the differential diagnosis of the severe forms of COVID-19 has not been definitely established. The aim of this study was to look for the warning index in severe COVID-19 patients. We investigated 43 adult patients with COVID-19. The patients were classified into mild group (28 patients) and severe group (15 patients). A comparison of the hematological parameters between the mild and severe groups showed significant differences in interleukin-6 (IL-6), d-dimer (d-D), glucose, thrombin time, fibrinogen, and C-reactive protein (P < .05). The optimal threshold and area under the receiver operator characteristic curve (ROC) of IL-6 were 24.3 and 0.795 µg/L, respectively, while those of d-D were 0.28 and 0.750 µg/L, respectively. The area under the ROC curve of IL-6 combined with d-D was 0.840. The specificity of predicting the severity of COVID-19 during IL-6 and d-D tandem testing was up to 93.3%, while the sensitivity of IL-6 and d-D by parallel test in the severe COVID-19 was 96.4%. IL-6 and d-D were closely related to the occurrence of severe COVID-19 in the adult patients, and their combined detection had the highest specificity and sensitivity for early prediction of the severity of COVID-19 patients, which has important clinical value.


Assuntos
Betacoronavirus/patogenicidade , Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Interleucina-6/sangue , Pneumonia Viral/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Idoso , Área Sob a Curva , Betacoronavirus/genética , Biomarcadores/sangue , Glicemia/metabolismo , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/patologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Complicações do Diabetes/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/patologia , Feminino , Fibrinogênio/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tempo de Trombina
20.
Sci Rep ; 10(1): 5570, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32221372

RESUMO

Chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) are known risk factors for mortality. In this study, we examined the overlap of CKD and airflow limitation (AFL) that characterises COPD and its effect on 10-year mortality in a community-based population. This study included 1,233 health check-up participants (mean age, 63.7 years; 46.7% men). We defined serum creatinine-based CKD (CKDcr) and serum cystatin C-based CKD (CKDcys) as glomerular filtration rate <60 mL/min/1.73 m2, estimated using serum creatinine or cystatin C, and/or dipstick proteinuria ≥1+. AFL was defined as forced expiratory volume in 1 s to forced vital capacity ratio <70% on spirometry. Compared with subjects without AFL, those with AFL showed a significantly higher prevalence of CKDcys but not of CKDcr. Cox proportional hazard analysis adjusted for confounders showed that the hazard ratio (95% confidence interval) for all-cause mortality was 1.45 (0.77-2.63) in subjects with CKDcys alone, 1.29 (0.60-2.54) in those with AFL alone, and 2.94 (1.33-6.12) in those with both CKDcys and AFL, with subjects without both AFL and CKD as the reference. This study showed that AFL and CKDcys are strongly associated and that their overlap is a significant risk factor for mortality in community-based populations.


Assuntos
Ventilação Pulmonar/fisiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Creatinina/sangue , Cistatina C/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Insuficiência Renal Crônica/sangue , Fatores de Risco , Espirometria/métodos
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