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1.
Int Heart J ; 62(5): 1076-1082, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34544969

RESUMO

The impact of beta2-agonists (B2As) on heart failure (HF) remains controversial. This study aimed to investigate whether inhaled B2As increased in-hospital mortality in ICU patients with HF.The Multiparameter Intelligent Monitoring in Intensive Care III database was initially searched to identify adult patients (≥ 18 years old) with HF in ICU. Then, patients using or not using inhaled B2As were matched using propensity score matching on a 1:1 basis to control for baseline confounders. In-hospital mortality was compared between the two groups, and logistic regression analysis was performed to assess the association between B2As and in-hospital mortality.The initial search retrieved 2345 eligible patients with HF from the database. After propensity score matching, 705 pairs of patients were included in the final analysis. Patients using B2As had markedly higher in-hospital mortality than those not using B2As (4.68% versus 2.27%; P = 0.013). In the multivariate logistic regression analysis, B2A use (odd ratios (OR), 2.471; 95% confidence interval (CI), 1.289-4.734; P = 0.006), stroke (OR, 4.581; 95% CI, 1.621-12.948; P = 0.004), and simplified acute physiology score II (SAPS-II) scores (OR, 1.090; 95% CI, 1.064-1.116; P < 0.001) were significantly associated with increased risk of in-hospital mortality, whereas renin angiotensin system inhibitor use (OR, 0.396; 95% CI, 0.202-0.778; P = 0.007) was significantly associated with decreased risk of in-hospital mortality. Subgroup analysis further indicated that the association between B2A use and mortality was significant only in patients with HF without chronic pulmonary disease (OR, 2.427; 95% CI, 1.351-4.362; P = 0.003), but not in those with chronic pulmonary disease (OR, 2.094; 95% CI, 0.582-7.537; P = 0.258).In ICU patients with HF but without chronic pulmonary disease, the use of inhaled B2As is associated with increased in-hospital mortality.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Análise de Regressão , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos
2.
PLoS One ; 16(8): e0255617, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34343220

RESUMO

BACKGROUND: Coal mine dust lung disease comprises a group of occupational lung diseases including coal workers pneumoconiosis. In many countries, there is a lack of robust prevalence estimates for these diseases. Our objective was to perform a systematic review and meta-analysis of published contemporary estimates on prevalence, mortality, and survival for coal mine dust lung disease worldwide. METHODS: Systematic searches of PubMed, EMBASE and Web of Science databases for English language peer-reviewed articles published from 1/1/2000 to 30/03/2021 that presented quantitative estimates of prevalence, mortality, or survival for coal mine dust lung disease. Review was conducted per PRISMA guidelines. Articles were screened independently by two authors. Studies were critically assessed using Joanna Briggs Institute tools. Pooled prevalence estimates were obtained using random effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias using Egger's tests. RESULTS: Overall 40 studies were included, (31 prevalence, 8 mortality, 1 survival). Of the prevalence estimates, fifteen (12 from the United States) were retained for the meta-analysis. The overall pooled prevalence estimate for coal workers pneumoconiosis among underground miners was 3.7% (95% CI 3.0-4.5%) with high heterogeneity between studies. The pooled estimate of coal workers pneumoconiosis prevalence in the United States was higher in the 2000s than in the 1990s, consistent with published reports of increasing prevalence following decades of declining trends. Sub-group analyses also indicated higher prevalence among underground miners, and in Central Appalachia. The mortality studies were suggestive of reduced pneumoconiosis mortality rates over time, relative to the general population. CONCLUSION: The ongoing prevalence of occupational lung diseases among contemporary coal miners highlights the importance of respiratory surveillance and preventive efforts through effective dust control measures. Limited prevalence studies from countries other than the United States limits our understanding of the current disease burden in other coal-producing countries.


Assuntos
Antracose/patologia , Minas de Carvão/métodos , Pneumopatias/epidemiologia , Pneumopatias/mortalidade , Doenças Profissionais/epidemiologia , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Antracose/etiologia , Humanos , Agências Internacionais , Pneumopatias/patologia , Doenças Profissionais/patologia , Prevalência
3.
BMC Infect Dis ; 21(1): 698, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284734

RESUMO

BACKGROUND: The incidence and prevalence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) are reportedly increasing in many parts of the world. However, there are few published data on NTM-PD-related death. Using data from a national inpatient database in Japan, we aimed in this study to identify the characteristics of patients with NTM-PD and clinical deterioration and to identify risk factors for in-hospital mortality. METHODS: We examined data from the Diagnosis Procedure Combination (DPC) database in Japan from July 2010 to March 2014. We extracted data for HIV-negative NTM-PD patients who required unscheduled hospitalization. We evaluated these patients' characteristics and performed multivariable logistic regression analysis to identify risk factors for all-cause in-hospital mortality. RESULTS: A total of 16,192 patients (median age: 78 years; women: 61.2%) were identified. The median body mass index (BMI) was 17.5 kg/m2 (IQR 15.4-20.0). All cause In-hospital death occurred in 3166 patients (19.6%). The median BMI of the patients who had died was 16.0 kg/m2 (IQR 14.2-18.4). Multivariable analysis revealed that increased mortality was associated with male sex, lower BMI, lower activities of daily living scores on the Barthel index, hemoptysis, and comorbidities, including pulmonary infection other than NTM, interstitial lung disease, pneumothorax, and malignant disease. CONCLUSIONS: We found associations between being underweight and having several comorbidities and increased in-hospital mortality in patients with NTM-PD. Preventing weight loss and management of comorbidities may have a crucial role in improving this disease's prognosis.


Assuntos
Mortalidade Hospitalar , Pneumopatias/mortalidade , Infecções por Mycobacterium não Tuberculosas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Japão/epidemiologia , Pneumopatias/microbiologia , Pneumopatias/terapia , Masculino , Infecções por Mycobacterium não Tuberculosas/terapia , Prognóstico , Fatores de Risco
4.
Am J Respir Crit Care Med ; 204(8): 910-920, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34233141

RESUMO

Rationale: Natural history of preserved ratio impaired spirometry (PRISm), often defined as FEV1/FVC ⩾lower limit of normal and FEV1 <80% of predicted value, is not well described. Objectives: To investigate the natural history and long-term prognosis of the following PRISm trajectories: persistent PRISm trajectory (individuals with PRISm both young and middle-aged), normal to PRISm trajectory (individuals developing PRISm from normal spirometry in young adulthood), and PRISm to normal trajectory (individuals recovering from PRISm in young adulthood by normalizing spirometry while middle-aged). Methods: We followed 1,160 individuals aged 20-40 years from the Copenhagen City Heart Study from 1976 to 1983 until 2001 to 2003 to determine their lung function trajectory; 72 had persistent PRISm trajectory, 76 had normal to PRISm trajectory, 155 had PRISm to normal trajectory, and 857 had normal trajectory. From 2001-2003 until 2018, we determined the risk of cardiopulmonary disease and death. Measurements and Main Results: We recorded 198 admissions for heart disease, 143 for pneumonia, and 64 for chronic obstructive pulmonary disease as well as 171 deaths. Compared with individuals with normal trajectory, hazard ratios for individuals with persistent PRISm trajectory were 1.55 (95% confidence interval, 0.91-2.65) for heart disease admission, 2.86 (1.70-4.83) for pneumonia admission, 6.57 (3.41-12.66) for chronic obstructive pulmonary disease admission, and 3.68 (2.38-5.68) for all-cause mortality. Corresponding hazard ratios for individuals with normal to PRISm trajectory were 1.91 (1.24-2.95), 2.74 (1.70-4.42), 7.61 (4.21-13.72), and 2.96 (1.94-4.51), respectively. Prognosis of individuals with PRISm to normal trajectory did not differ from those with normal trajectory. Conclusions: PRISm in middle-aged individuals is associated with increased risk of cardiopulmonary disease and all-cause mortality, but individuals who recover from PRISm during their adult life are no longer at increased risk.


Assuntos
Regras de Decisão Clínica , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Espirometria , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Dinamarca/epidemiologia , Feminino , Seguimentos , Volume Expiratório Forçado , Inquéritos Epidemiológicos , Cardiopatias/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Capacidade Vital
5.
Am J Respir Crit Care Med ; 204(8): 967-976, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34319850

RESUMO

Rationale: Chronic lung allograft dysfunction (CLAD) results in significant morbidity after lung transplantation. Potential CLAD occurs when lung function declines to 80-90% of baseline. Better noninvasive tools to prognosticate at potential CLAD are needed. Objectives: To determine whether parametric response mapping (PRM), a computed tomography (CT) voxel-wise methodology applied to high-resolution CT scans, can identify patients at risk of progression to CLAD or death. Methods: Radiographic features and PRM-based CT metrics quantifying functional small airway disease (PRMfSAD) and parenchymal disease (PRMPD) were studied at potential CLAD (n = 61). High PRMfSAD and high PRMPD were defined as ⩾30%. Restricted mean modeling was performed to compare CLAD-free survival among groups. Measurements and Main Results: PRM metrics identified the following three unique signatures: high PRMfSAD (11.5%), high PRMPD (41%), and neither (PRMNormal; 47.5%). Patients with high PRMfSAD or PRMPD had shorter CLAD-free median survival times (0.46 yr and 0.50 yr) compared with patients with predominantly PRMNormal (2.03 yr; P = 0.004 and P = 0.007 compared with PRMfSAD and PRMPD groups, respectively). In multivariate modeling adjusting for single- versus double-lung transplant, age at transplant, body mass index at potential CLAD, and time from transplant to CT scan, PRMfSAD ⩾30% or PRMPD ⩾30% continue to be statistically significant predictors of shorter CLAD-free survival. Air trapping by radiologist interpretation was common (66%), was similar across PRM groups, and was not predictive of CLAD-free survival. Ground-glass opacities by radiologist read occurred in 16% of cases and were associated with decreased CLAD-free survival (P < 0.001). Conclusions: PRM analysis offers valuable prognostic information at potential CLAD, identifying patients most at risk of developing CLAD or death.


Assuntos
Regras de Decisão Clínica , Pneumopatias/diagnóstico por imagem , Transplante de Pulmão , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Doença Crônica , Diagnóstico Precoce , Feminino , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 100(25): e26483, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160461

RESUMO

ABSTRACT: To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves.Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ±â€Š9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ±â€Š20% and 38 ±â€Š21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ±â€Š6 mm and 0.95 ±â€Š0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.


Assuntos
Aorta/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico , Pneumopatias/complicações , Transplante de Pulmão/estatística & dados numéricos , Artéria Pulmonar/diagnóstico por imagem , Adulto , Aorta/patologia , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/mortalidade , Pneumopatias/patologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/patologia , Curva ROC , Medição de Risco/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Teste de Caminhada
7.
J Heart Lung Transplant ; 40(9): 936-947, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34172387

RESUMO

BACKGROUND: There are limited data on management strategies and outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). We implemented management protocols based on the best available evidence and consensus among multidisciplinary teams. The current study reports our experience and outcomes using this protocol-based management strategy. METHODS: We included single or bilateral LT patients who tested positive for SARS-CoV-2 on nasopharyngeal swab between March 1, 2020, to December 15, 2020 (n = 25; median age: 60, range 20-73 years; M: F 17:8). A group of patients with Respiratory Syncytial Virus (RSV) infection during 2016-18 were included to serve as a comparator group (n = 36). RESULTS: As compared to RSV, patients with COVID-19 were more likely to present with constitutional symptoms, spirometric decline, pulmonary opacities, new or worsening respiratory failure, and need for ventilator support. Patients with SARS-CoV-2 infection were less likely to receive a multimodality treatment strategy, and they experienced worse post-infection lung function loss, functional decline, and three-month survival. A significant proportion of patients with COVID-19 needed readmission for worsening allograft function (36.4%), and chronic kidney disease at initial presentation was associated with this complication. Lower pre-morbid FEV1 appeared to increase the risk of new or worsening respiratory failure, which was associated with worse outcomes. Overall hospital survival was 88% (n = 22). Follow-up data was available for all discharged patients (median: 43.5 days, range 15-287 days). A majority had persistent radiological opacities (19/22, 86.4%), with nearly half of the patients with available post-COVID-19 spirometry showing > 10% loss in lung function (6/13, median loss: 14.5%, range 10%-31%). CONCLUSIONS: Despite similar demographic characteristics and predispositions, LT patients with COVID-19 are sicker and experience worse outcomes as compared to RSV. Despite the availability of newer therapeutic agents, COVID-19 continues to be associated with significant morbidity and mortality.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Pneumopatias/cirurgia , Transplante de Pulmão , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Adulto , Idoso , COVID-19/diagnóstico , Estudos de Casos e Controles , Protocolos Clínicos , Feminino , Hospitalização , Humanos , Pneumopatias/mortalidade , Pneumopatias/virologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Respiração Artificial , Insuficiência Respiratória/mortalidade , Espirometria , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
8.
Transplantation ; 105(10): 2201-2212, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33982913

RESUMO

The concept of frailty has gained considerable interest in clinical solid-organ transplantation over the past decade. Frailty as a phenotypic construct to describe a patient's risk from biologic stresses has an impact on posttransplant survival. There is keen interest in characterizing frailty in lung transplantation, both to determine which patients are suitable candidates for listing and also to prepare for their care in the aftermath of lung transplantation. Here, we review the current status of research on frailty in lung transplant candidates and recipients. This review will highlight areas of uncertainty for frailty in clinical lung transplantation that are likely to impact the state-of-the-art in the field for the next decade.


Assuntos
Técnicas de Apoio para a Decisão , Fragilidade/diagnóstico , Pneumopatias/cirurgia , Transplante de Pulmão , Tomada de Decisão Clínica , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Nível de Saúde , Humanos , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Pneumopatias/fisiopatologia , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Seleção de Pacientes , Fenótipo , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Arch. bronconeumol. (Ed. impr.) ; 57(supl.2): 13-20, abr. 2021.
Artigo em Inglês | IBECS | ID: ibc-196726

RESUMO

INTRODUCTION: Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death. METHODS: A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored. RESULTS: 1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (p < 0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR = 1.78; 95%C.I. 1.58-2.01; p < 0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44; p = 0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death. CONCLUSIONS: Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes


INTRODUCCIÓN: Los pacientes con enfermedades respiratorias preexistentes pueden tener en el contexto de la covid-19 un mayor riesgo de complicaciones graves e incluso de muerte. MÉTODOS: Estudio de cohortes multicéntrico y retrospectivo de 5.847 pacientes con covid-19 ingresados en hospitales. Los pacientes se separaron en 2 grupos, sin y con enfermedad pulmonar previa. Se evaluaron factores asociados con la supervivencia y criterios combinados de valoración secundarios, como el ingreso en la UCI y la necesidad de asistencia respiratoria. RESULTADOS: Mil doscientos setenta y un (1.271) pacientes (22%) tenían una enfermedad pulmonar previa, principalmente EPOC. La mortalidad por todas las causas ocurrió en 376 pacientes con enfermedad pulmonar (29,5%) y en 819 pacientes sin enfermedad pulmonar (17,9%; p < 0,001). Las curvas de Kaplan-Meier mostraron que los pacientes con enfermedades pulmonares tenían una peor supervivencia a los 30 días (HR: 1,78; IC del 95%: 1,58-2,01; p < 0,001) y la EPOC tenía una mortalidad de casi el 40%. La regresión de Cox multivariante mostró que la enfermedad pulmonar previa seguía siendo un factor de riesgo de mortalidad (HR: 1,21; IC del 95%: 1,02-1,44; p = 0,02). Las variables asociadas de forma independiente con el riesgo de muerte por todas las causas en pacientes con enfermedades pulmonares fueron la saturación de oxígeno inferior al 92% al ingreso (HR: 4,35; IC del 95%: 3,08-6,15) y el dímero D elevado (HR: 1,84; IC del 95%: 1,27-2,67). La edad menor de 60 años (HR: 0,37; IC del 95%: 0,21-0,65) se asoció con una disminución del riesgo de muerte. CONCLUSIONES: La enfermedad pulmonar previa es un factor de riesgo de muerte en pacientes con covid-19. La edad avanzada, el sexo masculino, la oxigenoterapia domiciliaria y la insuficiencia respiratoria al ingreso se asociaron con un aumento de la mortalidad. Se deben realizar esfuerzos para identificar a los pacientes respiratorios y establecer medidas para mejorar sus resultados clínicos


Assuntos
Humanos , Masculino , Feminino , Idoso , Mortalidade Hospitalar , Pneumopatias/mortalidade , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Pandemias , Pneumopatias/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Estudos Retrospectivos , Prevalência , Fatores Sexuais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estimativa de Kaplan-Meier , Prognóstico , Comorbidade
10.
Respir Res ; 22(1): 116, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882928

RESUMO

BACKGROUND: Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. METHODS: We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ). RESULTS: Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. CONCLUSIONS: Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.


Assuntos
Dispneia/mortalidade , Pneumopatias/mortalidade , Transplante de Pulmão , Pulmão/fisiopatologia , Inquéritos e Questionários , Listas de Espera/mortalidade , Adulto , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/cirurgia , Feminino , Nível de Saúde , Humanos , Japão , Pulmão/cirurgia , Pneumopatias/diagnóstico , Pneumopatias/fisiopatologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
11.
Lab Med ; 52(5): 493-498, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33928380

RESUMO

OBJECTIVE: The aim of the study was to assess the role of midregional proadrenomedullin (MR-proADM) in patients with COVID-19. METHODS: We included 110 patients hospitalized for COVID-19. Biochemical biomarkers, including MR-proADM, were measured at admission. The association of plasma MR-proADM levels with COVID-19 severity, defined as a requirement for mechanical ventilation or in-hospital mortality, was evaluated. RESULTS: Patients showed increased levels of MR-proADM. In addition, MR-proADM was higher in patients who died during hospitalization than in patients who survived (median, 2.59 nmol/L; interquartile range, 2.3-2.95 vs median, 0.82 nmol/L; interquartile range, 0.57-1.03; P <.0001). Receiver operating characteristic curve analysis showed good accuracy of MR-proADM for predicting mortality. A MR-proADM value of 1.73 nmol/L was established as the best cutoff value, with 90% sensitivity and 95% specificity (P <.0001). CONCLUSION: We found that MR-proADM could represent a prognostic biomarker of COVID-19.


Assuntos
Adrenomedulina/sangue , COVID-19/diagnóstico , Hipertensão/diagnóstico , Pneumopatias/diagnóstico , Precursores de Proteínas/sangue , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/mortalidade , COVID-19/virologia , Comorbidade , Feminino , Humanos , Hipertensão/sangue , Hipertensão/mortalidade , Hipertensão/virologia , Interleucina-6/sangue , Pneumopatias/sangue , Pneumopatias/mortalidade , Pneumopatias/virologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Análise de Sobrevida , Triagem/métodos
13.
Surgery ; 170(1): 257-262, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33775395

RESUMO

BACKGROUND: Surgical re-exploration after lung resection remains poorly characterized, although institutional series have previously reported its association with greater mortality and complications. The present study sought to examine the impact of institutional lung-resection volume on the incidence of and short-term outcomes after surgical re-exploration. METHODS: The 2007 to 2018 National Inpatient Sample was used to identify all adults who underwent lobectomy or pneumonectomy. Hospitals were divided into tertiles based on institutional lung-resection caseload. Multivariable regressions were used to identify associations between independent covariates on clinical outcomes. RESULTS: Of an estimated 329,273 patients, 3,592 (1.09%) were re-explored with decreasing incidence over time. Open and minimal access pneumonectomy among other factors were associated with greater odds of reoperation. Those re-explored had greater odds of mortality and complications as well as increased duration of stay and adjusted costs. Although risk of re-exploration was similar across hospital tertiles, reoperative mortality was significantly lower at high-volume hospitals. CONCLUSION: Re-exploration after lung resection is uncommon; however, when occurring, it is associated with worse clinical outcomes. After re-exploration, high-volume center status was associated with reduced odds of mortality relative to low volume. Failure to rescue at lower-volume centers suggests the need for optimization of perioperative factors to decrease incidence of reoperation.


Assuntos
Pneumopatias/cirurgia , Pneumonectomia/mortalidade , Reoperação/mortalidade , Idoso , Feminino , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Humanos , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Reoperação/estatística & dados numéricos , Falha de Tratamento , Estados Unidos/epidemiologia
14.
J Korean Med Sci ; 36(12): e79, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33783144

RESUMO

BACKGROUND: There is currently a lack of data on the impact of the recent revision of the domestic lung allocation system on transplant performance. METHODS: We conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study periods were classified according to the introduction of the revised lung allocation system as follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019. RESULTS: During the study period, a total of 627 patients were on the waiting list, of which 398 lung transplantations were performed. Total waiting list size increased by 98.6%, from 210 in period 1 to 417 in period 2. The number of transplant patients also increased by 32.7%, from 171 in period 1 to 227 in period 2. The number of donors decreased from 1,042 to 878, whereas the usage rate, i.e., the number of lung donors used for transplantation among the total number of reported lung donors, increased from 16.4% to 25.9%. The proportion of patients with high urgent status at transplantation increased from 45% to 60.4%, whereas those with urgent status decreased from 46.8% to 35.7% (P = 0.006). The use of marginal donor lungs increased from 29.8% to 53.7% (P < 0.001). To adjust urgency status and marginal donor usage between two groups, we conducted a propensity score matching analysis. No significant differences were detected in 1-year survival rates between the two periods after propensity score matching. As well, no significant difference was observed in mortality on the waiting list between the two periods. CONCLUSION: The recent revision of the lung allocation system in Korea did not change the performance of lung transplant in terms of waiting list mortality and 1-year survival. The rapid increase in the volume of waiting list between the two periods increased the waiting time, transplantation of high-urgency patients, and use of marginal lung donors.


Assuntos
Disseminação de Informação/legislação & jurisprudência , Transplante de Pulmão/normas , Políticas , Obtenção de Tecidos e Órgãos/organização & administração , Idoso , Bases de Dados Factuais , Feminino , Humanos , Pneumopatias/mortalidade , Pneumopatias/patologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Sistema de Registros , República da Coreia , Estudos Retrospectivos , Taxa de Sobrevida , Listas de Espera
16.
Nat Commun ; 12(1): 1039, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589602

RESUMO

Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030 s and 5.5% (0.5-9.9%) in the 2090 s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.


Assuntos
Doenças Cardiovasculares/mortalidade , Mudança Climática/mortalidade , Pneumopatias/mortalidade , Modelos Estatísticos , Saúde Pública/tendências , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Simulação por Computador , Escolaridade , Feminino , Temperatura Alta , Humanos , Lactente , Recém-Nascido , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
17.
J Thorac Cardiovasc Surg ; 161(4): 1546-1555.e1, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32747131

RESUMO

OBJECTIVE: Acceptance of lungs from donation after circulatory determination of death has been generally restricted to donors who have cardiac arrest within 60 minutes after withdrawal of life-sustaining therapies. We aimed to determine the effect of the interval between withdrawal of life-sustaining therapies to arrest and recipient outcomes. Second, we aimed to compare outcomes between donation after circulatory determination of death transplants and donation after neurologic determination of death transplants. METHODS: A single-center, retrospective review was performed analyzing the clinical outcomes of transplant recipients who received donation after circulatory determination of death lungs and those who received donation after neurologic determination of death lungs. Donation after circulatory determination of death cases were then grouped on the basis of the interval between withdrawal of life-sustaining therapies and asystole: 0 to 19 minutes (rapid), 20 to 59 minutes (intermediate), and more than 60 minutes (long). Recipient outcomes from each of these groups were compared. RESULTS: A total of 180 cases of donation after circulatory determination of death and 1088 cases of donation after neurologic determination of death were reviewed between 2007 and 2017. There were no significant differences in the 2 groups in terms of age, gender, recipient diagnosis, and type of transplant (bilateral vs single). Ex vivo lung perfusion was used in 118 of 180 (65.6%) donation after circulatory determination of death cases and 149 of 1088 (13.7%) donation after neurologic determination of death cases before transplantation. The median survivals of recipients who received donation after circulatory determination of death lungs versus donation after neurologic determination of death lungs were 8.0 and 6.9 years, respectively. Time between withdrawal of life-sustaining therapies and asystole was available for 148 of 180 donors (82.2%) from the donation after circulatory determination of death group. Mean and median time from withdrawal of life-sustaining therapies to asystole were 28.6 minutes and 16 minutes, respectively. Twenty donors required more than 60 minutes to experience cardiac arrest, with the longest duration being 154 minutes before asystole was recorded. Recipients of donation after circulatory determination of death lungs who had cardiac arrest at 0 to 19 minutes (90 donors), 20 to 59 minutes (38 donors), and more than 60 minutes (20 donors) did not demonstrate any significant differences in terms of short- and long-term survivals, primary graft dysfunction 2 and 3, intensive care unit stay, mechanical ventilation days, or total hospital stay. CONCLUSIONS: Short- and long-term outcomes in recipients who received donation after neurologic determination of death versus donation after circulatory determination of death lungs are similar. Different withdrawals of life-sustaining therapies to arrest intervals were not associated with recipient outcomes. The maximum acceptable duration of this interval has yet to be established.


Assuntos
Parada Cardíaca , Pneumopatias/mortalidade , Pneumopatias/cirurgia , Transplante de Pulmão , Disfunção Primária do Enxerto/epidemiologia , Obtenção de Tecidos e Órgãos , Adulto , Idoso , Cuidados Críticos , Feminino , Sobrevivência de Enxerto , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Suspensão de Tratamento
18.
Surgery ; 169(2): 460-469, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32962834

RESUMO

BACKGROUND: Pulmonary complications are the most common adverse event after injury and second greatest cause of failure to rescue (death after pulmonary complications). It is not known whether readily accessible trauma center data can be used to stratify center-level performance for various complications. Performance variation between trauma centers would allow sharing of best practices among otherwise similar hospitals. We hypothesized that high-, average-, and low-performing centers for pulmonary complication and failure to rescue could be identified and that hospital factors associated with success and failure could be discovered. METHODS: Pennsylvania state trauma registry data (2007-2015) were abstracted for pulmonary complications. Burns and age <17 were excluded. Multivariable logistic regression models were developed for pulmonary complication and failure to rescue, using demographics, comorbidities, and injuries/physiology. Expected event rates were compared with observed rates to identify outliers. Center-level variables associated with outcomes of interest were taken from the American Hospital Association Annual Survey Database and assessed for inclusion. RESULTS: Included in the study were 283,121 patients (male [60%] blunt trauma [92%]). Of these patients, 3% (8,381 of 283,121) developed pulmonary complications (center-level range 0.18%-5.8%). The percentage of failure-to-rescue patients was 13.4% (1,120/8,381, center-level range 0.0%-22.6%). For pulmonary complications, 13 out of 27 centers were high performers (95% CI for O:E ratio <1) and 7 out of 27 were low (95% CI for an O:E ratio >1). For failure-to-rescue patients, 2 out of 27 centers were low performers and the remainder average. There was little concordance between performance for pulmonary complications and failure to rescue. Research programs, large non-teaching hospitals, those with advanced practice providers, and those with health maintenance organizations had reduced failure-to-rescue patients. CONCLUSION: Factors associated with complications were distinct from those affecting failure to rescue and center-level success in reducing complications often did not translate into success in preventing death once they occurred. Our data demonstrate that high- and low-performing centers and the factors driving success or failure are identifiable. This work serves as a guide for comparing practices and improving outcomes with readily available data.


Assuntos
Falha da Terapia de Resgate/estatística & dados numéricos , Pneumopatias/mortalidade , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Falha da Terapia de Resgate/normas , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumopatias/etiologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia
19.
Asian Cardiovasc Thorac Ann ; 29(2): 111-115, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33175560

RESUMO

AIM: Destroyed lung refers to destruction of a large portion of a lung induced by chronic or recurrent lung infections. The aim of this single-center retrospective review was to evaluate patients with a diagnosis of destroyed lung undergoing pneumonectomy via video-assisted thoracoscopic surgery, in terms of surgical technique, postoperative morbidity and mortality, and long-term outcomes. METHODS: Data of 15 patients who underwent video-assisted thoracoscopic pneumonectomy for destroyed lung during a 4-year period were analyzed retrospectively. There were 9 (60%) males and 6 (40%) females with a median age of 33.87 years (range 8-52 years). Bronchiectasis (n = 7), tuberculosis (n = 5), and fungal infection (n = 3) were the main etiologies. Hemoptysis was the most common presenting symptom (n = 8, 53.3%). Destroyed lung was detected on the left side in 13 (86.7%) patients and on the right side in 2 (13.3%). Seven patients showed narrowing or thickening of the main bronchus. RESULTS: Video-assisted thoracoscopic pneumonectomy was attempted in all patients but 5 (33.3%) were converted to a thoracotomy. The mean operative time was 273.8 min. The postoperative morbidity rate was 13.3%. The mortality rate was 6.67%. The median length of hospital stay was 3.5 days. The mean follow-up period was 23.7 months. Significant improvement was observed in inflammatory symptoms and quality of life in all patients. The overall 1-year survival was 93.3%. CONCLUSION: Video-assisted thoracoscopic pneumonectomy for destroyed lung is a safe and feasible option in selected patients, which can be used as an alternative to thoracotomy.


Assuntos
Pneumopatias/cirurgia , Pulmão/cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Criança , Feminino , Humanos , Tempo de Internação , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/mortalidade , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Trends Cardiovasc Med ; 31(2): 93-98, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-31932098

RESUMO

The relationship between lung and heart diseases has long been recognized, with necropsy studies demonstrating silent myocardial infarctions or coronary artery calcification in patients with advanced emphysema as the death cause. Improvements in non-invasive techniques and epidemiologic approaches established that lung and cardiovascular diseases frequently coexist in mid and late life. Even among those without diagnosed lung disease, lower than expected forced vital capacity, forced expiratory volume in 1 s, and their ratio each portend greater risk of developing cardiovascular risk factors including hypertension, obesity, and metabolic syndrome, and for incident cardiovascular diseases including left heart failure, atrial fibrillation and stroke. Greater longitudinal declines in these spirometric measures are further associated with cardiovascular morbidity and mortality. While obstructive ventilatory patterns are more common, restrictive ventilatory patterns seem to demonstrate an independent and more robust association with cardiovascular diseases such as heart failure. These subclinical alterations in pulmonary function also relate to subclinical abnormalities of cardiac structure and function. Although the biologic pathways linking pulmonary and cardiovascular dysfunction are not clear, chronic systemic inflammation appears to be one important underlying pathophysiologic link. Despite the growing evidence of lung dysfunction as a cardiovascular risk factor, spirometric evaluation is still underutilized in clinical practice, particularly among cardiac patients, and optimal therapeutic and preventive strategies are still unclear. In this review, we address the current knowledge and controversies regarding the links between lung function and cardiovascular disease.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Comorbidade , Humanos , Incidência , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Pneumopatias/terapia , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco
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