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Citgez, Emanuel, Job van der Palen, Paul van der Valk, Huib A. M. Kerstjens, and Marjolein Brusse-Keizer. "Stability in eosinophil categorisation during subsequent severe exacerbations of COPD." BMJ Open Respiratory Research 8, no. 1 (August 2021): e000960. http://dx.doi.org/10.1136/bmjresp-2021-000960.
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BackgroundThe blood eosinophil count has been shown to be a promising biomarker for establishing personalised treatment strategies to reduce corticosteroid use, either inhaled or systemic, in chronic obstructive pulmonary disease (COPD). Eosinophil levels seem relatively stable over time in stable state, but little is known whether this is also true in subsequent severe acute exacerbations of COPD (AECOPD).Aims and objectivesTo determine the stability in eosinophil categorisation between two subsequent severe AECOPDs employing frequently used cut-off levels.MethodsDuring two subsequent severe AECOPDs, blood eosinophil counts were determined at admission to the hospital in 237 patients in the Cohort of Mortality and Inflammation in COPD Study. The following four cut-off levels were analysed: absolute counts of eosinophils ≥0.2×10⁹/L (200 cells/µL) and ≥0.3×10⁹/L (300 cells/µL) and relative eosinophil percentage of ≥2% and ≥3% of total leucocyte count. Categorisations were considered stable if during the second AECOPD their blood eosinophil status led to the same classification: eosinophilic or not.ResultsDepending on the used cut-off, the overall stability in eosinophil categorisation varied between 70% and 85% during two subsequent AECOPDs. From patients who were eosinophilic at the first AECOPD, 34%–45% remained eosinophilic at the subsequent AECOPD, while 9%–21% of patients being non-eosinophilic at the first AECOPD became eosinophilic at the subsequent AECOPD.ConclusionsThe eosinophil variability leads to category changes in subsequent AECOPDs, which limits the eosinophil categorisation stability. Therefore, measurement of eosinophils at each new exacerbation seems warranted.
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Stone, Philip, Nikhil Sood, Johanna Feary, C. Michael Roberts, and Jennifer K. Quint. "Validation of acute exacerbation of chronic obstructive pulmonary disease (COPD) recording in electronic health records: a systematic review protocol." BMJ Open 10, no. 2 (February 2020): e032467. http://dx.doi.org/10.1136/bmjopen-2019-032467.
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IntroductionMany patients with chronic obstructive pulmonary disease (COPD) experience a sustained worsening in symptoms termed an acute exacerbation (AECOPD). AECOPDs impact on patients’ quality of life and lung function, are costly to health services and are an important topic for research. Electronic health records (EHR) are increasingly being used to study AECOPD, requiring accurate detection of AECOPD in EHRs to ensure generalisable results. The aim of this protocol is to provide an overview of studies that validate AECOPD definitions used in EHRs and administrative claims databases.Methods and analysisMedline and Embase will be searched for terms related to COPD exacerbation, EHRs and validation. All studies published between 1 January 1990 and 30 September 2019 written in English that validate AECOPD in EHRs and administrative claims databases will be considered. Inclusion criteria: EHR data must be routinely collected; the AECOPD detection algorithm must be compared against a reference standard; and a measure of validity must be calculable. Two independent reviewers will screen articles for inclusion, extract study details and assess risk of bias using QUADAS-2. Disagreements will be resolved by consensus or arbitration by a third reviewer. This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.Ethics and disseminationThis will be a review of previously published literature therefore no ethical approval is required. Results from this review will be published in a peer-reviewed journal. The results can be used in future research to identify occurrences of AECOPD.PROSPERO registration numberCRD42019130863.
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Nguyen, Huong Q., Richard A. Mularski, Marilyn L. Moy, Janet S. Lee, and Ernest Shen. "Association between self-reported moderate to vigorous physical activity and the rate of outpatient treated COPD exacerbations: retrospective cohort study." BMJ Open Respiratory Research 7, no. 1 (May 2020): e000590. http://dx.doi.org/10.1136/bmjresp-2020-000590.
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IntroductionLittle has been published regarding the relationship between physical activity (PA) and outpatient treated, mild to moderate acute exacerbation of chronic obstructive pulmonary disease exacerbations (AECOPD). The purpose of this study was to determine the association between self-reported PA and outpatient treated AECOPD over 2 years using real-world data obtained from existing electronic medical records (EMRs).MethodsWe included 44 896 patients with a chronic obstructive pulmonary disease diagnosis from the EMR in this retrospective cohort study. Moderate to vigorous PA was measured via patient self-report, obtained during routine clinical care; patients were classified as inactive (0 min/week), insufficiently active (1–149 min/week) or active (≥150 min/week). AECOPDs were measured using both encounter and prescription fill (antibiotics and/or oral steroids) data. We used Poisson regression models to compare the unadjusted and adjusted rates of outpatient treated AECOPD over 2 years across the PA categories.ResultsIn adjusted models, the 2-year AECOPD incidence rate ratio (IRR) was not different between the inactive and insufficiently inactive groups (IRR 0.98, 95% CI 0.96 to 1.01) and only marginally meaningful lower for the active group (IRR 0.97, 95% CI 0.95 to 0.98). Sensitivity analyses of patients meeting or not meeting obstructive criteria produced similar results with generally weak or non-significant associations.ConclusionThe lack of an association between PA and AECOPD contrasts with previous published findings of a strong relationship between moderate to vigorous PA and hospitalisations for severe AECOPD. This difference could partially be attributed to the imprecision of our measurements for both the exposure and outcome.
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MacDonald, Martin I., Christian R. Osadnik, Lauren Bulfin, Elizabeth Leahy, Paul Leong, Eskandarain Shafuddin, Kais Hamza, Paul T. King, and Philip G. Bardin. "MULTI-PHACET: multidimensional clinical phenotyping of hospitalised acute COPD exacerbations." ERJ Open Research 7, no. 3 (June 3, 2021): 00198–2021. http://dx.doi.org/10.1183/23120541.00198-2021.
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BackgroundThe generic term “exacerbation” does not reflect the heterogeneity of acute exacerbations of COPD (AECOPD). We utilised a novel algorithmic strategy to profile exacerbation phenotypes based on underlying aetiologies.MethodsPatients hospitalised for AECOPD (n=146) were investigated for aetiological contributors summarised in a mnemonic acronym ABCDEFGX (A: airway virus; B: bacterial; C: co-infection; D: depression/anxiety; E: eosinophils; F: failure (cardiac); G: general environment; X: unknown). Results from clinical investigations were combined to construct AECOPD phenotypes. Relationships to clinical outcomes were examined for both composite phenotypes and their specific aetiological components. Aetiologies identified at exacerbation were reassessed at outpatient follow-up.ResultsHospitalised AECOPDs were remarkably diverse, with 26 distinct phenotypes identified. Multiple aetiologies were common (70%) and unidentifiable aetiology rare (4.1%). If viruses were detected (29.5%), patients had longer hospitalisation (7.7±5.6 versus 6.0±3.9 days, p=0.03) despite fewer “frequent exacerbators” (9.3% versus 37%, p=0.001) and lower mortality at 1 year (p=0.03). If bacterial infection was found (40.4%), patients were commonly “frequent exacerbators” (44% versus 18.4%, p=0.001). Eosinophilic exacerbations (28%) were associated with lower pH (7.32±0.06 versus 7.36±0.09, p=0.04), higher venous carbon dioxide tension (PvCO2) (53.7±10.5 versus 48.8±12.8, p=0.04), greater noninvasive ventilation (NIV) usage (34.1% versus 18.1%) but shorter hospitalisation (4 (3–5) versus 6 (4–9) days, p<0.001) and lower infection rates (41.4% versus 80.9%, p<0.0001). Cardiac dysfunction and severe anxiety/depression were common in both infective and non-infective exacerbations. Characteristics identified at exacerbation often persisted after recovery.ConclusionsHospitalised AECOPDs have numerous causes, often in combination, that converge in complex, multi-faceted phenotypes. Clinically important differences in outcomes suggest that a phenotyping strategy based on aetiologies can enhance AECOPD management.
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Dai, Guangming, Yajuan Ran, Jiajia Wang, Xingru Chen, Junnan Peng, Xinglong Li, Huojin Deng, Min Xiao, and Tao Zhu. "Clinical Differences between Eosinophilic and Noneosinophilic Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study." Mediators of Inflammation 2020 (November 12, 2020): 1–9. http://dx.doi.org/10.1155/2020/1059079.
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Rationale. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is highly heterogeneous with a plethora of different etiologic factors and inflammatory presentations. COPD with higher blood eosinophil count is associated with increased readmission rates and better corticosteroid responses. However, the clinical features of eosinophilic AECOPD are not well explored. Thus, this study was aimed at exploring the clinical differences between eosinophilic and noneosinophilic AECOPD. Methods. A total of 643 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 455 were included, 214 in the normal-eosinophil AECOPD (NEOS-AECOPD) group, 63 in the mild increased-eosinophil AECOPD (MEOS-AECOPD) group, and 138 in the severe increased-eosinophil AECOPD (SEOS-AECOPD) group. Demographic data, underlying diseases, symptoms, and laboratory findings were collected. Multiple logistic regression analysis was performed to identify the independent factors associated with blood eosinophils (EOS). Correlations between blood EOS and its associated independent factors were evaluated. Results. The significant differences in 19 factors, including underlying diseases, clinical symptoms, and laboratory parameters, were identified by univariate analysis. Subsequently, multiple logistic regression analysis revealed that lymphocyte%, neutrophil% (NS%), procalcitonin (PCT), and anion gap (AG) were independently associated with blood EOS in AECOPD. Both blood EOS counts and EOS% were significantly correlated with lymphocyte%, NS%, PCT, and AG. Conclusions. Collectively, blood EOS was independently associated with lymphocyte%, NS%, PCT, and AG in AECOPD patients. Lymphocyte% was lower, and NS%, PCT, and AG were higher in eosinophilic AECOPD. Our results indicate that viral-dominant infections are the probable major etiologies of eosinophilic AECOPD. Noneosinophilic AECOPD is more likely associated with bacterial-dominant infections. The systemic inflammation in noneosinophilic AECOPD was more severe.
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Guo, Xuequn, Hongsheng Lin, Donghao Guo, and Qiu Luo. "Azithromycin use prior to ICU admission is associated with a lower short-term mortality for critically ill acute exacerbations of chronic obstructive pulmonary disease patients: A retrospective cohort study." Chronic Respiratory Disease 19 (January 2022): 147997312211407. http://dx.doi.org/10.1177/14799731221140797.
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Azithromycin was thought to prevent acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) by anti-microbial and anti-inflammatory effects. However, it′s value in the treatment of critically ill patients with AECOPD before ICU admission remains unclear. Our study aimed to find whether azithromycin use prior to ICU admission leads to better clinical outcomes for those individuals. 533 critically ill patients with AECOPD from the MIMIC-IV database were included. Univariate followed multivariate logistic regression was used to select risk factors for short-term mortality. The multivariable logistic regression models were implemented to investigate the association between azithromycin use before ICU admission and short-term mortality. Lower short-term mortality was observed in the azithromycin group ( p = .021), independent of differences in demographic data and other clinical outcomes ( p>.05). Azithromycin use before ICU admission was proved to have a decreased short-term mortality by multivariable logistic regression ( p<.05). The results remained consistent after being stratified by age, SOFA scores, pH, and cancer diagnosis. Azithromycin use prior to ICU admission was associated with lower short-term mortality for critically ill AECOPD patients.
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Guo, Wei, Ning Wang, Zhaobo Cui, Wenjing Liu, Shufen Guo, Xiaoya Yang, Yajing Liu, Liye Shao, and Jing Wang. "Clinical Value of FeNO for Pulmonary Hypertension Diagnosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease." Emergency Medicine International 2022 (January 28, 2022): 1–6. http://dx.doi.org/10.1155/2022/9924047.
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Objective. To investigate the clinical value of fractional exhaled nitric oxide (FeNO) in the diagnosis of pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. In this study, the medical records of AECOPD patients were retrospectively reviewed. The patients were divided into AECOPD and AECOPD + PH groups based on the absence or presence of PH. Moreover, FeNO and other indexes were compared between the two groups. The value of FeNO in diagnosing AECOPD with PH was determined using the ROC curve. Results. A total of 83 patients were enrolled (56 in the AECOPD group and 27 in the AECOPD + PH group). The level of FeNO was significantly lower in the AECOPD + PH group than in the AECOPD group ( P = 0.022 ). Moreover, FeNO level (25.22 ± 8.45 ppb) was higher in the mild PH subgroup than in the moderate (16.64 ± 5.67 ppb, P = 0.005 ) or severe (11.75 ± 2.36, P = 0.002 ) PH subgroups. FeNO level was positively correlated with C-reactive protein in AECOPD patients while negatively correlated with brain natriuretic peptide in the AECOPD + PH group. ROC analysis showed that the optimal cutoff value of FeNO in the diagnosis of AECOPD with PH was 24.5 ppb. Conclusion. FeNO level at admission can act as an indicator for PH diagnosis in AECOPD patients.
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Kherad, Omar, Pierre-Olivier Bridevaux, Laurent Kaiser, Jean-Paul Janssens, and Olivier T. Rutschmann. "Is Acute Exacerbation of COPD (AECOPD) Related to Viral Infection Associated with Subsequent Mortality or Exacerbation Rate?" Open Respiratory Medicine Journal 8, no. 1 (April 4, 2014): 18–21. http://dx.doi.org/10.2174/1874306401408010018.
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Background: There is a growing interest in better defining risk factors associated with increased susceptibility to exacerbation in patients with COPD. Introduction: The aim of the study was to determine whether identification of a respiratory virus during a severe acute exacerbation of COPD (AECOPD) increases the risk of subsequent exacerbations and mortality during a one-year followup. Methods: Secondary analysis of 86 COPD patients admitted for AECOPD between June 2007 and December 2008 at Geneva’s University Hospital who were followed up for 1 year. Fifty-one percent of index AECOPD were related to viral infection. Rate of AECOPD, time to next AECOPD, and all-cause mortality were compared between patients with vs without viral index AECOPD. Results: Eighty-one cases were included in this secondary follow-up analysis. Mean exacerbation rate was 1.9 AECOPD per person-year for patients with viral index AECOPD vs 4.0 AECOPD per person year for those with non-viral index AECOPD. Incidence rate ratio (IRR) for subsequent AECOPD during one year follow up was lower for patients with viral index AECOPD (IRR 0.57; [CI 95% 0.39-0.84]), after controlling for previous exacerbations, and was strongly associated with the number of exacerbations in the year preceding the index AECOPD. During the one-year follow-up period, 16 patients (19%) died. In a Cox regression model, patients with a proven viral infection did not have a higher mortality (HR 0.56 [CI 95% 0.20 -1.58]). Conclusion: Viral AECOPD was not associated with a higher rate of subsequent exacerbations or mortality during the following year.
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Sarc, Irena, Alesa Lotric Dolinar, Tina Morgan, Joze Sambt, Kristina Ziherl, Dalibor Gavric, Julij Selb, Ales Rozman, and Petra Dosenovic Bonca. "Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study." Therapeutic Advances in Respiratory Disease 16 (January 2022): 175346662210810. http://dx.doi.org/10.1177/17534666221081047.
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Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.
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Mou, Shan, Wei Zhang, Yan Deng, Zhijun Tang, and Depeng Jiang. "Comparison of CRP, Procalcitonin, Neutrophil Counts, Eosinophil Counts, sTREM-1, and OPN between Pneumonic and Nonpneumonic Exacerbations in COPD Patients." Canadian Respiratory Journal 2022 (March 31, 2022): 1–9. http://dx.doi.org/10.1155/2022/7609083.
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Introduction. The patients with community-acquired pneumonia (CAP) and acute exacerbations of COPD (AECOPD) could have a higher risk of acute and severe respiratory illness than those without CAP in AECOPD. Consequently, early identification of pneumonia in AECOPD is quite important. Methods. 52 subjects with AECOPD + CAP and 93 subjects with AECOPD from two clinical centers were enrolled in this prospective observational study. The values of osteopontin (OPN), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), procalcitonin (PCT), eosinophil (EOS) counts, and neutrophil (Neu) counts in blood on the first day of admission and clinical symptoms were compared in AECOPD and AECOPD + CAP. In addition, subgroup analyses of biomarker difference were conducted based on the current use of inhaled glucocorticoids (ICS) or systemic corticosteroids (SCS). Results. Patients with AECOPD + CAP had increased sputum volume, sputum purulence, diabetes mellitus, and longer hospital stays than AECOPD patients ( p < 0.05 ). A clinical logistic regression model showed among the common clinical symptoms, purulent sputum can independently predict pneumonia in AECOPD patients after adjusting for a history of diabetes. At day 1, AECOPD + CAP patients had higher values of Neu, CRP, PCT, and OPN, while serum sTREM-1 levels and EOS counts were similar in the two groups. CRP fared best at predicting AECOPD with CAP ( p < 0.05 for the test of difference), while OPN had similar accuracy with Neu, PCT, and purulent sputum ( p > 0.05 for the test of difference). Multivariate analysis, including clinical symptoms and biomarkers, suggested that CRP ≥15.8 mg/dL at day 1 was a only promising predictor of pneumonia in AECOPD. CRP and OPN were not affected by ICS or SCS. Conclusions. CRP ≥15.8 mg/dL is an ideal promising predictor of pneumonia in AECOPD, and its plasma level is not affected by ICS or SCS. The diagnostic performance of CRP is not significantly improved when combined with clinical symptoms or other markers (OPN, PCT, and Neu).
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Ritumbhara, Gunjan Soni, Ravi Gaur, J. K. Khatri, and Kritika Soni. "Correlation of neutrophil to lymphocyte with acute exacerbation in chronic obstructive pulmonary disease at tertiary care hospital in North West Rajasthan." IP Indian Journal of Immunology and Respiratory Medicine 7, no. 3 (October 15, 2022): 116–23. http://dx.doi.org/10.18231/j.ijirm.2022.027.
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Acute exacerbation of COPD (AECOPD), is one of the most common disease in patients with infections, having frequent hospitalization. The aim of this study is to evaluate the potential for NLR to be used as a biomarker of COPD exacerbation. The hospital based case control Study is was conduct on hospitalized 100 patient with primary and final diagnosis of AECOPD and 100 patient of stable period of COPD. Socio-demographic variable in both groups were comparable. BMI was significantly lower in AECOPD patients. The mean PACK/YR in AECOPD group was 29.52±3.70 and in Stable COPD was 23.50±2.05. FEV1was significantly lower in AECOPD patients. Mean admission per year was significantly higher in AECOPD patients. Mean neutrophil count was significantly higher in AECOPD patients (11.49±2.32) as compare to stable COPD patients (6.47±2.01). Mean lymphyocyte count was significantly higher in AECOPD patients (2.07±0.05) as compare to stable COPD patients (1.71±0.07). Mean NLR was significantly higher in AECOPD patients (5.54±2.12) as compare to stable COPD patients (3.77±0.22). The difference in both groups was found statically significant. 5.00% hospital mortality in AECOPD patients. Mean neutrophil count was significantly higher in death as compare to survived patients. Mean NLR was significantly higher in death as compare to survived patients. NLR is readily available (Available at PHC) and simple parameter, could also be used as a cost-effective marker of inflammation in AECOPD. We have concluded that the neutrophil lymphocyte ratio on the day of presenting the illness was significantly higher in AECOPD as compare to stable COPD. Those patients who had a high NLR during admission were associated with poor survival.
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Liu, Dingfang, Ying Zou, and Yumei Wang. "Investigation on the Relationship between Sleep Quality and Depression and Anxiety in Hospitalized Patients with Different Levels of AECOPD." Computational and Mathematical Methods in Medicine 2022 (April 30, 2022): 1–5. http://dx.doi.org/10.1155/2022/5901552.
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Purpose. To explore the correlations between sleep quality and depression and anxiety in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. A total of 131 AECOPD patients treated at No.6th People’s Hospital affiliated to Shanghai Jiao Tong University School from January 2018 to December 2020 were selected and divided into the classes I ( n = 30 ), II ( n = 23 ), III ( n = 37 ), and IV ( n = 41 ) based on the severity of AECOPD. The Pittsburgh sleep quality index (PSQI) and the hospital anxiety and depression scale (HADS) were employed to assess the quality of sleep and anxiety/depression in AECOPD patients. The Pearson correlation analysis explored the associations between PSQI score and HADS anxiety/depression score. Binary logistic regression was utilized to determine risk factors for anxiety/depression in AECOPD patients. Results. The PSQI score, HADS anxiety score, and HADS depression score in patients with AECOPD class III and class IV were significantly higher than those of classes I and II. The severe anxiety and depression ratio were significantly different among patients with classes I–IV AECOPD. The severity of AECOPD was significantly correlated with the PSQI score ( r = 0.51 , P < 0.001 ), HADS anxiety score ( r = 0.66 , P < 0.001 ), and HADS anxiety score ( r = 0.65 , P < 0.001 ). Binary logistic regression analysis showed that the COPD duration, the severity of AECOPD, and PSQI score were the risk factors for anxiety and depression in patients with AECOPD. Conclusions. Poor sleep quality, anxiety, and depression are common in patients with AECOPD. Improvement of sleep quality may help to alleviate anxiety and depression in AECOPD patients.
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Tang, Leilei, Lingdi Zhang, Xuan Mei, Jiawen Yu, and Guojun Jiang. "Pulmonary infection is associated with an increased IL-6 in acute exacerbation chronic obstructive pulmonary disease." European Journal of Inflammation 21 (January 5, 2023): 1721727X2211495. http://dx.doi.org/10.1177/1721727x221149534.
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Objective Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD) is associated with an acute worsening of respiratory symptoms that have effects on lung function, quality of life and health economic burden. In addition, the development of pulmonary infections is a common complication of Chronic Obstructive Pulmonary Disease (COPD). In the pathophysiology of AECOPD, interleukin (IL)-6 is a pleiotropic cytokine that can be produced by inflammatory and primary lung epithelial cells in response to a variety of different stimuli. We aim to investigate the correlation between serum cytokine levels and AECOPD with pulmonary infection. Methods 37 AECOPD patients diagnosed with pulmonary infection and 33 patients diagnosed with AECOPD only were selected. All COPD patients were diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Serum samples for C-reactive protein (CRP) and cytokines were obtained from the patients immediately after admission. Serum concentrations of cytokines were measured using a fluorescent bead immunoassay on a flow cytometer. Logistic regression was used to identify risk factors for AECOPD co-infection of the lungs. Results Serum characterization of our cohort showed patients with AECOPD and pulmonary infection had higher levels of IL-6 and IL-10 compared with the AECOPD group, and IL-6 was independently associated with AECOPD with pulmonary infection. ROC curve analysis showed that IL-6 was a useful predictor of the incidence of pulmonary infection in AECOPD patients. Conclusions Our findings highlight the role of IL-6 in the pathogenesis of AECOPD with pulmonary infection.
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Yong, Wenxing, Liying Zhang, Yuexuan Chen, Juan Li, Yongqi Liu, and Zhiming Zhang. "Jianpi Huatan Tongfu granule alleviates inflammation and improves intestinal flora in patients with acute exacerbation of chronic obstructive pulmonary disease." Journal of International Medical Research 48, no. 4 (April 2020): 030006052090923. http://dx.doi.org/10.1177/0300060520909235.
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Objectives To investigate the clinical efficacy and mechanism of Jianpi Huatan Tongfu granule in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixty patients with AECOPD were enrolled in either of two groups: integrative treatment (Western medicine combined with Jianpi Huatan Tongfu granule) (n = 30) and Western medical treatment (n = 30). Thirty healthy individuals were included in the control group. Results Compared with healthy participants, patients with AECOPD had elevated clinical symptom and dyspnea severity scores. Patients with AECOPD had worsened lung function, compared with healthy participants. The therapeutic efficacy for integrative treatment was superior to Western medical treatment. Inflammatory proteins and cytokines were significantly elevated in patients with AECOPD, including C-reactive protein, interleukin-6, interleukin-8, and tumor necrosis factor-α; these were alleviated by both treatments, with more obvious effects for integrative treatment. Integrative treatment significantly changed the intestinal flora in patients with AECOPD, reaching levels comparable with those of healthy participants. Firmicutes abundance was significantly higher in healthy participants, whereas Bacteroidetes abundance was significantly higher in patients with AECOPD. After treatment, Verrucomicrobia abundance was significantly reduced in patients with AECOPD. Conclusion Jianpi Huatan Tongfu granule could alleviate inflammatory responses and improve clinical therapeutic efficacy in patients with AECOPD.
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Tinè, Mariaenrica, Erica Bazzan, Umberto Semenzato, Davide Biondini, Elisabetta Cocconcelli, Elisabetta Balestro, Alvise Casara, et al. "Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department." Journal of Clinical Medicine 9, no. 8 (August 14, 2020): 2644. http://dx.doi.org/10.3390/jcm9082644.
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Background: Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. Aims: To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. Methods: Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. Results: At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW’s in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. Conclusions: HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.
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Pérez-Trallero, Emilio, José M. Marimón, Julián Larruskain, Marta Alonso, and María Ercibengoa. "Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease." Antimicrobial Agents and Chemotherapy 55, no. 6 (March 14, 2011): 2729–34. http://dx.doi.org/10.1128/aac.01546-10.
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ABSTRACTIn the elderly,Streptococcus pneumoniaeis the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n= 401) and AECOPD (n= 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test;P= 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.
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AboEl-Magd, Gehan Hassan, and Maaly Mohamed Mabrouk. "Soluble urokinase-type plasminogen activator receptor as a measure of treatment response in acute exacerbation of COPD." Jornal Brasileiro de Pneumologia 44, no. 1 (February 2018): 36–41. http://dx.doi.org/10.1590/s1806-37562017000000151.
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ABSTRACT Objective: To evaluate the value of soluble urokinase-type plasminogen activator receptor (suPAR) in the diagnosis of acute exacerbation of COPD (AECOPD) and in monitoring treatment response, analyzing the relationship between suPAR and fibrinogen in AECOPD. AECOPD leads to increased airway inflammation, contributing to an exaggerated release of inflammatory mediators. Methods: We recruited 45 patients with AECOPD and 20 healthy control subjects. Medical histories were taken, and all subjects underwent clinical examination, chest X-ray, pulmonary function tests, and blood gas analysis. On day 1 (treatment initiation for the AECOPD patients) and day 14 (end of treatment), blood samples were collected for the determination of serum suPAR and plasma fibrinogen. Results: Serum levels of suPAR were significantly higher in the AECOPD group than in the control group. In the AECOPD patients, there was a significant post-treatment decrease in the mean serum suPAR level. The sensitivity, specificity, and accuracy of suPAR were 95.6%, 80.0%, and 93.0%, respectively. The Global Initiative for Chronic Obstructive Lung Disease stage (i.e., COPD severity) correlated positively and significantly with serum levels of suPAR and plasma levels of fibrinogen. Conclusions: Monitoring the serum suPAR level can be helpful in the evaluation of the COPD treatment response and might be a valuable biomarker for determining the prognosis of AECOPD. Because serum suPAR correlated with plasma fibrinogen, both markers could be predictive of AECOPD.
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Gaur, Ravi, Vijay Kumar Tundwal, Ritumbhara Gaur, Mohit Gaur, and J. K. Khatri. "Study of correlation of red cell distribution width with acute exacerbation of chronic obstructive pulmonary disease." IP Indian Journal of Immunology and Respiratory Medicine 7, no. 3 (October 15, 2022): 108–15. http://dx.doi.org/10.18231/j.ijirm.2022.026.
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Acute exacerbation of COPD is one of the most common disease in patients with infections, having frequent hospitalization. The aim of this study is to find whether there is any relationship between RDW with mortality in AECOPD. The hospital based case control Study is was conduct on hospitalized 50 patient with primary and final diagnosis of AECOPD and 50 patient of stable period of COPD. Socio-demographic variable in both groups were comparable. BMI was significantly lower in AECOPD patients. The mean PACK/YR in AECOPD group was 24.44±6.23 and in Stable COPD was 20.66±8.21. Mean admission per year were significantly higher in AECOPD patients (1.88±0.80 per year) as compare to stable COPD patients (0.80±0.67 per year). Mean FEV1 % was significantly lower in AECOPD patients (43.87±14.26) as compare to stable COPD patients (48.12±20.18). Mean RDW significantly higher in AECOPD (17.60±5.70%) as compare to stable COPD patients (13.80±3.33%). The difference in both groups was found statistically significant. MCV was significantly lower in AECOPD (82.04±1.49) as compare to stable COPD patients (86.50±1.87). The difference in both groups was found statistically significant. RDW was significantly higher in those patient who were died (19.50±0.70%) as compare to survived patients (17.52±5.61%). The difference in both groups was found statistically significant. 4.00% hospital mortality in AECOPD group. We have concluded that the mean red cell distribution width on the day of presenting the illness was significantly higher in AECOPD as compare to stable COPD. Those patients who had a high red cell distribution width during admission were associated with poor prognosis.
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Lecheler, Leopold, Maximilian Richter, Daniel P. Franzen, Silvana K. Rampini, Marcus Cheetham, Josef Jenewein, Edouard Battegay, and Albina Nowak. "The frequent and underrecognised co-occurrence of acute exacerbated COPD and depression warrants screening: a systematic review." European Respiratory Review 26, no. 144 (June 14, 2017): 170026. http://dx.doi.org/10.1183/16000617.0026-2017.
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Patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) and concurrent depression suffer significant psychological stress and decreased quality of life. The aim of this study was to collate data, guidelines and recommendations from publications on the screening and management of depressive mood disorders in patients hospitalised with AECOPD.We systematically searched four databases for publications reporting screening or management of depression in patients hospitalised for AECOPD. The identification of articles was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Out of 1494 original articles screened, 35 met all inclusion criteria. These report a prevalence of depression in AECOPD ranging between 9.5% and 85.6%. Some studies report high postadmission mortality rates for depressive AECOPD patients, and higher readmission rates in depressive versus nondepressive AECOPD patients. Importantly, none of the 35 publications included suggestions on the screening and management of depression in AECOPD.Depression and AECOPD frequently co-occur, and this worsens outcomes. Yet we did not find recommendations on management, and few interventional studies. Patients hospitalised with AECOPD should be systematically screened for depression and treatment recommendations should be developed for these patients. Randomised studies on how to screen and treat depression in hospitalised AECOPD are necessary.
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Stolz, Daiana, Eleni Papakonstantinou, Leticia Grize, Daniel Schilter, Werner Strobel, Renaud Louis, Christian Schindler, Hans H. Hirsch, and Michael Tamm. "Time-course of upper respiratory tract viral infection and COPD exacerbation." European Respiratory Journal 54, no. 4 (August 7, 2019): 1900407. http://dx.doi.org/10.1183/13993003.00407-2019.
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Viral respiratory tract infections have been implicated as the predominant risk factor for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We aimed to evaluate, longitudinally, the association between upper respiratory tract infections (URTI) caused by viruses and AECOPD.Detection of 18 viruses was performed in naso- and orοpharyngeal swabs from 450 COPD patients (Global Initiative for Chronic Obstructive Lung Disease stages 2–4) who were followed for a mean of 27 months. Swabs were taken during stable periods (n=1909), at URTI onset (n=391), 10 days after the URTI (n=356) and during an AECOPD (n=177) and tested using a multiplex nucleic acid amplification test.Evidence of at least one respiratory virus was significantly higher at URTI onset (52.7%), 10 days after the URTI (15.2%) and during an AECOPD (38.4%), compared with the stable period (5.3%, p<0.001). During stable visits, rhinovirus accounted for 54.2% of all viral infections, followed by coronavirus (20.5%). None of the viruses were identified in two consecutive stable visits. Patients with a viral infection at URTI onset did not have a higher incidence of exacerbation than patients without viral infection (p=0.993). Τhe incidence of any viral infection during an AECOPD was similar between URTI-related AECOPD and non-URTI-related AECOPD (p=0.359). Only 24% of the patients that had a URTI-related AECOPD had the same virus at URTI onset and during an AECOPD. Detection of parainfluenza 3 at URTI onset was associated with a higher risk of an AECOPD (p=0.003). Rhinovirus and coronavirus were the most frequently detected viruses during AECOPD visits, accounting for 35.7% and 25.9% of all viral infections, respectively.The prevalence of viral infection during the stable period of COPD was low. The risk of exacerbation following the onset of URTI symptoms depends on the particular virus associated with the event and was significant only for parainfluenza 3.
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Song, Wen, Yue Wang, Fengming Tian, Liang Ge, Xiaoqian Shang, Qiang Zeng, Ning Feng, Jiahui Fan, Jing Wang, and Xiumin Ma. "Clinical Significance of Procalcitonin, C-Reactive Protein, and Interleukin-6 in Helping Guide the Antibiotic Use for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease." Disease Markers 2021 (March 15, 2021): 1–9. http://dx.doi.org/10.1155/2021/8879401.
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Background. Currently, standards of antibiotic use in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients are controversial. Objective. The aim of the present study was to analyze the value of procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) levels to guide the antibiotic treatment of AECOPD patients. Methods. A total of 371 patients with COPD or AECOPD were included in the study. Clinical and laboratory data were obtained at admission, 325 AECOPD patients and 46 sCOPD patients treated with antibiotics. The receiver operating curve (ROC) was used to evaluate the relationship between CRP, PCT, and IL-6. Results. This study included medical record/case control 1, the COPD group ( n = 46 ) and the AECOPD group ( n = 325 ), and medical record control 2, the nonchanged antibiotic group ( n = 203 ) and the changed antibiotic group ( n = 61 ). In case 1, CRP, PCT, and IL-6 levels in the AECOPD group were higher than that in the control group ( P < 0.05 ), while the result of ROC showed that IL-6 had higher AUC values (0.773) and higher sensitivity (71.7%) than other indicators. The specificity of PCT (93.5%) is higher than other indicators. In case 2, ROC curve results showed that the AUC value of IL-6 (0.771) was slightly higher than PCT and CRP. The sensitivity (85.2%) and specificity (65.5%) of CRP were higher than other indicators. Conclusions. IL-6 and PCT were elevated in AECOPD patients, resulting in a higher diagnostic value for AECOPD. CRP had a higher diagnostic value for antibiotic use in AECOPD patients.
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Yu, Suyun, Min Xue, Zhijun Yan, Bin Song, Haiping Hong, and Xiwen Gao. "Correlation between TNF-α -308 and +489 Gene Polymorphism and Acute Exacerbation of Chronic Obstructive Pulmonary Diseases." BioMed Research International 2021 (March 1, 2021): 1–8. http://dx.doi.org/10.1155/2021/6661281.
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Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is becoming a common respiratory disease, leading to increased morbidity and mortality worldwide. Tumor necrosis factor-alpha (TNF-α) is a powerful proinflammatory cytokine involved in the pathogenesis of AECOPD. Therefore, we proposed a close correlation between the TNF-α polymorphism [-308G/A (rs1800629), +489G/A (rs1800610)] and the disease progress of patients with AECOPD. Comparison of the TNF-α genotypes between the 198 AECOPD diagnosed patients groups and 195 healthy peoples suggested their significant differences of the three genotypes (AA, GA, GG) distribution for TNF-α -308 ( P < 0.05 ), but no differences of that for TNF-α +489. We found that patients with TNF-α -308 GA/AA genotypes showed smaller adjacent arterial diameter, thicker bronchial wall, higher bronchial artery ratio, higher bronchial wall grading, and higher frequency of acute exacerbations than those with TNF-α -308 GG genotype. Patients with TNF-α +489 GA/AA genotypes showed the same AECOPD properties as patients with TNF-α -308 except for the high frequency of acute exacerbations. Further experiment showed that the TNF-α -308 and+489 gene polymorphisms could affect the expression level of TNF-α in macrophages, suggesting the involvement of the macrophage population in disease regulation of AECOPD patients with TNF-α -308G/A and+489G/A genotype heterogeneity. In conclusion, the TNF-α -308 G/A genotype was related to AECOPD susceptibility and progress, while the TNF-α +489G/A genotype was related to AECOPD progress, but not AECOPD susceptibility.
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Liu, Yanbo, Yuxiong Chen, Dehui Kong, Xiaole Liu, Jia Fu, Yongqiao Zhang, Yakun Zhao, et al. "Short-term effects of cold spells on hospitalisations for acute exacerbation of chronic obstructive pulmonary disease: a time-series study in Beijing, China." BMJ Open 11, no. 1 (January 2021): e039745. http://dx.doi.org/10.1136/bmjopen-2020-039745.
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ObjectivesOur work aimed at exploring the relationship between cold spells and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalisations in Beijing, China, and assessing the moderating effects of the intensities and the durations of cold spells, as well as identifying the vulnerable.DesignA time-series study.SettingWe obtained time-series data of AECOPD hospitalisations, meteorological variables and air quality index in Beijing, China during 2012–2016.ParticipantsAll AECOPD hospitalisations among permanent residents in Beijing, China during the cold seasons (November–March) of 2012–2016 were included (n=84 571).Primary and secondary outcome measuresA quasi-Poisson regression with a distributed lag model was fitted to investigate the short-term effects of cold spells on AECOPD hospitalisations by comparing the counts of AECOPD admissions during cold spell days with those during non-cold spell days.ResultsCold spells under different definitions were associated with increased risk of AECOPD hospitalisations, with the maximum cumulative relative risk (CRR) over 3 weeks (lag0–21). The cumulative effects at lag0–21 increased with the intensities and the durations of cold spells. Under the optimal definition, the most significant single-day relative risk (RR) was found on the days of cold spells (lag0) with an RR of 1.042 (95% CI 1.013 to 1.072), and the CRR at lag0–21 was 1.394 (95% CI 1.193 to 1.630). The elderly (aged ≥65) were more vulnerable to the effects of cold spells on AECOPD hospitalisations.ConclusionCold spells are associated with increased AECOPD hospitalisations in Beijing, with the cumulative effects increased with intensities and durations. The elderly are at particular risk of AECOPD hospitalisations triggered by cold spells.
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Shin, Beomsu, Sang-Ha Kim, Suk Joong Yong, Won-Yeon Lee, Sunmin Park, Sang Jun Lee, Seok Jeong Lee, and Myoung Kyu Lee. "Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia." Chronic Respiratory Disease 16 (November 14, 2018): 147997231880948. http://dx.doi.org/10.1177/1479972318809480.
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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. Pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. We performed a prospective cohort study to evaluate the prognosis of AECOPD patients with or without community-acquired pneumonia (CAP) who hospitalized from January 2012 to December 2015. We investigated mortality and readmission rates within 6 months after the first admission between two groups and analyzed the difference of survival rate according to readmission duration (≤30 vs. >30 days) or intensive care unit (ICU) treatment. Total 308 AECOPD patients (134 with CAP and 174 without CAP) were enrolled. The mean age was 72.3 ± 9.5 years old, and 235 patients (76.3%) were male. The 180-day mortality was higher in AECOPD with CAP than without CAP (24.6% vs. 13.2%; hazard ratio (HR): 1.982; 95% CI: 1.164–3.375; p = 0.012). However, readmission rate showed no significant difference between two groups (51.5% vs. 46.6%; HR: 1.172; 95% CI: 0.850–1.616; p = 0.333). It showed a significantly lower survival rate in AECOPD with CAP rather than without CAP when were readmitted within 30 days (HR: 1.738; 95% CI:1.063–3.017; p = 0.031). According to ICU treatment, survival rate was not significantly different between two groups. Multivariate analysis revealed the readmission within 30 days ( p < 0.001), serum hemoglobin concentration ( p = 0.010), and albumin level ( p = 0.049) were significantly associated with 180-day mortality of AECOPD with CAP. AECOPD with CAP showed lower survival rate than AECOPD without CAP during 6 months. Early readmission within 30 days was significantly associated with an increased risk of mortality.
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Pathak, Ranjan, Smith Giri, Paras Karmacharya, and Anthony Donato. "Prevalence of Pulmonary Embolism Among Patients with Acute Exacerbations of Chronic Obstructive Pulmonary: Data from Nationwide Inpatient Sample." Blood 126, no. 23 (December 3, 2015): 2076. http://dx.doi.org/10.1182/blood.v126.23.2076.2076.
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Abstract Background Patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are thought to be at a higher risk of developing venous thromboembolism due to various reasons such as smoking, immobilization and a transient procoagulant state. However, clinical diagnosis of acute pulmonary embolism (PE) in patients with AECOPD is often difficult due to the similarity in the presenting symptoms of the two conditions. Literature regarding the true prevalence of PE among patients with AECOPD and the role of routine screening for PE in these patients with imaging is controversial. Although some studies have suggested prevalence rates to be as high as 20-25%, thus justifying a routine CT pulmonary angiography (CTPA) to evaluate for PE in these patients, other studies have refuted such findings. Methods We used the 2011 Nationwide Inpatient Sample database to identify patients aged ≥18 years admitted with AECOPD (International Classification of Diseases, 9th Revision, Clinical-Modification [ICD-9-CM] code 491.21). Patients with AECOPD with co-existing PE were identified using the ICD-9-CM codes 415.1x and 673.2x. Prevalence of PE in patients with AECOPD was calculated. Similarly, in-hospital mortality, length of stay and mean hospital charge was derived for patient with AECOPD, with and without PE. Statistical analysis was performed using Stata 13.1 (STATA Corp, College Station, TX), which accounted for the complex survey design and clustering of the database. Results A total of 1,187,808 admissions with AECOPD were identified, of which 1.18% (n=13,988) patients were found to have co-existent PE. On Univariate analyses, no differences were seen in the demographic characteristics (mean age, sex, race, primary payer, region, bed-size, teaching status) of AECOPD patients with and without PE. However, diagnosis of concurrent PE in patients with AECOPD was associated with higher in-hospital mortality (10.6% vs. 3.81%, p<0.001), mean length of stay (9.38 vs. 5.92 days, p<0.001) and mean total hospital charges ($74,234 vs. 40,424, p<0.001). Conclusion In this study of large national database, we found the prevalence of PE in patients admitted for AECOPD to be much lower than reported in literature, suggesting that routine imaging to rule out PE is unlikely to be cost effective. Furthermore, routine screening of AECOPD patients for PE with CTPA might actually result in more untoward effects such as incidental pulmonary nodules and PEs with further unnecessary testing and treatment. Disclosures No relevant conflicts of interest to declare.
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Ye, Yan-Ping, Hang Zhao, Tao Kang, Li-Hua Zhao, Ning Li, Jing Chen, and Xiao-Xia Peng. "Optimal cut-off value of serum procalcitonin in predicting bacterial infection induced acute exacerbation in chronic obstructive pulmonary disease: A prospective observational study." Chronic Respiratory Disease 19 (January 2022): 147997312211085. http://dx.doi.org/10.1177/14799731221108516.
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Objective To explore the optimal cut-off value of serum procalcitonin (PCT) level in predicting bacterial infection in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods 204 hospitalized patients with AECOPD were enrolled in this study. Their diagnoses and treatments followed routine protocols in Fu-Xing Hospital affiliated to Capital Medical University, Beijing, China. Extra blood samples were taken for serum PCT level testing and the results were blinded to the treating physicians. On discharge, clinical data were collected and the treating physicians made comprehensive analyses to determine whether the AECOPD were triggered by respiratory tract bacterial infection or non-bacterial causes according to the “new diagnostic criteria” defined in this study. In the AECOPD patients with bacterial infection, treating physicians decided whether they had bacterial pneumonia based on imaging studies. Receiver operating characteristic curve (ROC) was used to analyze the accuracy of serum PCT level in predicting bacterial infection. Results In the 173 AECOPD patients who did not have pneumonia, 115 had evidences of bacterial infection while 58 did not. The median PCT levels were 0.1(0.08, 0.18) ng/ml and 0.07 (0.05, 0.08) ng/ml for each group, which were statistically different. The proposed optimal cut-off value of serum PCT level in predicting bacterial infection was 0.08 ng/mL according to this study, with a sensitivity of 81%, specificity of 67% and area under the ROC curve (AUC) of 0.794. There were 31 AECOPD patients diagnosed with pneumonia, their median PCT level was 0.23 ng/mL. Conclusions The serum PCT levels slightly increased in the majority of hospitalized patients with AECOPD compared with reference range. When PCT level was ≥0.08 ng/mL, AECOPD was more likely to be caused by bacterial infection. A significantly elevated PCT levels may indicate combination of AECOPD and bacterial pneumonia.
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Lang, Susanne M. "Akute COPD-Exazerbationen: Auswirkungen einer Antibiotikabehandlung." Kompass Pneumologie 10, no. 2 (2022): 70–71. http://dx.doi.org/10.1159/000523692.
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<b>Background:</b> Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. <b>Objectives:</b> This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. <b>Methods:</b> A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. <b>Results:</b> Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. <b>Conclusion:</b> Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.
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Zhang, Jing, Jinping Zheng, Kewu Huang, Yahong Chen, Jingping Yang, and Wanzhen Yao. "Use of glucocorticoids in patients with COPD exacerbations in China: a retrospective observational study." Therapeutic Advances in Respiratory Disease 12 (January 1, 2018): 175346661876951. http://dx.doi.org/10.1177/1753466618769514.
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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim of the study was to identify current use of glucocorticoids for the treatment of AECOPD in China. Methods: This retrospective, multicenter, noninterventional study evaluated the treatment pattern of AECOPD in patients hospitalized from January 2014 to September 2014 at 43 sites (41 tertiary hospitals and two secondary hospitals) in China. The endpoints of the study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization. Results: A total of 4569 patients (90.17%) received glucocorticoids for AECOPD treatment. A combination of nebulized and systemic route was most frequently used (40.51%), followed by using nebulized route alone (38.00%), systemic route alone (15.45%), and inhaled route other than nebulization (6.04%). Furthermore, the most commonly prescribed glucocorticoids of the nebulized, intravenous, inhaled (other than nebulized) and oral route was budesonide (69.4%), methylprednisolone sodium succinate (45.31%), fluticasone propionate (19.54%), and prednisone acetate (11.90%), respectively. The in-hospital mortality rate was 1.24% and the mean length of hospitalization was 12.22 ± 6.20 days (± SD). Conclusions: Our study was the first study of the treatment pattern of glucocorticoids in the management of hospitalized AECOPD patients in China. Data indicates that there is a gap in the implementation of international guidelines for the treatment of AECOPD in China. Further studies are warranted to clarify the appropriate glucocorticoids strategy for the management of AECOPD to determine the optimal route of administration, dose and duration, and resulting clinical outcomes.
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Wu, Chia-Tung, Guo-Hung Li, Chun-Ta Huang, Yu-Chieh Cheng, Chi-Hsien Chen, Jung-Yien Chien, Ping-Hung Kuo, Lu-Cheng Kuo, and Feipei Lai. "Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study." JMIR mHealth and uHealth 9, no. 5 (May 6, 2021): e22591. http://dx.doi.org/10.2196/22591.
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Background The World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality. Objective The aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days. Methods This prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality–sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model. Results The continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality–sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1%, sensitivity of 94%, and specificity of 90.4%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved. Conclusions Using wearable devices, home air quality–sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data.
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Shpagina, L. A., O. S. Kotova, I. S. Shpagin, G. V. Kuznetsova, D. A. Gerasimenko, and E. V. Anikina. "Virus-induced and bacteria-induced exacerbations of chronic obstructive pulmonary disease caused by industrial aerosols or tobacco smoke exposure." PULMONOLOGIYA 32, no. 2 (April 30, 2022): 189–98. http://dx.doi.org/10.18093/0869-0189-2022-32-2-189-198.
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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with disease progression and increased risk of death. We need to better understand the phenotypes of AECOPD to improve treatment strategies. The main triggers of COPD exacerbations are viral and bacterial infections.The aim is to characterize the viral, bacterial, and viral-bacterial phenotypes of acute exacerbations in patients with COPD caused by industrial aerosol exposure or tobacco smoke.Methods. 180 subjects with established moderate and severe COPD who met the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, 2020 – 2021, and were hospitalized with AECOPD, were enrolled in this prospective observational study. The virus-induced, bacteria-induced, and virus-bacteria-induced AECOPD strata (n = 60 each) were formed. Each stratum included 30 patients with occupational COPD and 30 patients with COPD caused by tobacco smoke. Virus-induced AECOPDs were diagnosed by PCR of bronchoalveolar fluid. Length of hospital stay, symptoms, lung function, mean pulmonary artery pressure (mPAP), and type of inflammation were assessed. Cox proportional hazard regression was used to examine the relationships.Results. The length of hospital stay was highest in patients with virus-induced and virus-bacteria-induced exacerbations of occupational COPD, being equal to (Me, IQR) 16.5 (14 – 18) and 18 (16 – 20) days. The virus-induced exacerbations in occupational COPD and in COPD caused by tobacco smoke featured the highest bronchodilation coefficient, 10.9 (9.8 – 11,5)% and 9.2 (8.3 – 10.3)%, respectively, decrease in the diffusing capacity of the lungs (DLCO/Va) by 42 (40 – 45)% and 49 (47 – 52)%, increase in mPAP by 44 (39 – 45) и 33 (29 – 38) mmHg, and eosinophilic inflammation with blood eosinophil count of 425 (385 –527) and 350 (310 – 391) cells per μl (р > 0.01). Virus-bacteria-induced AECOPD in occupational COPD and in COPD caused by smoke were characterized by decrease in FEV1 by 40.2 (36.6 – 42.2)% and 31.0 (28.1 – 33.6%), decrease in DLCO/Va by 48 (44 – 50)% and 37 (35 – 41)%, increase in mPA by 43 (38 – 46) and 50 (45 – 54) mmHg, and eosinophilic-neutrophilic inflammation in 63.3 and 66.6% of patients. The mid-range FEV1, highest DLCO/Va, and neutrophilic inflammation were seen in patients with bacteria-induced AECOPD.Conclusion. Exacerbations of occupational COPD are characterized by more severe functional impairment and inflammation with high eosinophil count when these exacerbations have viral origin.
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Shpagina, L. A., O. S. Kotova, I. S. Shpagin, D. A. Gerasimenko, G. V. Kuznetsova, S. A. Karmanovskaya, E. M. Loktin, et al. "Clinical and molecular features of virus-induced acute exacerbations of chronic obstructive pulmonary diseas." Meditsinskiy sovet = Medical Council 16, no. 18 (October 14, 2022): 30–39. http://dx.doi.org/10.21518/2079-701x-2022-16-18-30-39.
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Introduction. Inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (COPD) is not studied enough.The aim was to establish molecular pattern of inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in comparison with bacterial AECOPD and to reveal associations with AECOPD phenotype and subsequent COPD progression.Materials and methods. Subjects hospitalized with acute exacerbations of COPD (AECOPD) of which 60 were viral, 60 were bacterial and 60 were viral-bacterial were recruited to single center prospective (52 weeks) cohort study. Control group – 30 healthy people. COPD were diagnosed previously during stable phase of the disease according to spirographic criteria. Viral AECOPD were confirmed by detection of RNA of influenza A and B, respiratory syncytial virus, rhinovirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in sputum or bronchoalveolar lavage fluid (BALF) using reverse transcription-polymerase chain reaction (RT-PCR). Bacterial AECOPD were confirmed by sputum/BALF neutrophilia or elevated blood procalcitonin levels or by detecting bacteria by standard culture method. Plasma concentrations of cytokines, fibrotic markers, enzymes were measured by enzyme-linked immunosorbent assay, plasma fibrinogen – by Clauss method. Complex lung function investigation, Dopplerechocardiography, subsequent AECOPD assessment were done. Kruskal-Wallis and chi-square test were used to compare groups, Cox regression and linear regression – to explore relationships.Results. Viral AECOPD were characterized by highest plasma concentrations of Eosinophilic cationic protein (62,3 (52,4; 71,0) ng/ml)), interleukin-5 (IL-5) (11,3 (8,4; 15,9) pg/ml), fibroblast growth factor-2 (FGF-2) (10,4 (6,2; 14,9) pg/ml), transforming growth factor-β1 (TGF-β1) (922,4 (875,7; 953,8) pg/ml), hyaluronic acid (185,4 (172,8; 196,3) ng/ml), amino-terminal propeptide of type III procollagen (PIIINP) (249,2 (225,1; 263,7) ng/ml), matrix metalloproteinase-1 (MMP-1) (235,2 (208,6; 254,9) pg/ml). Levels of IL-5 during AE COPD was the predictor of FEV1, bronchodilation coefficient, subsequent exacerbations at remote period, fibrinogen was associated with FEV1, PIIINP and FGF-2 with DLco, PaO2, mean pulmonary artery pressure (mPAP), exacerbations, MMP-1 – with mPAP.Conclusions. In virus-induced AECOPD inflammation pattern differed from those in bacterial one and associated with AECOPD phenotype and COPD phenotype at the stable phase.
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Olaee, Aseih Hatefi, Fariba Rezaeetalab, and Nasim Lotfinejad. "Comparison of diagnostic values of haematological and inflammatory parameters in predicting COPD exacerbation." Pneumologia 69, no. 4 (December 1, 2020): 227–33. http://dx.doi.org/10.2478/pneum-2021-0016.
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Abstract Objective: Many patients with chronic obstructive pulmonary disease (COPD) suffer from acute exacerbation. Acute exacerbation of COPD (AECOPD) is currently known as the most important leading cause of death worldwide. Therefore, recognising beneficial biomarkers in order to detect acute exacerbations promptly is crucial. This study aimed to evaluate the role of haematological and inflammatory parameters in the diagnosis of AECOPD. Methods: This cross-sectional study was carried out on 63 patients with AECOPD, during exacerbation and stable period, and on 62 sex- and age-matched healthy controls. Haematological and inflammatory parameters were analysed, and other data were collected. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) level, and mean platelet volume (MPV) in the diagnosis of patients with AECOPD. Results: The predictive ability of NLR was higher than that of CRP and MPV. The cut-off value of NLR was 2.85, and the sensitivity and specificity for detecting AECOPD were 87% and 70%, respectively (AUC = 0.84, P < 0.001). NLR values positively correlated with the CRP level, erythrocyte sedimentation rate (ESR) and platelet (PLT) count (r = 0.44, P = 0.001; r = 0.31, P = 0.020; and r = 0.32, P = 0.010, respectively) and negatively correlated with the albumin level and MPV in patients with AECOPD (r = −0.31, P = 0.049 and r = −0.27, P = 0.040). Conclusion: NLRs and CRP levels were both increased in patients with AECOPD, and they are both available and beneficial markers in the prompt detection of AECOPD. Further studies should be performed to underpin the diagnostic and prognostic values of haematological and inflammatory biomarkers in patients with COPD.
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Lawless, Michael, Mark Burgess, and Stephen Bourke. "Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care." Medicina 58, no. 1 (January 1, 2022): 66. http://dx.doi.org/10.3390/medicina58010066.
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Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.
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Chen, Dawei, Changchun Cao, Linglin Jiang, Yan Tan, Hongbo Yuan, Binbin Pan, Mengqing Ma, Hao Zhang, and Xin Wan. "Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD." Chronic Respiratory Disease 17 (January 1, 2020): 147997312094067. http://dx.doi.org/10.1177/1479973120940677.
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Hospital-acquired acute kidney injury (HA-AKI) is associated with poor prognosis. In this study, we evaluated whether serum cystatin C on admission could predict AKI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The retrospective study was conducted using data on adult inpatients with AECOPD from January 2014 to January 2017. A total of 1035 patients were included, among which 79 (7.6%) with HA-AKI were identified. Univariate and multivariate logistic regression analyses were used to investigate predictors of HA-AKI in patients with AECOPD. HA-AKI was associated with poor prognosis, and patients with HA-AKI had higher inpatient mortality (34.2% vs. 2.6%, p < 0.001). Furthermore, after adjusting for confounders, HA-AKI was an independent risk factor for inpatient mortality for patients with AECOPD (odds ratio (OR) 11.02; 95% confidence interval (CI) 4.77–25.45; p < 0.001). Four independent risk factors for HA-AKI (age, levels of urea and cystatin C, and platelet count on admission) were identified in patients with AECOPD. Cystatin C (OR 5.22; 95% CI 2.49–10.95; p < 0.001) was a significant independent predictor of AKI in patients with AECOPD. HA-AKI in patients with AECOPD could be identified with a sensitivity of 73.5% and a specificity of 75.9% (area under the curve (AUC) = 0.803, 95% CI 0.747–0.859) by cystatin C level (cutoff value = 1.3 mg/L) and with a sensitivity of 75.9% and a specificity of 82.0% (AUC = 0.853, 95% CI 0.810–0.896) using a model comprising all significant predictors. Serum cystatin C has the potential for use to predict the risk of HA-AKI in patients with AECOPD.
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S., Lashmipriya, Ravindran Chetambath, Amitha Sunny, Sanjeev Shivashankaran, and Muhammed Aslam. "Aspergillus spp. infection as a cause of acute exacerbations of chronic obstructive pulmonary disease: a prospective observational study." International Journal of Research in Medical Sciences 7, no. 5 (April 26, 2019): 1604. http://dx.doi.org/10.18203/2320-6012.ijrms20191644.
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Background: Majority of exacerbations of COPD (AECOPD) are due to infections. Usual agents causing AECOPD are gram negative bacteria, but rarely viruses and fungi are also implicated. However, the role of fungal infection, especially Aspergillus spp. in the clinical deterioration of COPD still remains unclear. This prospective observational study looks at the prevalence of aspergillus infection in AECOPD. The Objectives of this study were to analyse the prevalence and risk factors associated with Aspergillus infection in AECOPD, and to investigate the clinical outcomes.Methods: Patients admitted with AECOPD for a period of 3 months from 1st October 2017 to 31st December 2017 were prospectively included from ICU and general ward of Pulmonary Medicine department of a tertiary care hospital. Clinical, radiological and microbiological data were collected at admission and during the hospital stay. Clinical course and outcome are recorded.Results: There were 104 cases of AECOPD during the study period out of which 96 were males and 8 were females. 17 patients had evidence of aspergillus infection and diabetes was found to be an independent risk factor for aspergillus infection.Conclusions: Aspergillus infection is an important cause of COPD exacerbation and this is directly related to diabetes mellitus.
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Lozo Vukovac, Emilija, Kornelija Miše, Ivan Gudelj, Irena Perić, Darko Duplančić, Ivica Vuković, Zoran Vučinović, and Mislav Lozo. "Bronchoalveolar pH and inflammatory biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease." Journal of International Medical Research 47, no. 2 (November 29, 2018): 791–802. http://dx.doi.org/10.1177/0300060518811560.
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Objectives This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase (LDH), C-reactive protein (CRP), and glucose levels in serum and bronchoalveolar aspirate, and identify bacterial pathogens from bronchoalveolar fluid during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods We performed an observational, analytical case–control study from February 2015 to March 2017. We included 84 patients with AECOPD and 42 with stable chronic obstructive pulmonary disease (COPD). All participants underwent detailed medical anamnesis, a clinical examination, chest radiography, spirometry, an arterial blood gas test, bronchoscopy, bacterial culture, and serum/bronchiolar aspirate laboratory testing. Results The mean pH of bronchoalveolar fluid was significantly higher in patients with AECOPD than in patients with stable COPD. The mean lung pH value, bronchoalveolar and serum LDH levels, and serum CRP levels in patients with isolated bacteria were higher than those in patients without isolated bacteria in the AECOPD patient group. Lung pH values in patients with AECOPD were significantly correlated with bronchoalveolar LDH and glucose levels. Conclusions AECOPD is associated with local cell and tissue injury in the lungs, especially in the presence of bacterial pathogens, which is accompanied by a low systemic inflammatory response.
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Chakraborty, Subhankar, Swapnendu Misra, Sumanta Jha, Sukanta Kodali, and Abhijit Mandal. "Comparative study of some routinely measured Serum biochemical parameters between acute exacerbation of Chronic Obstructive Pulmonary Disease and stable Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Kolkata: an attempt to make simple prognostic indicators." International Journal of Research in Medical Sciences 8, no. 2 (January 27, 2020): 484. http://dx.doi.org/10.18203/2320-6012.ijrms20200222.
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Background: Patients with COPD often have exacerbations which frequently require hospitalization, resulting in higher mortality rates and costs than patients managed at OPD. Some easily available blood parameters in both stable COPD and AECOPD patients are measured that can be done in every patient even in poor resource settings. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients with or without any prognostic significance.Methods: In institution based observational case control study, authors measured 1. FBS and PPBS 2. Serum Urea and Creatinine 3. Serum Electrolytes- Na+, K+, Cl- 4. LFT 5. Uric acid in both stable COPD(n=50) and AECOPD (n=50) patients. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients.Results: AECOPD patients had statistically significant higher urea, uric acid levels and higher fasting hyperglycemia than stable COPD patients. Hypernatremia, hyponatremia and hyperkalemia, hypokalemia - all were significantly higher in AECOPD group. Low level of serum bilirubin and higher level of AST and ALP were common in AECOPD patients. AECOPD patients with high urea value (>50 mg/dl) (but not high creatinine) was associated with poor patient outcome in respect to ICU transfer, death and prolonged hospital stay. Low bilirubin, high ALP and AST level in AECOPD patients was associated with higher ICU transfer and mortality but only high ALP level was associated with prolonged hospital stay. High uric acid level (>6 mg/dl) was a major determinant of ICU transfer, mortality and prolonged hospital stay.Conclusions: Predicting exacerbation by these parameters early in the course of disease can decrease morbidity and mortality as well as health care cost to great extent. By measuring the changes in it can also be predicted early who will need ICU support in future and who can be treated at ward.
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Jiang, Min, Huifang Liu, Zheng Li, Jing Wang, Fengbo Zhang, Kaixiu Cao, Fengsen Li, and Jianbing Ding. "ILC2s Induce Adaptive Th2-Type Immunity in Acute Exacerbation of Chronic Obstructive Pulmonary Disease." Mediators of Inflammation 2019 (June 20, 2019): 1–12. http://dx.doi.org/10.1155/2019/3140183.
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To investigate the effect of ILC2s on Th2-type adaptive immunity during the acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the study enrolled healthy people, stable COPD patients, and AECOPD patients. Flow cytometry was used to detect Th1, Th2, and ILC2 in the peripheral blood and CD80 and MHC II levels on ILC2. The mRNA levels of GATA3, RORα, and CRTH2 of ILC2s were detected by RT-PCR. In addition, ILC2s from the peripheral blood of AECOPD patients were cocultured with CD4+ T cells from the peripheral blood of healthy controls. Cytokine levels in serum of the three groups and the in vitro coculture supernatants were measured by ELISA. Compared with the stable COPD group or the healthy control group, Th2 in the peripheral blood of AECOPD group increased dramatically, inducing an increase of Th2/Th1 ratio in AECOPD patients. Meanwhile, the level of IL-4 in the serum of this group was also increased. However, we also detected ILC2s in the peripheral blood of the AECOPD group and found that it was also increased, alone with the increased GATA3, RORα, and CRTH2 mRNA levels. We also found that the CD80 and MHC II on ILC2 were significantly upregulated and the proportion of MHC II+ ILC2 cells was significantly positively correlated with the proportion of Th2 cells in AECOPD patients. To further demonstrate the effect of ILC2 on Th2 cells, we cocultured ILC2 with CD4+ T cells in vitro, which also showed a significant increase of Th2 ratio as well as Th2-associated cytokines IL-4, IL-5, and IL-13. However, we found that this effect of ILC2s on Th2 cells could be inhibited by the addition of anti-MHC II. The Th2/Th1 balance shifts to Th2 in AECOPD. ILC2s may function as APC by the upregulation of MHC II and regulate adaptive immunity shift to Th2-type response in AECOPD.
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Phillips, Rhiannon, Helen Stanton, Amina Singh-Mehta, David Gillespie, Janine Bates, Micaela Gal, Emma Thomas-Jones, et al. "C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation." British Journal of General Practice 70, no. 696 (May 18, 2020): e505-e513. http://dx.doi.org/10.3399/bjgp20x709865.
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BackgroundAntibiotics are prescribed to >70% of patients presenting in primary care with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The PACE randomised controlled trial found that a C-reactive protein point-of-care test (CRP-POCT) management strategy for AECOPD in primary care resulted in a 20% reduction in patient-reported antibiotic consumption over 4 weeks.AimTo understand perceptions of the value of CRP-POCT for guiding antibiotic prescribing for AECOPD; explore possible mechanisms, mediators, and pathways to effects; and identify potential barriers and facilitators to implementation from the perspectives of patients and clinicians.Design and settingQualitative process evaluation in UK general practices.MethodSemi-structured telephone interviews with 20 patients presenting with an AECOPD and 20 primary care staff, purposively sampled from the PACE study. Interviews were audio-recorded, transcribed, and analysed using framework analysis.ResultsPatients and clinicians felt that CRP-POCT was useful in guiding clinicians’ antibiotic prescribing decisions for AECOPD, and were positive about introduction of the test in routine care. The CRP-POCT enhanced clinician confidence in antibiotic prescribing decisions, reduced decisional ambiguity, and facilitated communication with patients. Some clinicians thought the CRP-POCT should be routinely used in consultations for AECOPD; others favoured use only when there was decisional uncertainty. CRP-POCT cartridge preparation time and cost were potential barriers to implementation.ConclusionCRP-POCT-guided antibiotic prescribing for AECOPD had high acceptability, but commissioning arrangements and further simplification of the CRP-POCT need attention to facilitate implementation in routine practice.
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Li, Ting, Li Gao, Hong-Xia Ma, Yang-Yang Wei, Yue-Hua Liu, Ke-Ru Qin, Wen-Tao Wang, Hai-Long Wang, and Min Pang. "Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients." Experimental Biology and Medicine 245, no. 14 (June 3, 2020): 1290–98. http://dx.doi.org/10.1177/1535370220931765.
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Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory disease and eosinophils (EOS) participate in inflammation process. Acute exacerbation of COPD (AECOPD) is an inevitable trend in the development of the disease and has attracted widespread attention. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of interleukin-13 and eosinophil cationic protein in the serum and sputum were measured to explore their clinical value in eosinophilic AECOPD patients. The patients were divided into an eosinophilic group (52 cases, 48.15%) and a noneosinophilic group (56 cases, 51.85%). The eosinophilic group had fewer acute exacerbations in the past year, shorter average hospitalization days, lower respiratory failure rate, mechanical ventilation utilization rate, and lower CAT and mMRC scores ( P < 0.05). The levels of interleukin-13 and eosinophil cationic protein in sputum in the eosinophilic group were higher than those in the noneosinophilic group ( P < 0.05), and there was no significant difference in the serum between the two groups ( P > 0.05). The receiver operating characteristic (ROC) curves of sputum interleukin-13 and eosinophil cationic protein predicting peripheral blood EOS% ≥2% of AECOPD patients were statistically significant ( P < 0.05). The noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up, and there was no significant difference in mortality between the two groups. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. Interleukin-13 and eosinophil cationic protein are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies in the future. Impact statement Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an inevitable trend in the development of the disease and eosinophils (EOS) participate in inflammation process. It is important to explore some relatively simple biomarkers in AECOPD which are useful to recognize the disease. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of IL-13 and ECP in the serum and sputum were measured. The levels of IL-13 and ECP in sputum in the eosinophilic group were higher than those in the noneosinophilic group. Moreover, the noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. IL-13 and ECP are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies.
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Kaleem Ullah, Mohammed, Ashwaghosha Parthasarathi, Jayaraj Biligere Siddaiah, Prashant Vishwanath, Swapna Upadhyay, Koustav Ganguly, and Padukudru Anand Mahesh. "Impact of Acute Exacerbation and Its Phenotypes on the Clinical Outcomes of Chronic Obstructive Pulmonary Disease in Hospitalized Patients: A Cross-Sectional Study." Toxics 10, no. 11 (November 6, 2022): 667. http://dx.doi.org/10.3390/toxics10110667.
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Acute exacerbations of COPD (AECOPD) are clinically significant events having therapeutic and prognostic consequences. However, there is a lot of variation in its clinical manifestations described by phenotypes. The phenotypes of AECOPD were categorized in this study based on pathology and exposure. In our cross-sectional study, conducted between 1 January 2016 to 31 December 2020, the patients were categorized into six groups based on pathology: non-bacterial and non-eosinophilic; bacterial; eosinophilic; bacterial infection with eosinophilia; pneumonia; and bronchiectasis. Further, four groups were classified based on exposure to tobacco smoke (TS), biomass smoke (BMS), both, or no exposure. Cox proportional-hazards regression analyses were performed to assess hazard ratios, and Kaplan–Meier analysis was performed to assess survival, which was then compared using the log-rank test. The odds ratio (OR) and independent predictors of ward admission type and length of hospital stay were assessed using binomial logistic regression analyses. Of the 2236 subjects, 2194 were selected. The median age of the cohort was 67.0 (60.0 to 74.0) and 75.2% were males. Mortality rates were higher in females than in males (6.2% vs. 2.3%). AECOPD-B (bacterial infection) subjects [HR 95% CI 6.42 (3.06–13.46)], followed by AECOPD-P (pneumonia) subjects [HR (95% CI: 4.33 (2.01–9.30)], were at higher mortality risk and had a more extended hospital stay (6.0 (4.0 to 9.5) days; 6.0 (4.0 to 10.0). Subjects with TS and BMS-AECOPD [HR 95% CI 7.24 (1.53–34.29)], followed by BMS-AECOPD [HR 95% CI 5.28 (2.46–11.35)], had higher mortality risk. Different phenotypes have different impacts on AECOPD clinical outcomes. A better understanding of AECOPD phenotypes could contribute to developing an algorithm for the precise management of different phenotypes.
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He, Fang, Ping Zhao, Yan Chu, Na Zhao, and Jiexi Cheng. "Red blood cell distribution width and serum CA-125 level as prognostic markers in acute exacerbation of chronic obstructive pulmonary disease." Journal of International Medical Research 49, no. 5 (May 2021): 030006052110202. http://dx.doi.org/10.1177/03000605211020229.
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Objective Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a primary cause of hospitalization and death in COPD. Serum CA-125 and red blood cell distribution width (RDW) are related to AECOPD. We investigated correlations between serum markers and AECOPD. Methods In total, 132 patients with AECOPD were included from January 2017 to December 2019. Participants were followed for 1 year. Patients were assigned to the poor prognosis (n = 40) or good prognosis (n = 92) group. We collected serum samples and general clinical information and conducted routine blood tests. We used logistic regression, receiver operating characteristic (ROC), and area under the ROC curve (AUC) analyses to assess differences between groups. Results We found significant differences between groups (odds ratio, 95% confidence interval) for age (1.046, 1.005–1.09), RDW (2.012, 1.339–3.023), and cancer antigen 125 (CA-125; 1.022, 1.006–1.039); these remained risk factors for AECOPD prognosis in multivariate analyses. RDW and CA-125 in combination was significant in ROC curve analysis. The AUC of RDW, CA-125, and these combined were 0.691, 0.779, and 0.772, respectively. Patients with RDW >12.75% and CA-125 >15.65 U/mL were predicted to have poor prognosis. Conclusions We found that RDW and CA-125 are potential prognostic indicators for AECOPD.
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Zheng, Jingtong, Yue Shi, Lingxin Xiong, Weijie Zhang, Ying Li, Peter G. Gibson, Jodie L. Simpson, et al. "The Expression of IL-6, TNF-α, and MCP-1 in Respiratory Viral Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease." Journal of Immunology Research 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/8539294.
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Viral infection is a common trigger for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aim of this study is to investigate the expression of cytokines in AECOPD. Patients with AECOPD requiring hospitalization were recruited. Meanwhile healthy volunteers of similar age that accepted routine check-ups and showed no clinical symptoms of inflammatory diseases were also recruited. Induced sputum and serum were collected. Induced sputum of participants was processed and tested for thirteen viruses and bacteria. Forty cytokines were assayed in serum using the Quantibody Human Inflammation Array 3 (Ray Biotech, Inc.). The most common virus detected in virus positive AECOPD (VP) was influenza A (16%). No virus was found in controls. Circulating levels of IL-6, TNF-α, and MCP-1 were elevated in VP and coinfection subjects (p<0.05), while the levels of 37 other cytokines showed no difference, compared with virus negative groups and controls (p>0.05). Additionally, VP patients were less likely to have received influenza vaccination. VP patients had a systemic inflammation response involving IL-6, TNF-α, and MCP-1 which may be due to virus-induced activation of macrophages. There are important opportunities for further investigating AECOPD mechanisms and for the development of better strategies in the management and prevention of virus-related AECOPD.
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Westerdahl, Elisabeth, Christian Osadnik, and Margareta Emtner. "Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden." Chronic Respiratory Disease 16 (January 1, 2019): 147997311985586. http://dx.doi.org/10.1177/1479973119855868.
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There is considerable global variability in clinical practice regarding the prescription of airway clearance techniques (ACTs) for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the physical therapy practice, and no international guidelines are available. The aim of this survey was to identify current physical therapy practice regarding ACT prescription for patients with AECOPD in Sweden. A cross-sectional, descriptive study was conducted via a Web-based questionnaire, sent to all ( n = 70) hospitals that offer physical therapy service for patients with AECOPD in Sweden. Responses were received from 117 physical therapists (76%) across all sites. ACTs were prescribed for more than half of all patients with an AECOPD by 75% of physical therapists. The most frequently used ACTs were positive expiratory pressure (PEP) devices (90%), directed huffing (88%) and cough (71%). Most physical therapists (89%) perceived sputum clearance to be an important aspect of the overall management of patients with AECOPD. The main factors influencing choice of ACT were the ‘degree of dyspnoea or work of breathing’ and ‘access to resources/equipment’. Physical therapists prescribe predominantly PEP-based ACTs for patients with AECOPD in Sweden. Several factors come into consideration that influences the choice of treatment technique.
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Wei, Bing, and Chun Sheng Li. "Changes in Th1/Th2-producing cytokines during acute exacerbation chronic obstructive pulmonary disease." Journal of International Medical Research 46, no. 9 (June 27, 2018): 3890–902. http://dx.doi.org/10.1177/0300060518781642.
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Objective This study aimed to explore cytokine serum levels and the ratio of type 1 T helper (Th1)/Th2 cells in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total 245 patients diagnosed with AECOPD and 193 patients who progressed to stable COPD after the initiation of treatment in hospital were selected, while a further 50 healthy individuals served as controls. All patients with COPD were diagnosed using Global Initiative for Chronic Obstructive Lung Disease criteria. Serum concentrations of interleukin (IL)-2, interferon (IFN)-γ, IL-4, IL-10, IL-17, and immunoglobulin (Ig)E were measured using enzyme-linked immunosorbent assays. Results AECOPD patients had higher levels of IL-2, IFN-γ, IL-4, IL-10, IL-17, and IgE than those with stable COPD or controls. Intriguingly, the ratios of Th1/Th2 and IL-17/IgE were lower in AECOPD patients compared with the other two groups. These data suggest that AECOPD patients produce more IgE and have more differentiated Th2 cells than other groups. Conclusion Our findings suggest that an imbalance of circulating CD4+ T cell subsets correlates with AECOPD, and that a shift of Th1/Th2 and IL-17/IgE ratios may be caused by increased Th2 cell production.
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Huang, Qingsong, Hongjing Yang, Chuantao Zhang, Jianying Wu, Wei Xiao, and Zhu Zeng. "Xiaoqinglong Decoction Protects the Lungs of AECOPD Mice through the AMPK/mTOR Signaling Pathway." Evidence-Based Complementary and Alternative Medicine 2020 (July 4, 2020): 1–9. http://dx.doi.org/10.1155/2020/9865290.
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Background/Aim. Chronic obstructive pulmonary disease (COPD) is one of the most common health problems around the world. Xiaoqinglong decoction (XQLD) has been clinically reported to improve lung function and shorten cough and sputum in AECOPD patients, but its mechanism is still unclear. This study aims to investigate the effects of XQLD on inflammation and apoptosis of lung tissues and explore the underlying mechanisms in acute exacerbation in COPD (AECOPD) mice. Method. Male C57BL/6J mice were used to establish AECOPD model by cigarette smoke and bacterial exposure. Mice were randomly divided into normal control (NC), AECOPD, XQLD, Compound C (Com C), Com C + XQLD, and Clarithromycin (CLA) groups. After treatment, the pulmonary function was evaluated by whole-body plethysmograph. The lung histopathology was observed by HE staining. The serum levels of IL-6, TNF-α, and COX-2 were detected by ELISA assay. The apoptotic index was measured by TUNEL assay, and the protein expressions of Bax, Bcl-2, Caspase-3, GRP78, and CHOP in the lung tissues were measured by western blot assay. Results. XQLD treatment can improve pulmonary function (PF), ameliorate lung injury, and suppress inflammation and apoptosis of lung tissues. In addition, XQLD also markedly attenuated endoplasmic reticulum stress (ERS) and activated AMPK/mTOR pathway in the lung tissues of mice with AECOPD. However, the AMPK inhibitor Compound C decreased the protective effect of XQLD in AECOPD mice. Conclusion. These findings suggested that XQLD has protective effect against inflammation and apoptosis in AECOPD mice by attenuating ER stress via AMPK/mTOR pathway.
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Pudasaini, S., P. Adhikari, S. Maharjan, AK Jha, and N. Dhakal. "Role of CBC Parameters in COPD with Acute Exacerbation in a Tertiary Care Center." Nepal Medical College Journal 21, no. 4 (December 31, 2019): 306–12. http://dx.doi.org/10.3126/nmcj.v21i4.27627.
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Chronic obstructive pulmonary disease (COPD) is a major global health problem. It is a complex disease characterised by chronic inflammation in the airways by noxious particles. Episodes of increased symptoms called as acute exacerbations are associated with accelerated decline in the lung function. Blood cultures to find out the causative organism in these cases are time consuming. Complete Blood Count (CBC) parameters like Total leukocyte count (TLC), hemoglobin (Hb), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are found to be related with COPD and its acute exacerbation. An observational hospital based descriptive study was conducted for a period of six months in the Department of Pathology and Medicine of a tertiary care centre. A total of 144 patients of COPD with acute exacerbation (AECOPD) were included in the study. The mean age of the patients was 70.47 ± 9.49 years with female preponderance (61.1%). Though mean hemoglobin level (13.25 ± 2.70 gm %), (95% CI 12.80-13.69) showed statistical significance, other CBC parameters had no obvious difference among the different groups of AECOPD patients. But we cannot deny on the clinical significance of these parameters. The TLC and platelet count were slightly lower in the AECOPD patients with cor pulmonale when compared with AECOPD patients without cor pulmonale. Similarly, platelet parameters like MPV and PDW were slightly higher in the AECOPD patients who are smokers. Though these parameters were not statistically significant, they are found to be cost effective, time saving and clinically significant which would definitely help in the management of AECOPD patients. Hence, these parameters can be used as an easily measurable AECOPD biomarker.
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Feng, Feng, Jianchao Du, Yufeng Meng, Fang Guo, and Cuiling Feng. "Louqin Zhisou Decoction Inhibits Mucus Hypersecretion for Acute Exacerbation of Chronic Obstructive Pulmonary Disease Rats by Suppressing EGFR-PI3K-AKT Signaling Pathway and Restoring Th17/Treg Balance." Evidence-Based Complementary and Alternative Medicine 2019 (January 20, 2019): 1–14. http://dx.doi.org/10.1155/2019/6471815.
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Airway mucus hypersecretion is the main pathogenic factor in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the control of mucus secretion is closely associated with survival. Louqin Zhisou decoction (LQZS) has been found to improve lung function and reduce sputum in AECOPD patients, but the mechanism remains unclear. This study aimed to explore the mechanism of LQZS against mucus hypersecretion in lung tissues of rat AECOPD model. Wistar rats were used to establish AECOPD model by intratracheal instillation of LPS in combination with the continuous cigarette smoking. Rats were administrated LQZS/clarithromycin (CAM)/distilled water via gavage every day and all rats were sacrificed after 30 days. BALF and lung tissues were obtained. Lung morphology, cytokines levels, MUC5AC mRNA transcription and protein expression, phosphorylation of the EGFR-PI3K-AKT signaling pathway, and molecules involved in Th17/Treg balance were evaluated. The results demonstrated that LQZS protected rats from decline in pulmonary function and ameliorated lung injury. LQZS treatment decreased the number of goblet cells in airway and suppressed MUC5AC mRNA and protein expression of lung tissues. Furthermore, LQZS attenuated the level of phospho-EGFR, phospho-PI3K and phospho-AKT in AECOPD rats. In addition, LQZS could inhibit the production of proinflammatory cytokines in BALF, including IL-6 and IL-17A and downregulate the secretion of NE and MCP-1, indicating that LQZS could limit inflammatory responses in AECOPD. Moreover, LQZS reversed RORγt and Foxp3 expression, the key transcription factors of Th17 and Treg, respectively. In conclusion, this research demonstrated the inhibitory effects of LQZS against mucus hypersecretion in AECOPD via suppressing EGFR-PI3K-AKT signaling pathway and restoring Th17/Treg balance.
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Maleki-Yazdi, M. Reza, Suzanne M. Kelly, Sy S. Lam, Mihaela Marin, Martin Barbeau, and Valery Walker. "The Burden of Illness in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease in Canada." Canadian Respiratory Journal 19, no. 5 (2012): 319–24. http://dx.doi.org/10.1155/2012/328460.
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INTRODUCTION: No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published.OBJECTIVE: To assess the costs associated with maintenance therapy and treatment for acute exacerbations of COPD (AECOPD) over a one-year period.METHODS: Respirologists, internists and family practitioners from across Canada enrolled patients with an established diagnosis of moderate to severe COPD (Global initiative for chonic Obstructive Lung Disease stages 2 and 3) confirmed by postbronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented AECOPD over the previous year were obtained by chart review and patient survey.RESULTS: A total of 285 patients (59.3% male; mean age 70.4 years; mean pack years smoked 45.6; mean duration of COPD 8.2 years; mean postbronchodilator forced expiratory volume in 1 s 58.0% predicted) were enrolled at 23 sites across Canada. The average annual COPD-related cost per patient was $4,147. Across all 285 patients, maintenance costs were $2,475 per patient, of which medications accounted for 71%. AECOPD treatment costs were $1,673 per patient, of which hospitalizations accounted for 82%. Ninety-eight patients (34%) experienced a total of 157 AECOPD. Treatment of these AECOPD included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per AECOPD was $3,036.DISCUSSION: The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.
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Morasert, Thotsaporn, Methus Jantarapootirat, Phichayut Phinyo, and Jayanton Patumanond. "Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study." BMJ Open Respiratory Research 7, no. 1 (May 2020): e000488. http://dx.doi.org/10.1136/bmjresp-2019-000488.
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BackgroundAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common and deteriorating event leading to in-hospital morbidity and mortality. Identification of predictors for in-hospital mortality of AECOPD patients could aid clinicians in identifying patients with a higher risk of death during their hospitalisation.ObjectiveTo explore potential prognostic indicators associated with in-hospital mortality of AECOPD patients.SettingGeneral medical ward and medical intensive care unit of a university-affiliated tertiary care centre.MethodsA prognostic factor research was conducted with a retrospective cohort design. All admission records of AECOPD patients between October 2015 and September 2016 were retrieved. Stratified Cox’s regression was used for the primary analysis.ResultsA total of 516 admission records of 358 AECOPD patients were included in this study. The in-hospital mortality rate of the cohort was 1.9 per 100 person-day. From stratified Cox’s proportional hazard regression, the predictors of in-hospital mortality were aged 80 years or more (HR=2.16, 95% CI: 1.26 to 3.72, p=0.005), respiratory failure on admission (HR=2.50, 95% CI: 1.12 to 5.57, p=0.025), body temperature more than 38°C (HR=2.97, 95% CI: 1.61 to 5.51, p=0.001), mean arterial pressure lower than 65 mm Hg (HR=4.01, 95% CI: 1.88 to 8.60, p<0.001), white blood cell count more than 15 x 109/L (HR=3.51, 95% CI: 1.90 to 6.48, p<0.001) and serum creatinine more than 1.5 mg/dL (HR=2.08, 95% CI: 1.17 to 3.70, p=0.013).ConclusionSix independent prognostic indicators for in-hospital mortality of AECOPD patients were identified. All of the parameters were readily available in routine practice and can be used as an aid for risk stratification of AECOPD patients.