Thyroid dysfunction and inflammatory biomarkers in chronic obstructive pulmonary disease: Relation to severity and exacerbation

Background: Thyroid dysfunction or non-thyroidal illness syndrome [NTIS] is frequently detected in chronic, systemic diseases. The systemic manifestations of chronic obstructive pulmonary disease [COPD] include a number of endocrine disorders. The severity of hypoxia and airway obstruction in COPD patients might cause alterations in thyroid function. The aim of this study is to assess serum levels of thyroid hormones and the inflammatory biomarkers; IL-6, TNF-alpha in COPD patients during stability and acute exacerbation of the disease, and also to assess the relation between severity of COPD and levels of thyroid hormones

Subjects and methods: Forty stable COPD patients and twenty COPD patients with acute exacerbation were included in this study as patient groups and twenty healthy age-matched non smoker subjects with normal pulmonary function as a control group. The diagnosis of COPD and acute exacerbation of COPD were established according to GOLD [2011] criteria. Stable COPD patients were further subdivided into Mild-to-moderate COPD patient group [FEV1 >/= 50% of predicted value, which included 14 patients] and Severe COPD patient group [FEV1 < 50% of predicted value, which included 26 patients]. All enrolled patients were subjected to measurements of pulmonary function tests [FEV1%, FVC% and FEV1/FVC ratio], arterial blood gases [ABGs] [PaO[2], PaCO[2], pH], serum levels of thyroid hormones [TSH, total T3, total T4, free T3 and free T4] and the inflammatory biomarkers IL-6 and TNF-alpha on the first day of admission to RICU or first visit to the outpatient clinics

Results: There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients when compared to control subjects. Also, there was a significant decrease in serum total T3, free T3, TSH levels and TT3/TT4 ratio in the COPD exacerbation patient group when compared to control subjects and when compared to stable COPD patients. There were no statistically significant differences in serum levels of total T4, free T4 between the studied groups. Regarding disease severity, serum total T3, free T3 levels and TT3/TT4 ratio were significantly decreased in severe COPD patients when compared to mild-to-moderate COPD patients. There were significant positive correlations between PaO[2] and both serum total T3 and TT3/TT4 ratio in the stable COPD group. Serum IL-6 and TNF-alpha levels were significantly increased in both stable and exacerbation phase COPD patient groups when compared to control subjects

Conclusion: COPD is a systemic disease that may produce significant alterations in serum levels of thyroid hormones, especially in severe COPD patients and during exacerbation phases of COPD where NTIS is more evident. There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients and this decrease was more significantly evident with a superadded significant decrease in serum TSH levels during the exacerbation phase of COPD. The hormonal alterations are especially related to severity of the disease and hypoxemia. Serum IL-6 and TNF-alpha levels were increased even in stable COPD and this rise is magnified with increased disease severity and during exacerbation phases of COPD

Prognostic factors for bronchoscopic electrocautery and/or argon plasma coagulation in patients with central aifway obstruction

Significant portions of central airway stenosis patients present with unresectable disease. Using bronchotherapeutic procedures to maintain a patent airway and improve clinical symptoms and quality of life is a well-known armamentarium technique. To assess the contribution of different physiological and pathological prognostic factors on the yield of endobronchial therapies [argon plasma coagulation [APC] and electrocautery] in patients with central airway obstruction whether derived from malignant or non-malignant etiology. Twenty nine patients with central airway obstruction, 21 males arid eight females, were recruited in the study. All the studied patients were categorized into malignant and non-malignant groups with different pathological varieties. Interventional bronchoscopic procedures were performed under general anesthesia. The flexible bronchoscope was either passed via an endotra-cheal tube or through the rigid bronchoscope. Collected data included patient demographics, evaluation of performance scale and quality of life status, evaluation of dyspnea, cough and hemoptysis scores before the interventional bronchoscopy and 1 day after the last session. Also the collected data included; length, size, localization and bronchoscopic appearance of the lesion. Duration of symptoms, duration of mechanical ventilation and the presence of collapse prior to the intervention were all recorded. Number of sessions and type of bronchoscopic modalities used were recorded. Spiromet-ric pulmonary function tests were done before and 1 day after the last session. Complete recanalization was achieved in [17/29] 58.6% of patients, while incomplete or partial recanalization was achieved in [12/29] 41.4% of patients. Using linear regression analysis ofindependent factors affecting patient outcome; it was found that the length of lesion followed by presence of collapse, duration of symptoms and lastly lesion localization whether localized or diffuse [P < 0.0005], [P < 0.011], [P < 0.02] and [P < 0.039] were the most independent factors affecting patient outcome. For favorable outcome, selection of patients with central airway obstructing lesions candidates for bronchoscopic argon plasma coagulation and/or electrocautery should rely on several factors including; age, duration of symptoms, performance scale, co-morbidities, pre-therapeutic FEV1%, presence of lung collapse, and length of the obstructing lesion, moreover its shape and localization

impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following: a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE