Predictors of mortality in mechanically ventilated COPD patients

Patients with chronic obstructive pulmonary disease [COPD] commonly require hospitalization and admission to intensive care unit. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in mechanically ventilated COPD patients and to advice a scoring system using the baseline physiological variables for prognosticating these patients. This study comprised 220 patients with acute respiratory failure [ARF] secondary to COPD, requiring mechanical ventilation [MV] and admitted to the intensive care unit [ICU] of Menoufiya Chest Department over a two-year period. Clinical and demographic data including APACHE III [Acute Physiology and Chronic Health Status Evaluation] score and Charlson co-morbidity score were recorded on MV, at the time of admission to the ICU. In addition, the acid base status, renal and liver functions, serum electrolytes, LDH, CRP and albumin were recorded at the time of presentation. The length of stay in-hospital, in the ICU, and mechanical ventilation were also recorded. The mean serum albumin level was 2.77 +/- 0.39 gm/dL and 2.11 +/- 0.19 for survivors and non-survivors, respectively [p < 0.05]. As regards ABGs; the mean PaCO2 was 54.8 +/- 6.39 mmHg and 76.1 +/- 11.1, PaO2 was 54.8 +/- 7.1 mmHg and 50.2 +/- 4.9, and HCO3 was 34.7 +/- 4.2 mEq/L and 41.6 +/- 4.8 in survivors and non-survivors, respectively [p < 0.05]. Charlson co-morbidity index demonstrated a cut off value of 1.4 +/- 0.3 and 2.6 +/- 0.6 and APACHE III score off value was 45.2 +/- 12.62 and 80.9 +/- 15, for survivors and non-survivors, respectively with statistically significant correlation for both indices [p < 0.05]. The present results indicate that the severity scores, like Charlson co-morbidity and APACHE III scores, are useful and reliable tools for predicting mortality in COPD patients requiring MV. Serum albumin level, renal functions as well as the oxygenation and ventilation parameters can also, predict mortality

Role of CD15 in the diagnosis of lung cancer

The poor prognosis associated with lung cancer is closely related to the fact that most patients are not identified until their malignancy has reached an advanced stage. The aim of this study was to assess the role, sensitivity and of CD15 in the diagnosis of bronchogenic carcinoma as well as its predictive value in smoker's lungs not harboring tumor tissues. Three groups were included: Group I: 15 patients with biopsy proved adenocarcinoma. Group II: 15 patients with biopsy proved squamous cell carcinoma. Group III: 12 smokers with no evidence of malignancy and for whom bronchoscopy was done for other reasons .GI and GII were then pooled into a single group [group of pulmonary malignancy [Gpm]. Patients were excluded if their biopsy proved to be small cell lung cancer. An informed consent was taken from all patients. In addition to complete history, clinical examination, laboratory investigations, chest X-rays and CT chest, all patients were subjected to fibreoptic bronchoscopy for biopsy. Then the biopsy was stained by H and E and immunostained for CD15. The majority of the bronchogenic carcinoma cases were smokers 60% with an incidence of squamous cell carcinoma and adenocarcinoma of [66.7%, 53.3% respectively]. Twenty percent, 50%, and 30% of the patients in group of pulmonary malignancy presented in stages IIIa, IIIb, and IV respectively. Immunostaining for CD 15 was detected in 60% of the biopsies from group of pulmonary malignancy and none of group III with a highly significant difference [P<0.05] and a sensitivity of 73.68%, while it stained 66.7% of adenocarcinoma and 53.3% of squamous cell carcinoma with no significant differentiating value. It stained 33.3%, 38.9%, and 27.8% of tissue specimens from group of pulmonary malignancy in stages IIIa, IIIb, IV respectively with a significant positive correlation between CD 15 positivity and the stage of lung cancer. Immunostaining for CD15 has an important and significant role in the diagnosis of non-small cell lung cancer but it is not able to differentiate between its types. Also, it gives an important and significant clue about the dissemination and prognosis of this type of malignancy