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Objective To analyse the prognosis and risk factors of lung cancer with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Tongchuan City, and to provide a theoretical basis for improving the prognosis of patients with lung cancer complicated with AECOPD. Methods A total of 280 patients with lung cancer combined with AECOPD admitted to Tongchuan People's Hospital from January 2021 to August 2022 were selected and divided into survival group and death group according to whether the patients survived during hospitalization. Serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1) and other tumor markers were compared between the two groups. Lung function was measured by lung function instruments, and the levels of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and other lung function indicators were compared between the two groups. The patients' clinical data were collected from the medical record system, and univariate analysis and logistic regression were used to analyze the independent risk factors affecting the prognosis of patients with lung cancer complicated with AECOP. Results The values of FEV1, FVC and FEV1/FVC in the death group were significantly lower than those in the survival group (P<0.05). Serum CEA and CYFRA 21-1 levels in the death group were significantly higher than those in the survival group (P<0.05). Multiple logistic regression analysis showed that albumin level <35 g/L (OR=2.728), TNM stage III to IV (OR=2.416), multidrug-resistant bacterial infection (OR=2.982), and GOLD grade III to IV (OR=3.417) were independent risk factors for death in patients with lung cancer complicated with AECOPD in Tongchuan City (P<0.05). Conclusion Patients with lung cancer complicated with AECOPD in Tongchuan City have a high risk of death during hospitalization, especially patients with TNM stage III to IV and GOLD grade III to IV. Multi-drug resistant bacteria infection should be actively controlled to improve the albumin level of patients, which is conducive to the prognosis of patients.
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Introducción: la incidencia mundial de enfermedad pulmonar obstructiva crónica (EPOC) se ha incrementado en los últimos años y es actualmente la tercera causa de muerte en países con alto desarrollo de sistemas sanitarios. Objetivo: identificar la letalidad y variables relacionadas en pacientes con EPOC agudizada egresados de la Unidad de Cuidados Intensivos (UCI). Método: estudio de serie de casos, en un período de dos años. Se estudió la letalidad al egreso de la UCI en 52 pacientes con EPOC agudizada egresados de la UCI del Hospital V. I. Lenin, de Holguín, en el período noviembre de 2012 y octubre de 2014. Para el procesamiento de los datos se empleó el porcentaje así como la media y desviación estándar. Se consideraron significativos valores de P<0,05. Resultados: la letalidad fue de 42,3% asociada de manera significativa a valores de pH arterial más bajos. Los valores medios de la PaO2 evolutivamente fueron mejores en los egresados vivos. Sólo se empleó ventilación no invasiva en el 28,8% de los casos. Los pacientes fallecidos presentaron una duración media de la ventilación mecánica significativamente mayor (8,6 ± 5,9 días vs. 4,0 ± 2,8 días). El shock séptico tuvo el 100% de letalidad. Conclusiones: la letalidad hospitalaria fue elevada y el empleo de ventilación no invasiva fue limitada.
Introduction: the worldwide incidence of chronic obstructive pulmonary disease (COPD) has increased in recent years and is currently the third leading cause of death in countries with high development of health systems. Objective: to identify the mortality and related variables in patients with exacerbated COPD discharged from the Intensive Care Unit (ICU). Method: case series study, in a period of two years. The lethality at discharge from the ICU was studied in 52 patients with exacerbated COPD discharged from the ICU of the VI Lenin Hospital, Holguin, in the period November 2012 and October 2014. For the processing of the data the percentage was used as well as the mean and standard deviation. Values of P <0.05 were considered significant. Results: the mortality was 42.3%, significantly associated with lower arterial pH values. The mean values of PaO2 evolved better in patients alive at discharge. Only non-invasive ventilation was used in 28.8% of the cases. The deceased patients had a significantly longer average duration of mechanical ventilation (8.6 ± 5.9 days vs. 4.0 ± 2.8 days). Septic shock had 100% of mortality Conclusions: the hospitality mortality was high and the employment of non invasive ventilation was limited.
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Summary Introduction: Hospitalization due to chronic obstructive pulmonary disease exacerbation (eCOPD) may indicate worse prognosis. It is important to know the profile of hospitalized patients and their outcome of hospitalization to customize and optimize treatment. Method: Evaluation of patients hospitalized for eCOPD, with ≥ 10 pack/years and ≥ 1 previous spirometry with airway obstruction over the course of one year at the pulmonology service of a general hospital, applying: COPD assessment test (CAT); mMRc and Visual Analogue Scale (VAS) for dyspnea; hospitalized anxiety and depression questionnaire (HAD); Divo's comorbidities and Cote index; spirometry; and laboratory tests including number of eosinophils, C-reactive protein (CRP), brain natriuretic protein (BNP). Patient progression, number of days of hospitalization and hospitalization outcomes were observed. Results: There were 75 (12%) hospitalizations for eCOPD, with 27 readmissions, nine of which during a period ≤ 30 days after hospital discharge. The main outcomes were: number of days of hospitalization (17±16.5 [2-75]); hospital discharge (30 [62.5%] patients); discharge/rehospitalization (18 [37.5%] patients), eight of them more than once; death (7 [14.5%] patients), five during rehospitalization. We analyzed 48 patients in their first hospitalization. The sample comprised a heterogeneous group separated in three clusters according to age, FEV1, body mass index (BMI) and CAT. The clusters did not correlate with the main outcomes. Conclusion: Hospitalization for eCOPD is frequent. The number of readmissions was high and associated with death as an outcome. Patients hospitalized for eCOPD were a heterogeneous group separated in three clusters with different degrees of disease severity and no correlation with hospitalization outcomes.
Resumo Introdução: As hospitalizações por exacerbação da doença pulmonar obstrutiva crônica (eDPOC) podem indicar um pior prognóstico. É importante conhecer o perfil dos pacientes internados e os desfechos das internações para personalizar e otimizar seu tratamento. Método: Avaliação dos pacientes hospitalizados por eDPOC, com ≥ 10 anos/maços e ≥ 1 espirometria prévia com obstrução ao fluxo aéreo no período de um ano em um serviço de pneumologia de um hospital geral. Foram utilizados: teste de avaliação da DPOC (CAT); mMRC e Escala Analógica Visual (EAV) para aferição da dispneia; escala hospitalar de ansiedade e depressão (HAD); comorbidades pelos critérios de Divo e índice de Cote; espirometria; e exames laboratoriais, eosinófilos no sangue, proteína C reativa (PCR), brain natriuretic peptide (BNP). Observamos evolução dos pacientes, duração da internação e desfechos da hospitalização. Resultados: Ocorreram 75 (12%) internações por eDPOC, sendo 27 reinternações, nove das quais com menos de 30 dias após a alta. Os principais desfechos foram: duração da internação de 17±16,5 (2-75) dias; 30 (62,5%) altas hospitalares; 18 (37,5%) altas/reinternações, oito pacientes reinternaram mais de uma vez; e sete (14,5%) óbitos, cinco durante as reinternações. Analisamos 48 pacientes em sua primeira internação. A amostra era um grupo heterogêneo que ordenamos em três clusters de acordo com idade, VEF1, índice de massa corporal (IMC) e CAT. Os clusters não se correlacionaram com os principais desfechos. Conclusão: A eDPOC é causa frequente de internações. Foram frequentes as reinternações e estas se correlacionaram com o desfecho óbito. Os pacientes internados por eDPOC formaram um grupo heterogêneo, que pôde ser agrupado em três clusters com diferentes graus de gravidade e sem correlação com os desfechos das hospitalizações.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/therapy , Hospitalization/statistics & numerical data , Patient Readmission/statistics & numerical data , Comorbidity , Risk Factors , Length of Stay , Middle AgedABSTRACT
Introducción: A las metilxantinas se les atribuyen efectos broncodilatadores, entre otros. Se recomiendan en la enfermedad pulmonar obstructiva crónica (EPOC) estable, cuando el tratamiento con β2 agonistas y anticolinérgicos no es suficiente para mejorar los síntomas, en los estadios más avanzados de la enfermedad y en las exacerbaciones. Objetivo: Conocer la evidencia que respalda el uso de metilxantinas en las exacerbaciones de la EPOC y otros beneficios, además de su efecto broncodilatador. Métodos: Búsqueda computarízada en Medline y EMBASE de estudios controlados aleatorízados que compararon las metilxantinas (teofilina oral, aminofilina o doxofilina intravenosa) contra placebo para la exacerbación aguda de la EPOC en enfermos atendidos en urgencias y en su hospitalización inmediata. Resultados: De 1,356 estudios de EPOC, sólo cinco cumplieron con los criterios de inclusión para el análisis. La evidencia obtenida fue la siguiente: Con respecto a la función pulmonar (VEF1, la mayoría de los estudios no encontraron mejoría significativa, sólo en uno se obtuvo mejoría al tercer día de tratamiento; otro estudio mostró disminución de la PaCO2 y ligero aumento del pH a las 12 h, en el grupo de aminofilina vs placebo. No hubo diferencias significativas en los días de hospitalización, calidad de vida y escalas de disnea. Las náuseas y el vómito fueron más frecuentes en el grupo de metilxantinas. Conclusiones: El uso basado en evidencias de metilxantinas en las exacerbaciones de la EPOC requiere de protocolos perfectamente estructurados, controlados y aleatorizados que muestren resultados estadísticamente significativos.
Introduction: Methylxantines are used for stable chronic obstructive pulmonary disease (COPD), when there is need for an additional drug besides β2 agonists and anticholinergics, in the more advanced stages of the disease and during acute exacerbations. Among other effects, methylxantines are said to have bronchodilator properties. Objective: To review the evidence supporting the use of methylxantines during acute exacerbations of COPD , and the presence of other beneficial properties besides their bronchodilator effects. Method: Medline and EMBASE computer search for aleatorized controlled studies comparing methylxantines (oral theophylline, intravenous aminophylline or doxophylline) vs placebo. Results: Only five of 1,356 published studies fulfilled the inclusion criteria. The evidence showed no significant improvement in FEV1 only one study showed a 70 vs 40 mL improvement on day 3; there was also decrease in the PCO2 and slight increase in the pH 12 hours after the use of aminophylline. There was no significant improvement in length of stay, quality of life nor dyspnoea scales. Nausea and vomiting were more frequent in the methylxantine group. Conclusions: We need properly structured protocols with statistically significant results, to define the evidence based place for the use of methylxantines in the treatment of acute exacerbations of COPD.