Cardiac injury in patients with COPD presenting with dyspnea: a pilot study.

PURPOSE: The aim of this pilot study was to test the hypothesis that myocardial ischemia complicates the management of some patients with chest-pain-free chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: In this prospective, observational, cohort study, patients admitted to a 350-bed community teaching hospital, with dyspnea and a primary diagnosis of COPD exacerbation, were followed for enzymatic and electrocardiographic evidence of myocardial ischemia for the first 24 hours of hospital admission. RESULTS: A total of 114 patients were studied. Overall, four patients had definite myocardial infarctions, one had definite myocardial ischemia and 14 had possible myocardial ischemia. In multiple logistic regression models, age, number of coronary risk factors, and amount of administered albuterol were not associated with myocardial injury. CONCLUSION: While unrecognized myocardial injury is relatively rare in patients with an exacerbation of COPD, it occurs frequently enough to warrant some caution since beta-agonists are the mainstays of therapy.

Acute kidney injury predicts outcomes of non-critically ill patients.

OBJECTIVE: To evaluate whether acute kidney injury (AKI), defined as an increase in the serum creatinine level of 0.3 mg/dL or more within 48 hours, predicts outcomes of non-critically ill patients. PATIENTS AND METHODS: Among the adults admitted from June 1, 2005, to June 30, 2007, to the medical wards of a community teaching hospital, 735 patients with AKI and 5089 controls were identified. Demographic and health information, serum creatinine values, and outcomes were abstracted from patients' computerized medical records. Outcomes of patients with AKI were compared with those of controls. In an additional case-control analysis, more detailed clinical information was abstracted from the medical records of 282 pairs of randomly selected, age-matched AKI cases and controls. Conditional multivariate logistic regression analyses were used to adjust for potential confounders of AKI effect on outcomes. RESULTS: Overall, patients with AKI had higher in-hospital mortality (14.8% vs 1.5%; P<.001), longer lengths of stay (median 7.9 vs 3.7 days; P<.001), and higher rates of transfer to critical care areas (28.6% vs 4.3%; P<.001); survivors were more likely to be discharged to an extended care facility (43.1% vs 20.3%; P<.001). Conditional multivariate logistic regression analyses of the 282 pairs of cases and controls showed that patients with AKI were 8 times more likely to die in hospital (odds ratio [OR], 7.9; 95% CI [confidence interval], 2.9-15.3) and were 5 times more likely to have prolonged (>or=7 days) hospital stays (OR, 5.2; 95% CI, 3.5-7.9) and require intensive care (OR, 4.7; 95% CI, 2.7-8.1), after adjustment for age, comorbidities, and other potential confounders. CONCLUSION: In this study, AKI was associated with adverse outcomes in non-critically ill patients.