ABSTRACT
<p><b>BACKGROUND</b>Accurate prediction for prognosis is important for hospitalized patients with chronic obstructive pulmonary disease (COPD) requiring invasive mechanic ventilation (IMV) and for their family members to make end-of-life decisions. The response to therapy in such a patient population has rarely been investigated. The aim of the study was to evaluate the risk factors in these patients and investigate their response to IMV and the relationship between their responses and prognosis.</p><p><b>METHODS</b>A cohort of 138 patients with COPD requiring IMV >or= 12 hours for acute respiratory failure of diverse etiological factors during a 4-year period were retrospectively studied using prospectively gathered data. All variables potentially related to hospital mortality were evaluated by univariate and multiple stepwise logistic regression analysis.</p><p><b>RESULTS</b>The mean age of all patients investigated was (65.7 +/- 11.6) years and the hospital mortality was 39.9% (31.1% with COPD exacerbation). Correction of acidosis (pH >or= 7.30) was seen in 58 patients (69.9%) in survivors but only 12 patients (21.8%) in nonsurvivors (P < 0.05) after ventilation. Using multivariate logistic analysis, the variables independently associated with hospital mortality were a higher acute physiology score before intubation, lower pH value measured 24 hours after the onset of ventilation and development of multiorgan dysfunction syndrome (MODS).</p><p><b>CONCLUSIONS</b>In COPD patients requiring IMV, the postintubation pH value can not only reflect patients' response to treatment, but also serve as an independent determinant of hospital mortality apart from other risk factors such as a higher preintubation APACHE II score and development of MODS. A close correlation between the response to IMV and prognosis was proved in these patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cohort Studies , Forced Expiratory Volume , Hospital Mortality , Hydrogen-Ion Concentration , Logistic Models , Pulmonary Disease, Chronic Obstructive , Mortality , Therapeutics , Respiration, Artificial , Retrospective Studies , Risk FactorsABSTRACT
<p><b>OBJECTIVE</b>To provide a quantitative summary in estimating the association between polymorphisms of 3 loci in NRAMP1 gene and susceptibility to tuberculosis in East-Asia population by means of meta-analysis.</p><p><b>METHODS</b>We searched databases (MEDLINE, OVID and CBM disc) from January 1995 to May 2005 using "NRAMP1" or "SLC11A1", in combination with "tuberculosis", also performed a manual search of citations from relevant original studies and literature. For each study involved, information was collected concerning the characteristics of the subjects, such as mean age of cases and the size of study. These characteristics were used to evaluate the sources of variation. Summary ORs and corresponding 95% CI were estimated by fixed effects (Mantel-Haenszel) or random effects (DerSimonian and Laird) model. To check for publication bias,a funnel plot, using Egger's linear regression method, was constructed. Cumulative meta-analysis was performed to evaluate whether the summary OR for studies with the polymorphisms of the 3 loci in the NRAMP1 gene was changing along with the accumulation of more data. Chi-square goodness of fit was used to test deviation from Hardy-Weinberg equilibrium.</p><p><b>RESULTS</b>Eight publications, with the number of cases and controls of 1067 and 1084 respectively, were identified and all genotype frequencies were consistent with Hardy-Weinberg equilibrium. The summary ORs for studies with polymorphisms of 3' UTR, D543N and INT4 loci of the NRAMPI gene among the East-Asia population were 1.68(95% CI: 1.31-2.16, P< 0.001), 1.78(95% CI: 1.38-2.30, P< 0.001), 1.56 (95% CI: 0.72- 3.35, P = 0.26), respectively when compared with their corresponding common homozygotes. Publication bias was not found in the studies with the three loci, except for INT4 locus, by Egger linear regression method. The cumulative summary effects ORs were 1.85 (P = 0.02) in 2000, 1.35 (P = 0.12) in 2002,1.64 (P= 0.001) in 2003, and 1.68 (P<0.001) in 2004 for 3'UTR locus, 1.88 (P = 0.001) in 2000,1.65(P = 0.001) in 2002,1.70(P<0.001) in 2003,1.76(P<0.001) in 2004, and 1.78(P<0.001) in 2005 for D543N locus, and 0.88(P = 0:70) in 2002, 2.50(P = 0.41) in 2003, 1.52(P = 0.42) in 2004 and 1.56(P = 0.26) in 2005 for INT4 loucs.</p><p><b>CONCLUSION</b>Polymorphisms at 3' UTR and D543N loci had statistically significant association between the NRAMP1 variants and susceptibility to tuberculosis in the East-Asia descendants, and variant in the INT4 locus failed to show statistically significant association in the East-Asia population.</p>
