[Risk Assessment of Acute Exacerbation in COPD Patients in the Context of Pulmonary Follow-Up Rehabilitation Based on the Prevalence and Severity of Comorbidities]. / Risikoabschätzung einer akuten Exazerbation bei COPD-Patienten im Rahmen einer pneumologischen Anschluss-Rehabilitation anhand der Prävalenz und Schwergradausprägung von Komorbiditäten.

INTRODUCTION: Acute COPD exacerbations (AECOPD) in the context of pulmonary rehabilitation (PR) are frequent and dangerous complications and, in addition to impairing quality of life, lead to an interruption of PR and jeopardize PR success. In this study, a correlation between the health status and an increased risk of AECOPD is described. The question arises whether the Charlson Comorbidity Index (CCI) or the Cumulative Illness Rating Scale (CIRS) are suitable for the preventive detection of COPD patients at risk for exacerbation in PR. PATIENTS AND METHODS: In a retrospective study, data of COPD patients who underwent PR in 2018 were analyzed with the CCI as the primary endpoint. All data were taken from the Phoenix Clinical Information System, and COPD exacerbations were recorded. The 44 patients (22 with and 22 without exacerbation during PR) required according to the sample size planning were randomly recruited from this pool of patients (using a random list for each group). CCI and CIRS were determined for all the cases included in the two groups. The primary endpoint (CCI) was evaluated by group comparison of the arithmetic means and Welch test. This was supported by further statistical measures of position and dispersion (median, quartile, standard deviation).In addition, the optimal cut-off point for discrimination in AECOPD and non-AECOPD patients was obtained via Receiver Operating Characteristic (ROC) analysis for both the CCI and the CIRS. RESULTS: Out of 244 COPD patients who underwent PR for an average of 21 days, 59 (24 %) suffered AECOPD that required treatment during PR. The 22 patients with AECOPD had a mean CCI of 6.77 (SD: 1.97) and the 22 patients without AECOPD had a mean CCI of 4.32 (SD: 1.17). This difference of -2.45 was statistically significant at a level of significance of 5 % (p < 0.001; 95 % CI: [-3.45; -1.46]). The ROC analysis led to 6 as the optimal cut-off point for the CCI, with 81.8 % sensitivity for determining an AECOPD and 86.4 % specificity with an area under the curve (AUC) value of 0.87. The optimal cut-off point for CIRS was 19 with a sensitivity of 50 %, a specificity of 77.2 % and an AUC of 0.65. CONCLUSION: COPD patients with acute exacerbation during PR have a higher CCI. The CCI allows the risk of AECOPD to be assessed with high sensitivity and specificity in participants with COPD in an inpatient PR program.

[Classification of floater patients : Evaluation of a study database on the relationship between characteristics and impairment]. / Typisierung von Floaterpatienten : Auswertung einer Studiendatenbank zum Zusammenhang von Merkmalen und Beeinträchtigung.

Subjective impairment of floater patients can only be partially quantified using ophthalmological test methods. In order to classify floater patients, patient-related characteristics associated with higher level of impairment should be identified. A data set of a prospective, multicenter single-arm primary study of 64 floater patients who underwent vitrectomy includes patient-related characteristics and information on subjective preoperative and postoperative (3 months after vitrectomy) impairment. Data on impairment were collected with a floater-specific questionnaire and condensed into self-rated impairment indices (SRI). Medians of the SRI were calculated for the manifestation of sociodemographic and ophthalmological parameters as well as for the classification of floaters on the study and second eye and tested for significance. Higher preoperative SRI were associated with professional activity, young age, reduced preoperative visual acuity, retinal alterations and higher refractive errors as well as floaters on the second eye. Higher postoperative SRI were found in combination with cataract and younger age. The SRI differences were only occasionally significant. Classification of floaters as documented by the surgeon and by SRI were significantly correlated only for patients without other visual comorbidities besides floaters. The primary study reported high preoperative subjective impairment and a significant decrease in SRI after vitrectomy for almost all patients. The current study showed that some individual patient-related characteristics tended to be associated with greater preoperative impairment and greater benefit from vitrectomy.