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1.
Respir Care ; 68(12): 1683-1692, 2023 Nov 25.
Article in English | MEDLINE | ID: mdl-37402585

ABSTRACT

BACKGROUND: In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID-19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (ΔP). METHODS: This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. RESULTS: Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, ΔP, and composite variables were tested: oxygenation stretch index ([Formula: see text]/[Formula: see text] divided by ΔP) and ΔP × 4 + breathing frequency (f) (ΔP × 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, ΔP, [Formula: see text]/[Formula: see text], ΔP × 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, ΔP ≥ 14, [Formula: see text]/[Formula: see text] ≤ 152 mm Hg, ΔP × 4 + f ≥ 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. CONCLUSIONS: The oxygenation stretch index, which combines [Formula: see text]/[Formula: see text] and ΔP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Respiration, Artificial , Respiratory Distress Syndrome/therapy , COVID-19/complications , Lung , Respiration
2.
Eur J Case Rep Intern Med ; 8(12): 003004, 2021.
Article in English | MEDLINE | ID: mdl-35059334

ABSTRACT

A 48-year-old Peruvian man was diagnosed with COVID-19 in December 2020. His infection resolved and he was discharged from hospital after 14 days. However, 1 week later he presented with haemoptysis, malaise, pleuritic pain, infected cavitations, bullae, extensive interstitial lung disease and pneumomediastinum. He recovered after antibiotic treatment and was discharged after 8 days. His symptoms may have been due alveolar rupture due to persistent cough during and after diffuse inflammation of the lung parenchyma caused by COVID-19 infection. LEARNING POINTS: SARS-CoV-2 infection may be associated with lung bullae and cavitations as COVID-19 sequelae.Patients with respiratory problems after COVID-19 should be monitored closely and undergo pulmonary tests.COVID-19 patients may experience complications for several months due to bacterial infections.

3.
Eur J Case Rep Intern Med ; 7(9): 001867, 2020.
Article in English | MEDLINE | ID: mdl-32908841

ABSTRACT

We describe a patient with SARS-CoV-2 and severe pneumonia who required mechanical ventilation and developed associated rhabdomyolysis with probable myocardial involvement as evidenced by cardiac enzyme abnormalities and echocardiographic findings. Repeat testing should be done in cases highly suspicious for SARS-CoV-2 as initial molecular tests may be negative, as in our case. LEARNING POINTS: SARS-CoV-2 infection may be associated with rhabdomyolysis and myocarditis.Negative results for SARS-CoV-2 despite a clinical presentation suggestive of COVID-19 disease should be treated with caution.Drugs known to cause rhabdomyolysis and myocarditis should be carefully reviewed when treating SARS-CoV-2 patients.

4.
Respir Res ; 18(1): 175, 2017 09 29.
Article in English | MEDLINE | ID: mdl-28962654

ABSTRACT

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. METHODS: CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. RESULTS: During a median follow up of 65 months (ICR: 36-100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19-1.46, p < 001). CONCLUSIONS: In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings.


Subject(s)
Cardiovascular Diseases/blood , Cardiovascular Diseases/epidemiology , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/epidemiology , Smoking/blood , Smoking/epidemiology , Aged , Biomarkers/blood , Cardiovascular Diseases/diagnosis , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Risk Factors , Smoking/adverse effects , Spirometry/methods , Vascular Calcification/blood , Vascular Calcification/diagnosis , Vascular Calcification/epidemiology
5.
Rev Peru Med Exp Salud Publica ; 34(1): 98-104, 2017.
Article in Spanish | MEDLINE | ID: mdl-28538852

ABSTRACT

The objective of this study was to estimate the prevalence of symptomatic respiratory (SR) cases in the Peruvian population aged 15 years and over between 2013 and 2015. A secondary analysis of the Demographic and Family Health Survey (ENDES) was carried out. The subjects of the study were people aged 15 years and over who answered these interview questions: Do you currently have a cough with phlegm? How long have you had a cough with phlegm? People who had had a cough and phlegm for 15 days or more were defined as having SR. The prevalence of SR was 3.3% in 2013 (95% confidence interval [95% CI]: 2.8-3.9%), 3.8% in 2014 (95% CI: 3.5-4.1%), and 3.3% in 2015 (95% CI: 3.0-3.6%). The prevalence of SR was greater than 5% in people aged 60 years and over, in people in the poorest quintile, and in residents of rural areas. We conclude that 3-4% of Peruvian people aged 15 years and over report cough with phlegm for ≥15 days. The proportion with SR varies according to the region of the country. It is recommended that the expected number of symptomatic SR cases be assessed and that Peruvian healthcare be adjusted as necessary.


Subject(s)
Cough/epidemiology , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Family Health , Female , Health Surveys , Humans , Male , Middle Aged , Peru/epidemiology , Prevalence , Time Factors , Tuberculosis, Pulmonary/diagnosis , Young Adult
6.
Rev. peru. med. exp. salud publica ; 34(1): 98-104, ene.-mar. 2017. ilus, tab
Article in Spanish | LILACS, LIPECS | ID: biblio-991593

ABSTRACT

El objetivo del estudio fue estimar la prevalencia de sintomáticos respiratorios (SR) en población peruana de 15 a más años entre el 2013 y 2015. Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES). Los sujetos de estudio fueron los entrevistados de 15 años a más que completaron las preguntas: ¿actualmente tiene usted tos con flema? y ¿hace cuánto tiempo tiene usted tos con flema?. Se definió como SR a la persona con tos y flema de 15 o más días de duración. La prevalencia de SR el año 2013 fue 3,3% (intervalo de confianza al 95% [IC 95%]: 2,8% a 3,9%), 3,8% el 2014 (IC95%: 3,5% a 4,1%) y 3,3% el 2015 (IC95% de 3,0 a 3,6%). La prevalencia de SR fue mayor al 5% en personas de 60 a más años, en población de los quintiles más pobres y en residentes de zonas rurales. Concluimos que entre tres a cuatro de cada cien peruanos de 15 a más años se reporta tos con flema de ≥15 días. La proporción de SR varía según región del país. Se recomienda evaluar y ajustar la meta de sintomáticos respiratorios esperados para los establecimientos de salud del Perú.


The objective of this study was to estimate the prevalence of symptomatic respiratory (SR) cases in the Peruvian population aged 15 years and over between 2013 and 2015. A secondary analysis of the Demographic and Family Health Survey (ENDES) was carried out. The subjects of the study were people aged 15 years and over who answered these interview questions: Do you currently have a cough with phlegm? How long have you had a cough with phlegm? People who had had a cough and phlegm for 15 days or more were defined as having SR. The prevalence of SR was 3.3% in 2013 (95% confidence interval [95% CI]: 2.8-3.9%), 3.8% in 2014 (95% CI: 3.5-4.1%), and 3.3% in 2015 (95% CI: 3.0-3.6%). The prevalence of SR was greater than 5% in people aged 60 years and over, in people in the poorest quintile, and in residents of rural areas. We conclude that 3-4% of Peruvian people aged 15 years and over report cough with phlegm for ≥15 days. The proportion with SR varies according to the region of the country. It is recommended that the expected number of symptomatic SR cases be assessed and that Peruvian healthcare be adjusted as necessary.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Tuberculosis, Pulmonary/epidemiology , Cough/epidemiology , Peru/epidemiology , Time Factors , Tuberculosis, Pulmonary/diagnosis , Family Health , Prevalence , Health Surveys
7.
PLoS One ; 11(4): e0151856, 2016.
Article in English | MEDLINE | ID: mdl-27100872

ABSTRACT

BACKGROUND: The Global Initiative for Obstructive Lung Diseases (GOLD) defines COPD as a disease that is usually progressive. GOLD also provides a spirometric classification of airflow limitation. However, little is known about the long-term changes of patients in different GOLD grades. OBJECTIVE: Explore the proportion and characteristics of COPD patients that change their spirometric GOLD grade over long-term follow-up. METHODS: Patients alive for at least 8 years since recruitment and those who died with at least 4 years of repeated spirometric measurements were selected from the BODE cohort database. We purposely included the group of non survivors to avoid a "survival selection" bias. The proportion of patients that had a change (improvement or worsening) in their spirometric GOLD grading was calculated and their characteristics compared with those that remained in the same grade. RESULTS: A total of 318 patients were included in the survivor and 217 in the non-survivor groups. Nine percent of survivors and 11% of non survivors had an improvement of at least one GOLD grade. Seventy one percent of survivors and non-survivors remained in the same GOLD grade. Those that improved had a greater degree of airway obstruction at baseline. CONCLUSIONS: In this selected population of COPD patients, a high proportion of patients remained in the same spirometric GOLD grade or improved in a long-term follow-up. These findings suggest that once diagnosed, COPD is usually a non-progressive disease.


Subject(s)
Pulmonary Disease, Chronic Obstructive/pathology , Aged , Disease Progression , Female , Humans , Lung/pathology , Male , Prospective Studies , Severity of Illness Index
8.
Eur Respir J ; 46(3): 640-50, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26160874

ABSTRACT

Multimorbidity frequently affects the ageing population and their co-existence may not occur at random. Understanding their interactions and that with clinical variables could be important for disease screening and management.In a cohort of 1969 chronic obstructive pulmonary disease (COPD) patients and 316 non-COPD controls, we applied a network-based analysis to explore the associations between multiple comorbidities. Clinical characteristics (age, degree of obstruction, walking, dyspnoea, body mass index) and 79 comorbidities were identified and their interrelationships quantified. Using network visualisation software, we represented each clinical variable and comorbidity as a node with linkages representing statistically significant associations.The resulting COPD comorbidity network had 428, 357 or 265 linkages depending on the statistical threshold used (p≤0.01, p≤0.001 or p≤0.0001). There were more nodes and links in COPD compared with controls after adjusting for age, sex and number of subjects. In COPD, a subset of nodes had a larger number of linkages representing hubs. Four sub-networks or modules were identified using an inter-linkage affinity algorithm and their display provided meaningful interactions not discernible by univariate analysis.COPD patients are affected by larger number of multiple interlinked morbidities which clustering pattern may suggest common pathobiological processes or be utilised for screening and/or therapeutic interventions.


Subject(s)
Comorbidity , Information Services , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Age Distribution , Aged , Cluster Analysis , Cohort Studies , Disease Progression , Female , Humans , Male , Middle Aged , Prevalence , Prognosis , Prospective Studies , Registries , Risk Assessment , Sex Distribution , Statistics as Topic , Survival Analysis
9.
Thorax ; 69(9): 799-804, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24969641

ABSTRACT

BACKGROUND: The Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The added value provided by quantifying comorbidities and integrating them to multidimensional indices has not been explored. OBJECTIVE: Compare the prognostic value of the GOLD ABCD categories versus the BMI, Obstruction, Dyspnea, Exercise (BODE) index, and explore the added prognostic value of comorbidities evaluation to this multidimensional assessment. METHODS: From the patients who have been enrolled in the BODE study, we selected the most recent ones who had the available information needed to classify them by the ABCD GOLD categories. Cox proportional hazards ratios for all-cause mortality were performed for GOLD categories and BODE index. The added value of the comorbidity Copd cO-morbidity TEst (COTE) index was also explored using receiver operating curves (ROC) values. RESULTS: 707 patients were followed for 50±30 months including all degrees of airway limitation and BODE index severity. ABCD GOLD predicted global mortality (HR: 1.47; 95% CI 1.28 to 1.70) as did the BODE index (HR: 2.02; 95% CI 1.76 to 2.31). Area under the curve (AUC) of ROC for ABCD GOLD was 0.68; (95% CI 0.64 to 0.73) while for the BODE index was 0.71 (95% CI 0.67 to 0.76). The C statistics value was significantly higher for the observed difference. Adding the COTE index to the BODE index improved its AUC to 0.81 (95% CI 0.77 to 0.85), (χ(2)=40.28, p<0.001). CONCLUSIONS: In this population of COPD patients, the BODE index had a better survival prediction than the ABCD GOLD categories. Adding the COTE to the BODE index was complimentary and significantly improved outcome prediction.


Subject(s)
Pulmonary Disease, Chronic Obstructive/classification , Severity of Illness Index , Aged , Area Under Curve , Comorbidity , Female , Humans , Kaplan-Meier Estimate , Longitudinal Studies , Male , Middle Aged , Prognosis , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/physiopathology , ROC Curve
10.
Eur Respir J ; 44(2): 324-31, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24696115

ABSTRACT

Chronic obstructive pulmonary disease (COPD), although frequent in older individuals, can also occur at younger age; this latter population has not been well described. We reviewed the functional progression of 1708 patients with COPD attending pulmonary clinics. Those with three or more annual spirometries were divided into those who, at enrolment, were ≤ 55 (n = 103) or ≥ 65 (n = 463) years of age (younger and older COPD, respectively). Baseline and annual changes in lung function (forced expiratory volume in 1 s (FEV1)) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) score were recorded and compared between both groups. Severity distribution by Global Initiative for Chronic Obstructive Lung Disease and BODE scores were similar in both groups, except for mild obstruction, which was higher in the younger group. Mean FEV1 decline was 38.8 and 40.6 mL · year(-1), while BODE scores increased 0.19 and 0.23 units per year, for younger and older COPD, respectively. Both groups had similar proportion of FEV1 rapid decliners (42% and 46%, respectively). The severity distribution and progression of disease in younger patients with COPD is similar to that of patients of older age. This observation suggests that younger individuals presenting with COPD develop the disease from an already compromised pulmonary and systemic status, complementing the model of steeper decline of lung function proposed by Fletcher and Peto.


Subject(s)
Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Anthropometry , Body Mass Index , Cohort Studies , Disease Progression , Exercise Tolerance , Female , Forced Expiratory Volume , Humans , Lung/physiopathology , Male , Middle Aged , Models, Statistical , Prospective Studies , Pulmonary Medicine/standards , Respiratory Function Tests , Severity of Illness Index , Spirometry
11.
Chronic Obstr Pulm Dis ; 1(2): 229-238, 2014 Sep 25.
Article in English | MEDLINE | ID: mdl-28848824

ABSTRACT

Rationale: Contrary to the general population, in patients with chronic obstructive pulmonary disease (COPD) a low body mass index (BMI) is associated with excess mortality, while obesity appears protective (obesity paradox). We hypothesized that BMI is associated with a distinct number and expression of comorbidities in patients with COPD. The type of comorbidity may relate to mortality variability. Objectives and Methods: We followed 1659 COPD patients for a median of 51 months [IQR 27-77] with detailed comorbidity records and tracking pulmonary function, exercise capacity, dyspnea, health status, and cause of death. The cohort was categorized into the 5 National Heart Lung and Blood Institute (NHLBI) BMI groups with determination made about each group's relationship to specific comorbidities, clinical parameters and risk for death. Results: Whereas osteoporosis, substance abuse, abdominal aortic aneurism and peripheral arterial disease were more prevalent in patients with low BMI, metabolic and cardiac problems were more frequent in those with high BMI. The BMI was inversely related to the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC)(FEV1 %), BODE (Body mass index, airway Obstruction, Dyspnea, Exercise capacity) index and hyperinflation, had a "U" shape with dyspnea and the St. George's Respiratory Questionaire (SGRQ) score and an inverse "U" with exercise capacity. The crude mortality rate was 60%, 43%, 37%, 36% and 28% from the lowest to highest BMI groups (p<.0001). More respiratory deaths were observed in the lowest BMI group even though they had a lower number of comorbidities. Conclusions: Different BMI categories are associated with distinct clinical expressions of COPD and comorbidity patterns. The relationship between BMI and mortality in patients with COPD remains an unresolved paradox.

12.
PLoS One ; 8(6): e65593, 2013.
Article in English | MEDLINE | ID: mdl-23762399

ABSTRACT

RATIONALE: Epicardial Adipose Tissue (EAT) volume as determined by chest computed tomography (CT) is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population. OBJECTIVES: To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity. METHODS: We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC). EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables. RESULTS: COPD patients had a higher EAT volume [143.7 (P25-75, 108.3-196.6) vs 129.1 (P25-75, 91.3-170.8) cm(3), p = 0.02)] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001) and CRP (r = 0.32, p<0.001) but not with microalbuminuria (r = 0.12, p = 0.13). In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV1%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5-1.3), BMI (B = 7.8, 95% CI: 5.7-9.9) and 6 MWD (B = -0.2, 95% CI: -0.3--0.1), predicted EAT volume. CONCLUSIONS: EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.


Subject(s)
Adipose Tissue/pathology , Lung/pathology , Pericardium/pathology , Pulmonary Disease, Chronic Obstructive/pathology , Adipose Tissue/diagnostic imaging , Adipose Tissue/metabolism , Aged , Albumins/metabolism , Blood Glucose/metabolism , Blood Pressure , Body Mass Index , Case-Control Studies , Cholesterol/blood , Exercise , Female , Humans , Lung/diagnostic imaging , Lung/metabolism , Male , Middle Aged , Pericardium/diagnostic imaging , Pericardium/metabolism , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/metabolism , Radiography , Respiratory Function Tests , Smoking
13.
Respir Med ; 107(5): 702-7, 2013 May.
Article in English | MEDLINE | ID: mdl-23465176

ABSTRACT

BACKGROUND: COPD is an independent risk factor for lung cancer, especially in patients with mild to moderate disease. OBJECTIVE: To determine if performing lung cancer screening in GOLD 1 and 2 COPD patients, results in reduced lung cancer mortality. METHODS: This study compared patients with mild to moderate COPD from 2 cohorts matched for age, gender, BMI, FEV1%, pack-yrs history and smoking status. The screening group (SG) had an annual low dose computed tomography (LDCT). The control group (CG) was prospectively followed with usual care. Lung cancer incidence and mortality densities were compared between groups. RESULTS: From an initial sample of 410 (SG) and 735 (CG) patients we were able to match 333 patients from each group. At the same follow-up time lung cancer incidence density was 1.79/100 person-years in the SG and 4.14/100 person-years in the CG (p = 0.004). The most frequent histological type was adenocarcinoma in both SG and CG (65% and 46%, respectively), followed by squamous cell carcinoma (25% and 37%, respectively). Eighty percent of lung cancers in the SG (16/20) were diagnosed in stage I, and all of CG cancers (35/35) were in stage III or IV. Mortality incidence density from lung cancer (0.08 vs. 2.48/100 person-years, p < 0.001) was lower in the SG. CONCLUSIONS: This pilot study in patients with mild to moderate COPD suggests that screening with LDCT detects lung cancer in early stages, and could decrease lung cancer mortality in that high risk group. Appropriately designed studies should confirm these important findings.


Subject(s)
Early Detection of Cancer/methods , Lung Neoplasms/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/complications , Aged , Female , Forced Expiratory Volume/physiology , Humans , Kaplan-Meier Estimate , Lung Neoplasms/etiology , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Patient Selection , Pilot Projects , Pulmonary Disease, Chronic Obstructive/physiopathology , Radiation Dosage , Spain/epidemiology , Tomography, X-Ray Computed/methods , Vital Capacity/physiology
14.
Am J Respir Crit Care Med ; 186(2): 155-61, 2012 Jul 15.
Article in English | MEDLINE | ID: mdl-22561964

ABSTRACT

RATIONALE: Patients with chronic obstructive pulmonary disease (COPD) are afflicted by comorbidities. Few studies have prospectively evaluated COPD comorbidities and mortality risk. OBJECTIVES: To prospectively evaluate COPD comorbidities and mortality risk. METHODS: We followed 1,664 patients with COPD in five centers for a median of 51 months. Systematically, 79 comorbidities were recorded. We calculated mortality risk using Cox proportional hazard, and developed a graphic representation of the prevalence and strength of association to mortality in the form of a "comorbidome". A COPD comorbidity index (COPD specific comorbidity test [COTE]) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis. We tested the COTE index as predictor of mortality and explored whether the COTE index added predictive information when used with the validated BODE index. MEASUREMENTS AND MAIN RESULTS: Fifteen of 79 comorbidities differed in prevalence between survivors and nonsurvivors. Of those, 12 predicted mortality and were integrated into the COTE index. Increases in the COTE index were associated with an increased risk of death from COPD-related (hazard ratio [HR], 1.13; 95% confidence interval, 1.08-1.18; P < 0.001) and non-COPD-related causes (HR, 1.18; 95% confidence interval, 1.15-1.21; P < 0.001). Further, increases in the BODE and COTE were independently associated with increased risk of death. A COTE score of greater than or equal to 4 points increased by 2.2-fold the risk of death (HR, 2.26-2.68; P < 0.001) in all BODE quartile. CONCLUSIONS: Comorbidities are frequent in COPD and 12 of them negatively influence survival. A simple disease-specific comorbidities index (COTE) helps assess mortality risk in patients with COPD.


Subject(s)
Pulmonary Disease, Chronic Obstructive/mortality , Aged , Comorbidity , Female , Humans , Kaplan-Meier Estimate , Male , Multivariate Analysis , Proportional Hazards Models , Prospective Studies , Pulmonary Disease, Chronic Obstructive/epidemiology , Risk Factors , Spain/epidemiology , United States/epidemiology
15.
Chest ; 139(1): 36-42, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20705800

ABSTRACT

BACKGROUND: Phenotypic characterization of patients with COPD may have potential prognostic and therapeutic implications. Available information on the relationship between emphysema and the clinical presentation in patients with COPD is limited to advanced stages of the disease. The objective of this study was to describe emphysema presence, severity, and distribution and its impact on clinical presentation of patients with mild to moderate COPD. METHODS: One hundred fifteen patients with COPD underwent clinical and chest CT scan evaluation for the presence, severity, and distribution of emphysema. Patients with and without emphysema and with different forms of emphysema distribution (upper/lower/core/peel) were compared. The impact of emphysema severity and distribution on clinical presentation was determined. RESULTS: Fifty percent of the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%). Upper and core zones had the more severe degree of emphysema. Patients with emphysema were older, more frequently men, and had lower FEV(1)%, higher total lung capacity percentage, and lower diffusing capacity of the lung for carbon monoxide. No differences were found between the clinical or physiologic parameters of the different emphysema distributions. CONCLUSIONS: In patients with mild to moderate COPD, although the presence of emphysema has an impact on physiologic presentation, its severity and distribution seem to have little impact on clinical presentation.


Subject(s)
Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Emphysema/etiology , Cross-Sectional Studies , Disease Progression , Female , Follow-Up Studies , Forced Expiratory Volume , Humans , Incidence , Male , Middle Aged , Prevalence , Prognosis , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Emphysema/diagnostic imaging , Pulmonary Emphysema/epidemiology , Retrospective Studies , Severity of Illness Index , Spain/epidemiology , Spirometry , Tomography, X-Ray Computed , Total Lung Capacity
16.
Article in Spanish | LILACS, LIPECS | ID: lil-619868

ABSTRACT

Objetivos: Determinar cuáles son los parásitos intestinales más comunes entre los alumnos que acudieron por sintomatología al Servicio Médico de la Universidad de Piura; determinar si existe asociación entre el tipo de examen parasitológico que se solicita y la detección de parásitos intestinales Materiales y Métodos: Este estudio es un análisis retrospectivo de los exámenes coprológicos (simples y seriados), realizados a los estudiantes de la Universidad de Piura en el Laboratorio del Servicio Médico de esa Universidad, durante Julio del 2000 y Junio del 2002.Resultados: Se analizaron 179 exámenes parasitológicos, de los cuales 118 correspondieron a pacientes del sexo femenino. La edad promedio fue 20.5 ± 2.3 años. Se encontraron 70 casos positivos de parasitosis (39,1% de la población estudiada), de los cuales 41 casos eran mujeres (61,2% del total de mujeres). Giardia lamblia fue el parásito más común, hubo 67 casos: 41 mujeres y 26 varones. Sólo hubo reportes individuales de Ascaris lumbricoides, Endolimax nana e Hymenolepis nana. Según el tipo de examen, hubo 81 exámenes seriados y 98 exámenes simples. Hubo una asociación entre el diagnóstico positivo de parasitosis intestinal y el examen parasitológico seriado (OR=2.2; p=0.01). Conclusiones: Giardia lamblia fue el parásito intestinal más frecuente en los exámenes parasitológicos realizados a los alumnos atendidos en el Servicio Médico de la Universidad de Piura. Por otro lado, el examen parasitológico seriado permitió diagnosticar más casos positivos de parasitosis intestinal.


Objectives: To determine the most frequent intestinal parasites in students with symptoms of intestinal parasitosis in Universidad de Piura; to determine whether exist an association between the type of parasitological exam and the detection of intestinal parasites. Methods: This study is a retrospective analysis of parasitological exams, one stool specimen (OSS) or three stool specimens (TSS), performed to students of Universidad de Piura in the Clinical Laboratory of thtat University, during July 2000 and June 2002. Results: 179 parasitological exams were done, of which 118 were from females. The mean age was 20.5 ± 2.3 years. There were 70 positive cases of parasitosis (39,1% of population studied), in which 41 were females. Giardia lamblia was the most common parasite. There were just individual reports of Ascaris lumbricoides, Endolimax nana and Hymenolepis nana. According to the type of exam, there were 81 TSS exams and 98 OSS exams. There was an association between the positive diagnosis of intestinal parasitosis and the TSS exam (OR=2.2; p=0.01). Conclutions: Giardia lamblia was the most frequent intestinal parasite in the parasitological exams from students attended in the Universidad de Piura. On the other hand, the TSS exam let a more accuracy diagnosis of intestinal parasitosis.


Subject(s)
Humans , Male , Female , Parasitology , Students , Giardia lamblia , Intestinal Diseases, Parasitic , Retrospective Studies , Peru
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