Risk Factors for Length of Hospital Stay in Acute Exacerbation Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study.

Background/Purpose: A patient's length of hospital stay (LHS) is associated with the severity and outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Therefore, identification of patients with prolonged LHS at an early stage can potentially reduce the risk of adverse events and treatment costs in patients with AECOPD. Therefore, this study aimed to explore the independent predictors of prolonged LHS in AECOPD patients. Patients and Methods: This multicenter cross-sectional study was conducted at two tertiary hospitals between January 2019 and August 2020. Demographic data, underlying diseases, symptoms, and laboratory findings were collected. Univariate analysis was used to identify variables with significant differences. A collinearity diagnostic was applied to the selected variables before the establishment of the regression model. Ordinal logistic regression was performed to explore the independent risk factors for prolonged LHS in patients with AECOPD. Results: In total, 598 patients with AECOPD were screened. Finally, the LHS of 111, 218, and 100 patients was <7, 7-10, and ≥11 days, respectively. Significant differences in the 12 variables were found in the univariate analysis. Because collinearities among white blood cells (WBC), neutrophils (NS), and NS% were observed, WBC and NS% were excluded. Subsequently, an ordinal logistic regression model identified that rates of hypertension and chronic cor pulmonale (CCP), neutrophil-lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) were independent predictors of prolonged LHS in AECOPD patients. Conclusion: Collectively, our results showed that inflammatory status, hypertension, and CCP were independently associated with LHS in patients with AECOPD. These data indicate that early and appropriate administration of antibiotics and anti-inflammatory drugs is essential for reducing LHS. Hypertension and CCP were independent predictors of worse outcomes in patients with AECOPD. Therefore, advanced management and care should be provided to AECOPD patients with hypertension and/or CCP on admission.

CLINICAL PECULIARITIES AND PATHOGENETIC DETERMINANTS OF DEVELOPMENT AND PROGRESSION OF CHRONIC PULMONARY HEART WITH ARTERIAL HYPERTENSION.

OBJECTIVE: The aim: To investigate the clinical and pathogenetic peculiarities of formation and course of CCP and the relationship between clinical, hemodynamic and neurohumoral factors of comorbidity development in COPD combined with arterial hypertension (AH). PATIENTS AND METHODS: Materials and methods: The object of the study were 484 patients with COPD. Among them, 350 patients with CCP as a result of cardiac insufficiency/severe congestive heart failure (COPD III-IV) out of aggravation, combined with AH II stage (non-symptomatic organ damage) and 1 - 3 grades, including 55 patients (43 men, 12 women) with compensated CCP (average age 43.7 ± 3.4 years), and 295 patients (212 men and 83 women) with decompensated CCP and chronic heart failure (CHF), average age 63.2 ± 8.9 years. RESULTS: Results: It was found that the development and progression of the left and right CHF in patients with CCP combined with AH occurs due to the disorders of the central hemodynamic, progression of pulmonary hypertension, bronchial obstruction syndrome, neurohumoral and systemic immunoinflammatory activation, disorders of endothelial regulation of vascular tension, overproduction of epithelial and mitogenic growth factors, inducers of apoptosis, and is accompanied by increasing levels of natriuretic peptides. CONCLUSION: Conclusions: The main pathogenetic formation mechanisms of the heart failure on the background of CCP combined with AH are: neurohumoral and systematic immune-inflammatory activation with the development of endothelial dysfunction and (neo)angiogenesis, induction of pathological apoptosis, increase in the intrathoracic pressure, and deposition of blood in the extrathoracic tissues, which result in pulmonary and systemic hypertension, metabolic and hemodynamic remodelling and heart dysfunction.

Ginkgo leaf extract and dipyridamole injection for chronic cor pulmonale: a PRISMA-compliant meta-analysis of randomized controlled trials.

Ginkgo leaf extract and dipyridamole injection (GLED), a kind of Chinese herbal medicine preparation, has been considered as a promising supplementary treatment for chronic cor pulmonale (CCP). Although an analysis of the published literature has been performed, the exact effects and safety of GLED have yet to be systematically investigated. Therefore, a wide-ranging systematic search of electronic databases from which to draw conclusions was conducted. All randomized controlled trials concerning the GLED plus conventional treatments for CCP were selected in the present study. Main outcomes were treatment efficacy, blood gas and hemorrheology indexes, and adverse events. Data from 28 trials with 2457 CCP patients were analyzed. The results indicated that, compared with conventional treatments alone, the combination of conventional treatments with GLED obviously improved the markedly effective rate (RR = 1.44, 95% CI = 1.31-1.58, P < 0.00001) and total effective rate (RR = 1.28, 95% CI = 1.18-1.38, P < 0.00001). Moreover, the hemorrheology (PaO2, P < 0.00001; PaCO2, P < 0.00001; SaO2, P < 0.00001; pH value, P = 0.05) and blood gas indexes (PV, WBHSV, WBMSV, WBLSV, hematocrit and FBG, P < 0.01) of CCP patients were also significantly ameliorated after the combined therapy. The frequency of adverse events did not differ significantly between the two groups (P > 0.05). In summary, evidence from the meta-analysis suggested that the combination of conventional treatments and GLED appeared to be effective and relatively safe for CCP. Therefore, GLED mediated therapy could be recommended as an adjuvant treatment for CCP.

Effect of phentolamine on N terminal B-type natriuretic peptide precursor,blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale / 中国综合临床

Objective To observe the influence of phentolamine on N terminal B-type natriuretic peptide precursor(NT-proBNP),blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale Methods One hundred and one cases patients with chronic cor pulmonale were randomly divided into two groups,51 patients in the treatment group,50 patients in the control group.All patients were treated with normal anti-infection,eliminating phlegm to smooth wheezing antithrombotic for one week,as the same time patients in the treatment group were treated with phentolamine for one week.Through observed the treatment effect of phentolamine to chronic cor pulmonale,the level of NT-proBNP,blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale before and after the treatment were analyzed.Results Compared with before treatment,the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein,plasma D dimer were lower than after one week in two groups,while the level of PO2 was higher.Treatment group:NT-proBNP (1 712.76±572.32) ng/L vs.(271.59±163.05) ng/L,t=20.42,P<0.05,PCO2 (66.34±5.81) mmHg vs.(52.58±5.82) mmHg,t=16.46,P<0.05,PO2 (59.28±6.13) mmHg vs.(73.64±6.10) mmHg,t=23.02,P<0.05,hypersensitive c-reactive protein 86.0(28.0) mg/L vs.23.0(12.0) mg/L,Z=-6.22,P<0.05 mg/L,plasma D-dimer (4 953.37±1 654.09) μg/L vs.(1 847.90±838.66) μg/L,t=17.11,P<0.05.Control group:NT-proBNP (1 527.24±658.70) ng/L vs.(612.58±357.59) ng/L,t=14.52,P<0.05,PCO2 (65.41±5.23) mmHg vs.(56.46±5.65) mmHg,t=13.04,P<0.05,PO2(60.57±5.84) mmHg vs.(67.21±5.19) mmHg,t=-10.06,P<0.05,hypersensitive c-reactive protein 79.0(29.0) mg/L vs.43.0(20.0) mg/L,Z=-6.16,,P<0.05,plasma D-dimer (4 408.02±1 682.83) μg/L vs.(2 598.28±1 242.73) μg/L,t=12.15,P<0.05.But the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer reduced significantly,the level of PO2 increased more significantly in treatment group(t(z)=-6.19,-3.39,-7.16,-3.56,5.70,all P<0.05).Conclusion Phentolamine can reduce the level of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer and increased the level of PO2 in patients with chronic cor pulmonale.Phentolamine combined with routine treatment can improve the clinical efficacy of patients with chronic cor pulmonale.

Relationship between inflammation and blood coagulation function for the prognosis in the patients with acute exacerbation of chronic cor pulmonale / 实用医学杂志

Objective To investigate the relationship between inflammation and blood coagulation function in the patients with acute exacerbation of chronic cor pulmonale (AECCP) and discuss the potential mechanism and influence on the patients. Methods The present study was based on 30 healthy controls and 141 cases of AECCP in our hospital from January 2011 to June 2014.Levels of white blood cell (WBC), neutrophil (NEUT), high-sensitivity C-reactive protein (hs-CRP, Complement 3 (C3), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and thrombin time (TT) in the patients were determined. Results Compared with the healthy controls, the patients had higher levels of WBC, NEUT, hs-CRP, PT, APTT, FIB, TT (all P < 0.001) and lower level of C3 (P < 0.001). Significant positive correlations were found between the levels of WBC, NEUT and FIB (r = 0.196 and r = 0.199, both P < 0.05); hs-CRP and APTT, FIB(r = 0.234, P < 0.01 and r = 0.466, P < 0.001); C3 and FIB(r = 0.466, P < 0.001), and significant negative correlations were observed between the levels of C3 and PT, APTT, TT (r=-0.258, P<0.01;r=-0.279, P < 0.01 and r = -0.168, P < 0.05, respectively). Compared with the survival patients, the cases of death had higher levels of WBC and NEUT (both P < 0.01). The area under receiver operating characteristic curve of WBC and NEUT, predicting the prognosis, was 0.666 (95% CI 0.552, 0.780; P < 0.01) and 0.695 (95% CI 0.558, 0.801; P = 0.001) respectively. Conclusions Inflammation and blood coagulation function disorder usually coexist in the patients with AECCP, and are closely associated with the severity. Levels of both WBC and NEUT can be used as prognosis predictors for the patients.

Clinical Observation of Bleeding in Zhongfu on Pulmonary Arterial Hypertension Induced by Chronic Cor Pulmonale / 浙江中医药大学学报

[Objective]It is to observe the clinical effect of bleeding in Zhongfu on pulmonary arterial hypertension induced by chronic cor pulmonale. [Methods]60 cases of patients with chronic cor pulmonale were randomly divided into two groups. Control group was given standardizing normal drugs , and the treatment group was added with bleeding in Zhongfu on the basis treatment above. Pulmonary artery pressure and index of blood rheology were compared between the two groups after 14 days. [Results]Compared with each other,the difference was significant( P<0.05). Indexes of pulmonary artery and blood rheology were al improved obviously after treatment in both groups, especial y in treatment group( P<0.05). [Conclusion]Combination with bleeding in Zhongfu can more effectively increase the clinical effect, low down pulmonary artery pressure and improve blood viscosity.

Expression levels of induced sputum IL-8 and IL-10 and drug intervention effects in patients with acute exacerbated COPD complicated with chronic cor pulmonale at high altitude.

The aim of this study was to assess the expression levels of induced sputum interleukin (IL)-8 and IL-10 levels in patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) complicated with chronic cor pulmonale (CCP) at high altitude, and to evaluate the intervention effects of an inhaled corticosteroid (ICS) and a ß2-adrenoceptor agonist in this disease. A total of 186 patients with AECOPD complicated with CCP were randomly divided into three groups, with 62 cases in each. With regard to the two treatment groups, group A was treated with salmeterol/fluticasone (50 µg/250 µg, respectively) by airway inhalation twice daily, while group B received budesonide (1 mg) as a spray inhalation, twice daily. The routine treatment group (group C) received only routine treatment. The levels of IL-8 and IL-10 in the induced sputum and the predicted percentage of forced expiratory volume in one second (FEV1%pred), partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) were examined on admission and at a stable stage two weeks following treatment. Forty healthy volunteers served as a control group (group D). Compared with group D values, the IL-8 induced sputum level and the PaCO2 were significantly increased, while the level of IL-10, FEV1%pred and the PaO2 were markedly decreased in the three COPD groups prior to treatment. Following treatment, the induced sputum IL-8 level and the PaCO2 were significantly decreased, while the induced sputum IL-10 level, FEV1%pred and the PaO2 were markedly increased in the three treatment groups compared with the values pre-therapy (all P<0.01). The post-treatment parameters were significantly different among the three groups (P<0.01). The results indicate that IL-8 and IL-10 are involved in the airway inflammation of AECOPD complicated by CCP. Treatment with an ICS was demonstrated to be a successful method of reducing the local expression of IL-8 and increasing the local expression of IL-10; however, ICS combined with a long-acting ß2-adrenoceptor agonist (LABA) was more effective than the sole administration of ICS in patients with AECOPD complicated by CCP at high altitude.

Evaluation on Tei index for right heart function of elderly patients with chronic cor pulmonale / 重庆医学

Objective To study the evaluation function of Tei index for right heart function of elderly patients with chronic cor pulmonale .Methods Choosed 98 cases of elderly patients suspected chronic cor pulmonale and 68 cases of the medical health elder-ly population from March 2009 to March 2012 in our hospital as group A and B ,ultrasonic inspection and Tei index were measured , ultrasonic inspection indicators contains ,right room transverse diameter ,the main pulmonary artery diameter ,wall thickness and be-fore in pulmonary artery systolic pressure .Results A group of 31 patients(31 .6% ) with a clear cor pulmonale ultrasonic signs ,42 patients(42 .9% ) did not see clearly cor pulmonale ultrasonic signs ,but there was three tricuspid valve and (or) pulmonary valve re-gurgitation ,27 cases(25 .5% ) patients were not seen clear cor pulmonale ultrasonic signs ,and did not see the tricuspid valve and pulmonary valve regurgitation ,three types of Tei index patients were significantly higher than the group B (P<0 .05) .Conclusion Tei index can reflect patients right heart function and can be used as a sensitive index evaluation .

The relation between platelet activation and hypercoagulability in elderly patients with chronic cor pulmonary exacerbation / 中国免疫学杂志

Objective:To investigate the relation among platelet activation marker(GPⅡb/Ⅲa,CD62p) and amounts of fibrinogen (FG) and of D-dimer (DD) in elderly patients with chronic cor pulmonale exacerbation.Methods:Subjects were divided into four groups (42 elderly patients with chronic cor pulmonale exacerbation,42 elderly patients with chronic cor pulmonale remission stage,30cases of healthy elderly controls and 30 cases of healthy non-elderly controls).Positive rates of GPⅡb/Ⅲa and CD62p were measured with tricolor flow cytometry.We also determined FG and DD in patients with chronic cor pulmonale and in normal controls.Results:Compared with those of chronic cor pulmonale remission stage group,healthy elderly group and healthy non-elderly group,the levels of GPⅡb/Ⅲa,CD62p,FG and DD increased significantly in elderly patients with chronic cor pulmonale exacerbation (all P<0.001).There was a positive correlation between the amount of GPⅡb/Ⅲa or CD62p and the amount of FG and DD in elderly patients with chronic cor pulmonale exacerbation.Conclusion:There is increased coagulation and platelet activity in elderly patients with chronic cor pulmonale exacerbation,and there is a significant correlation between platelet activity and hypercoagulability.

The effect of ultrashortwave diathermy on pulmonary hypertension in patients with chronic pulmonary heart disease / 中华物理医学与康复杂志

Objective To investigate the effect of ultrashortwave diathermy on pulmonary hypertension in patients with chronic cor pulmonale(CCP), and its mechanism. Methods Eighty-seven cases of acute phase CCP were divided into 2 groups: an ultrashortwave treatment group, in which 45 patients were treated with both ultrashortwave diathermy and conventional treatment; and a control group, in which 42 patients received regular treatment. The plasma levels of VEGF, ET-1 and the PaO_2, mPAP and FEV1.0 in the two groups were measured before and after treatment. Results In contrast to the control group, the FEV1.0 and PaO_2 of the experimental group were remar-kably increased, while their VEGF, ET-1 and mPAP were significantly decreased after treatment. VEGF and ET-1 were negatively related to PaO_2, and positively related to mPAP. Conclusions Ultrashortwave therapy is effective in treating pulmonary hypertension in patients with CCP. The mechanism for this may involve the synthesis and release of VEGF and ET-1.

The detection of serum levels of sIL-2R and TNF-? and its significance in patients with chronic cor pulmonale / 中国综合临床

Objective To evaluate the significance of sIL 2R and TNF ? in chronic cor pulmonale.Methods The sIL 2R and TNF ? were detected by means of ELISA.The correlation with PaO 2 and PaCO 2 was analyzed using linear correlation.Results The levels of sIL 2R and TNF ? in patients at exacerbation stage were higher than that of remission stage and normal controls (P

Relationship between PaO_2 and Alterations of Hemorheology in Patients of Chronic Cor Pulmonale with Respiratory Failure / 昆明医科大学学报

A synchronous observation of pH, PaO_2 and PaCO_2in contrast to their corresponding Hb, HCT and Vb was made in 89 cases of chronic cor pulmonale with respiratory failure.The results showed that the Hb, HCT and Vb of the patients were apparently higher than the normal (P

PLASMA LEVELS OF TXB_2, 6-KPGF_(1?), cAMP AND cGMP IN CHRONIC COR PULMONALE / 解放军医学杂志

To investigate the relationship between plasma levels of TXB2, 6-KPGF1?, cAMP and cGMP and the hemodynamics of hypoxemia, 30 patients with chronic cor pulmonale (CCP) were studied. The influence of hypoxemia and isosorbide dinitrate therapy was also observed. The results showed: 1) Plasma TXB2 level was significantly higher and plasma 6- KPGF1? level was significantly lower in CCP patients than in healthy controls. There was a negative correlation between 6 KPGFl? and-Ppa levels and a positive correlation between TXB2, TXB2/ 6 KPGF1? ratio and Ppa levels. 2) High levels of plasma TXB2 and TXB2 / 6-KPGF1? were found in hypoxemia cases when the PaO2 level was less than 6.67 kPa (50 mmHg). 3) Reduced Ppa after isosorbide dinitrate infusion elevated the plasma levels of 6-KPGF1?, cAMP, and the cAMP/cGMP ratio, and reduced those of TXB2 and the TXB2/6-K.PGF1? ratio.