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Introduction: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care unit (ICU) are exposed to poor clinical outcomes, and no specific prognostic models are available among this population. We aimed to develop and validate a risk score for prognosis prediction for these patients. Methods: This was a multicenter observation study. AECOPD patients admitted to ICU were included for model derivation from a prospective, multicenter cohort study. Logistic regression analysis was applied to identify independent predictors for in-hospital death and establish the prognostic risk score. The risk score was further validated and compared with DECAF, BAP-65, CURB-65, and APACHE II score in another multicenter cohort. Results: Five variables were identified as independent predictors for in-hospital death in APCOPD patients admitted to ICU, and a corresponding risk score (PD-ICU score) was established, which was composed of procalcitonin >0.5 μg/L, diastolic blood pressure <60 mm Hg, need for invasive mechanical ventilation, disturbance of consciousness, and blood urea nitrogen >7.2 mmol/L. Patients were classified into three risk categories according to the PD-ICU score. The in-hospital mortality of low-risk, intermediate-risk, and high-risk patients was 0.3%, 7.3%, and 27.9%, respectively. PD-ICU score displayed excellent discrimination ability with an area under the receiver-operating characteristic curve (AUC) of 0.815 in the derivation cohort and 0.754 in the validation cohort which outperformed other prognostic models. Conclusion: We derived and validated a simple and clinician-friendly prediction model (PD-ICU score) for in-hospital mortality among AECOPD patients admitted to ICU. With good performance and clinical practicability, this model may facilitate early risk stratification and optimal decision-making among these patients. [ABSTRACT FROM AUTHOR]

Haidong He,1 Shuihua Sun,2 Weihua Xu,1 Mingwan Zhang3 1Department of Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, People’s Republic of China; 2Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, People’s Republic of China; 3Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, People’s Republic of ChinaCorrespondence: Haidong He, Department of Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Cuiyuan Street, Xihu District, Hangzhou City, Zhejiang Province, 310012, People’s Republic of China, Tel +86-571-89972427, Email hhd0901190040@163.comPurpose: Sangbaipi decoction (SBPD), a traditional Chinese medicine (TCM) prescription, has been widely used to treat acute exacerbation of chronic obstructive pulmonary disease (AECOPD), while the underlying pharmacological mechanism remains unclear due to the complexity of composition.Methods: A TCM-active ingredient-drug target network of SBPD was constructed utilizing the TCM-Systems-Pharmacology database. AECOPD-relevant proteins were gathered from Gene Cards and the Online-Mendelian-Inheritance-in-Man database. Protein–protein interaction, GO and KEGG enrichment analyses of the targets from the intersection of SBPD and AECOPD targets were performed to identify the core signaling pathway, followed by molecular docking verification of its interaction with active ingredients. The network pharmacology results were checked using in-vivo experiments. To induce AECOPD, rats were exposure to combined tobacco smoke and lipopolysaccharide (LPS). Then rats underwent gavage with stigmasterol (SM) after successful modeling. The involvement of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling was investigated using its inhibitor, LY294002. Lung function and histopathology were examined. The levels of inflammatory cytokines in the lung and serum were assessed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blot and/or Enzyme-linked immunosorbent assay (ELISA).Results: SM was recognized as an active ingredient of SBPD and stably bound to Akt1. SM improved lung function and histological abnormalities, concomitant with suppressed PI3K/Akt signaling, downregulated lung and serum Interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) levels and serum transforming growth factor-β (TGF-β) levels and upregulated lung and serum Interleukin 10 (IL-10) levels in AECOPD rats. In AECOPD rats, LY294002 restored lung function, and it also improved lung histological abnormalities and inflammation, which was found to be potentiated by SM.Conclusion: SM targets PI3K/Akt signaling to reduce lung injury and inflammation in AECOPD rats.Keywords: sangbaipi decoction, stigmasterol, acute exacerbation of chronic obstructive pulmonary disease, PI3K/Akt signaling, lung inflammation

Objective To explore the predictive value of Neutrophil-to-lymphocyte ratio (NLR) and fibrinogen-to-albumin ratio (FAR) for elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary hypertension. Methods A total of 50 elderly AECOPD patients with pulmonary hypertension who were hospitalized in the First Hospital of Shanxi Medical University from January to June 2021 were selected as the combined group, and 61 elderly AECOPD patients without pulmonary hypertension during the same period were selected as the control group. The clinical data and laboratory parameters of the patients at admission were collected, the risk factors of pulmonary hypertension in elderly patients with AECOPD were analyzed by multivariate logistic regression, and the predictive value of NLR and FAR for pulmonary hypertension in elderly patients with AECOPD was evaluated by ROC curve. Results There were significant differences in age, body mass index, length of hospital stay, AECOPD severity grade, use of ventilator, intravenous hormone therapy, antibiotic course, NLR, FAR, white blood cell count, neutrophil count, hemoglobin, fibrinogen, D-dimer, procalcitonin, B-type natriuretic peptide, partial pressure of carbon dioxide, right atrial diameter, right ventricular diameter, lymphocyte count, eosinophil count, albumin, oxygenation index, left atrial diameter and left ventricular end-diastolic diameter between the two groups (P

Abstract Background This study aims to construct a model predicting the probability of RF in AECOPD patients upon hospital admission. Methods This study retrospectively extracted data from MIMIC-IV database, ultimately including 3776 AECOPD patients. The patients were randomly divided into a training set (n = 2643) and a validation set (n = 1133) in a 7:3 ratio. First, LASSO regression analysis was used to optimize variable selection by running a tenfold k-cyclic coordinate descent. Subsequently, a multifactorial Cox regression analysis was employed to establish a predictive model. Thirdly, the model was validated using ROC curves, Harrell’s C-index, calibration plots, DCA, and K-M curve. Result Eight predictive indicators were selected, including blood urea nitrogen, prothrombin time, white blood cell count, heart rate, the presence of comorbid interstitial lung disease, heart failure, and the use of antibiotics and bronchodilators. The model constructed with these 8 predictors demonstrated good predictive capabilities, with ROC curve areas under the curve (AUC) of 0.858 (0.836–0.881), 0.773 (0.746–0.799), 0.736 (0.701–0.771) within 3, 7, and 14 days in the training set, respectively and the C-index was 0.743 (0.723–0.763). Additionally, calibration plots indicated strong consistency between predicted and observed values. DCA analysis demonstrated favorable clinical utility. The K-M curve indicated the model’s good reliability, revealed a significantly higher RF occurrence probability in the high-risk group than that in the low-risk group (P

Wenjie Sun,1,&ast; Yeshan Li,2,&ast; Shuxin Tan1 1Graduate School, Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 2Respiratory Department, The Second People’s Hospital of Wuhu City, Wuhu, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yeshan Li, Respiratory Department, The Second People’s Hospital of Wuhu City, Wuhu, Anhui, 241000, People’s Republic of China, Tel +8618055317993, Email liyeshan9177@163.comPurpose: Patients with chronic obstructive pulmonary disease (COPD) often face unknown risks during acute exacerbation of the disease (AECOPD), which could potentially result in mortality. This study aimed to develop and validate a nomogram model for predicting the risk of in-hospital mortality in AECOPD patients.Patients and Methods: Clinical data of patients hospitalized at The Second People’s Hospital of Wuhu City for AECOPD between January 2013 and December 2022 were retrospectively collected. Variables underwent selection through LASSO regression and multivariable logistic regression to develop a nomogram model. The model’s predictive performance was assessed using the concordance index, calibration curve, and decision curve analysis (DCA), with internal validation conducted using the bootstrap method.Results: A total of 1224 patients were included in this study, with 98 (8%) deaths occurring during hospitalization. LASSO regression identified 11 variables, used to construct model A. Further multivariable logistic regression was conducted to select variables with P < 0.05 to establish model B. model B was selected as the final model based on discrimination, calibration, and clinical utility, encompassing variables including acute respiratory failure, lung cancer, heart rate, hemoglobin, absolute neutrophil count, serum albumin, blood urea nitrogen, and serum chloride. The nomogram model achieved a concordance index of 0.858. Internal validation of the model was conducted using the bootstrap method with 500 repetitions, resulting in a concordance index of 0.851 (95% CI: 0.805, 0.893). The calibration curve demonstrated a good fit, with a Hosmer-Lemeshow goodness-of-fit test P-value of 0.520. Moreover, DCA findings suggested patient benefit within a threshold probability range of 0.02 to 0.73, with a maximum net benefit of 0.07.Conclusion: The model constructed in this study has good predictive performance, which helps clinical doctors identify patients at high risk of death early.Keywords: acute exacerbation of chronic obstructive pulmonary disease, prediction model, nomogram

Although rapid progression and a poor prognosis in influenza A virus (IAV) infection–induced acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are frequently associated with metabolic energy disorders, the underlying mechanisms and rescue strategies remain unknown. We herein demonstrated that the level of resting energy expenditure increased significantly in IAV‐induced AECOPD patients and that cellular energy exhaustion emerged earlier and more significantly in IAV‐infected primary COPD bronchial epithelial (pDHBE) cells. The differentially expressed genes were enriched in the oxidative phosphorylation (OXPHOS) pathway; additionally, we consistently uncovered much earlier ATP exhaustion, more severe mitochondrial structural destruction and dysfunction, and OXPHOS impairment in IAV‐inoculated pDHBE cells, and these changes were rescued by melatonin. The level of OMA1‐dependent cleavage of OPA1 in the mitochondrial inner membrane and the shift in energy metabolism from OXPHOS to glycolysis were significantly increased in IAV‐infected pDHBE cells; however, these changes were rescued by OMA1‐siRNA or melatonin further treatment. Collectively, our data revealed that melatonin rescued IAV–induced cellular energy exhaustion via OMA1‐OPA1‐S to improve the clinical prognosis in COPD. This treatment may serve as a potential therapeutic agent for patients in which AECOPD is induced by IAV. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical utility of metagenomic next-generation sequencing (mNGS) in diagnosing invasive pulmonary aspergillosis (IPA) among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the intensive care unit (ICU). Methods: A retrospective analysis was conducted on patients with AECOPD admitted to the ICU of Xinxiang Central Hospital in Henan Province, China, between March 2020 and September 2023, suspected of having IPA. Bronchoalveolar lavage fluid (BALF) samples were collected for fungal culture, the galactomannan (GM) test, and mNGS. Based on host factors, clinical features, and microbiological test results, patients were categorized into 62 cases of IPA and 64 cases of non-IPA. Statistical analysis was performed to compare the diagnostic efficacy of fungal culture, the serum and BALF GM test, and mNGS detection for IPA in patients with AECOPD. Results: 1. The sensitivity and specificity of mNGS in diagnosing IPA were 70.9% and 71.8% respectively, with the sensitivity of mNGS surpassing that of fungal culture (29.0%, P<0.01), serum GM test (35.4%, P<0.01), and BALF GM test (41.9%, P<0.05), albeit with slightly lower specificity compared to fungal culture (90.6%, P >0.05), serum GM test (87.5%, P >0.05), and BALF GM test (85.9%, P >0.05).Combining fungal culture with the GM test and mNGS resulted in a sensitivity of 80.6% and a specificity of 92.2%, underscoring a superior diagnostic rate compared to any single detection method. 2.mNGS accurately distinguished strains of the Aspergillus genus. 3.The area under the ROC curves of mNGS was 0.73, indicating good diagnostic performance. 4.The detection duration for mNGS is shorter than that of traditional fungal culture and GM testing. Conclusion: mNGS presents a pragmatic and highly sensitive approach, serving as a valuable complementary tool to conventional microbiological tests (CMT). Our research demonstrated that, compared to fungal culture and GM testing, mNGS exhibits superior diagnostic capability for IPA among patients with AECOPD. Integration of mNGS with established conventional methods holds promise for improving the diagnosis rate of IPA. [ABSTRACT FROM AUTHOR]

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Attention has been paid to the association between outdoor air pollutants and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Xi'an has special basin topography and meteorological conditions as well as developed industries. All these make the outdoor air pollution in Xi 'an serious. Thus, we wish to assess the association between outdoor air pollutants and AECOPD in Xi'an, China. Daily AECOPD inpatient and outpatient visits in 2018 were collected from the eight first-class large general hospitals at grade 3. Data on pollutants and weather conditions in Xi 'an from January 1 to December 31, 2018 were accessed from Xi 'an Environmental Protection Bureau and Xi 'an Meteorological Bureau. Spearman rank correlation, linear regression, and generalized additive models were used for data analysis. Outdoor air pollutants (PM10, PM2.5, SO2, NO2, and CO) increase the risk of AECOPD. The impact of air pollutants on AECOPD patients has a hysteresis effect. PM10, PM2.5, CO, and NO2 are associated with acute exacerbation in female COPD patients. PM10, PM2.5, CO, SO2, and NO2 are associated with acute exacerbation in old COPD patients (70 < age ≤ 80 years old). CO is associated with acute exacerbation in COPD Patients with eosinophils absolute count ≥ 300/μL. PM10 is associated with acute exacerbation in COPD patients with eosinophils absolute count < 100/μL. Exposure to PM10, PM2.5, SO2, NO2, and CO is positively associated significantly with hospital visits for AECOPD in Xi'an. Various air pollutants have different associations with different types of AECOPD patients. The relationship between O3 and AECOPD still needs to be further explored. [ABSTRACT FROM AUTHOR]

Background: This study aims to construct a model predicting the probability of RF in AECOPD patients upon hospital admission. Methods: This study retrospectively extracted data from MIMIC-IV database, ultimately including 3776 AECOPD patients. The patients were randomly divided into a training set (n = 2643) and a validation set (n = 1133) in a 7:3 ratio. First, LASSO regression analysis was used to optimize variable selection by running a tenfold k-cyclic coordinate descent. Subsequently, a multifactorial Cox regression analysis was employed to establish a predictive model. Thirdly, the model was validated using ROC curves, Harrell's C-index, calibration plots, DCA, and K-M curve. Result: Eight predictive indicators were selected, including blood urea nitrogen, prothrombin time, white blood cell count, heart rate, the presence of comorbid interstitial lung disease, heart failure, and the use of antibiotics and bronchodilators. The model constructed with these 8 predictors demonstrated good predictive capabilities, with ROC curve areas under the curve (AUC) of 0.858 (0.836–0.881), 0.773 (0.746–0.799), 0.736 (0.701–0.771) within 3, 7, and 14 days in the training set, respectively and the C-index was 0.743 (0.723–0.763). Additionally, calibration plots indicated strong consistency between predicted and observed values. DCA analysis demonstrated favorable clinical utility. The K-M curve indicated the model's good reliability, revealed a significantly higher RF occurrence probability in the high-risk group than that in the low-risk group (P < 0.0001). Conclusion: The nomogram can provide valuable guidance for clinical practitioners to early predict the probability of RF occurrence in AECOPD patients, take relevant measures, prevent RF, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

To investigate the value of platelet-to-lymphocyte ratio (PLR) and fibrinogen (Fib) in evaluating the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the elderly. Forty elderly patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of our hospital from January 2020 to December 2022 were selected as AECOPD group. According to the severity of the disease, they were divided into grade I (n=9), grade II (n=17) and grade III (n=14). Forty elderly patients with stable chronic obstructive pulmonary disease (SCOPD) were selected as SCOPD group. The general data, PLR and Fib levels of each group were compared. Logistic regression model was used to analyze the independent risk factors of elderly AECOPD. The predictive value of PLR and Fib for elderly AECOPD was evaluated by receiver operating characteristic curve (ROC). The levels of PLR and Fib in peripheral blood of AECOPD group were higher than those of SCOPD group (P<0.05). The levels of PLR and Fib in elderly patients with AECOPD of different clinical grades were compared, and the differences were statistically significant (P<0.05). Grade III was the highest, followed by grade II, and grade I was the lowest. Logistic regression analysis showed that the odds ratios of PLR and Fib were 1.857 and 2.094, respectively, which were independent risk factors for AECOPD in the elderly (P<0.05). ROC curve analysis showed that the area under the curve of PLR, Fib and their combination in predicting AECOPD in the elderly was 0.862, 0.853 and 0.948, respectively, and the combination of the two had the highest predictive value (sensitivity 87.50 %, specificity 95.00 % ). The levels of PLR and Fib in peripheral blood are related to the severity of AECOPD in elderly patients, and the combination of the two has the highest diagnostic value for AECOPD in elderly patients. [ABSTRACT FROM AUTHOR]

Zihan Zhou,1,2,&ast; Yuhui Wang,2,3,&ast; Yongsheng Wang,1,2 Bo Yang,4 Chuchu Xu,1,2 Shuqin Wang,1,2 Wanchun Yang1,2 1Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China; 2The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China; 3Department of Cardiology, Hefei Hospital Affiliated to Anhui Medical University, Hefei, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China; 4Affiliated Hospital of West Anhui Health Vocational College, The Second People’s Hospital of Lu’an City, Lu’an, 237005, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wanchun Yang, Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China, Email hfey2023@163.comPurpose: To develop and validate a nomogram for assessing the risk of developing hypercapnic respiratory failure (HRF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and Methods: From January 2019 to August 2023, a total of 334 AECOPD patients were enrolled in this research. We employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to determine independent predictors and develop a nomogram. This nomogram was appraised by the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer–Lemeshow goodness-of-fit test (HL test), decision curve analysis (DCA), and clinical impact curve (CIC). The enhanced bootstrap method was used for internal validation.Results: Sex, prognostic nutritional index (PNI), hematocrit (HCT), and activities of daily living (ADL) were independent predictors of HRF in AECOPD patients. The developed nomogram based on the above predictors showed good performance. The AUCs for the training, internal, and external validation cohorts were 0.841, 0.884, and 0.852, respectively. The calibration curves and HL test showed excellent concordance. The DCA and CIC showed excellent clinical usefulness. Finally, a dynamic nomogram was developed (https://a18895635453.shinyapps.io/dynnomapp/).Conclusion: This nomogram based on sex, PNI, HCT, and ADL demonstrated high accuracy and clinical value in predicting HRF. It is a less expensive and more accessible approach to assess the risk of developing HRF in AECOPD patients, which is more suitable for primary hospitals, especially in developing countries with high COPD-related morbidity and mortality.Keywords: acute exacerbation of chronic obstructive pulmonary disease, hypercapnic respiratory failure, nomogram, prediction model

Chuang Cai,1,&ast; Wentan Zeng,2,&ast; Hongwei Wang,3 Shuqi Ren2 1Cancer Research Institute of Zhongshan City, Zhongshan City People’s Hospital, Zhongshan City, Guangdong Province, People’s Republic of China; 2Department of Laboratory Medicine, Tanzhou People’s Hospital of Zhongshan, Zhongshan City Hospital of Integration of TCM & Western Medicine, Zhongshan City, Guangdong Province, People’s Republic of China; 3Department of Pediatrics, Tanzhou People’s Hospital of Zhongshan, Zhongshan City hospital of integration of TCM & western medicine, Zhongshan City, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shuqi Ren, Department of Laboratory Medicine, Tanzhou People’s Hospital of Zhongshan, Zhongshan City hospital of integration of TCM & western medicine, No. 10 Dexiu road, Zhongshan City, Guangdong Province, People’s Republic of China, Tel +8615521067602, Fax +860760-23639928, Email shuchijen@163.com Chuang Cai, Cancer Research Institute of Zhongshan City, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan City, Guangdong Province, 528404, People’s Republic of China, Tel +86 18826431030, Fax +86 0760-88823566, Email caich6@foxmail.comPurpose: Hierarchical management is advocated in China to effectively manage chronic obstructive pulmonary disease (COPD) patients and reduce the incidence and mortality of acute exacerbation of COPD (AE-COPD). However, primary and community hospitals often have limited access to advanced equipment and technology. Complete blood count (CBC), which is commonly used in these hospitals, offers the advantages of being cost-effective and easily accessible. This study aims to evaluate the significance of routine blood indicators in aiding of diagnosing AE-COPD.Patients and Methods: In this research, we enrolled a total of 112 patients diagnosed with AE-COPD, 92 patients with stable COPD, and a control group comprising 60 healthy individuals. Clinical characteristics, CBC parameters, and serum CRP levels were collected within two hours. To assess the associations between NLR/PLR/MLR and CRP by Spearman correlation test. The diagnostic accuracy of NLR, PLR and MLR in AE-COPD was assessed using Receiver Operating Characteristic Curve (ROC) and the area under the curve (AUC). Binary Logistic Regression analysis was conducted for the indicators of NLR, PLR and MLR.Results: We found that patients with AE-COPD had significantly higher levels of NLR, PLR and MLR in contrast to patients with stable COPD. Additionally, the study revealed a noteworthy correlation between CRP and NLR (rs=0.5319, P< 0.001), PLR (rs=0.4424, P< 0.001), and MLR (rs=0.4628, P< 0.001). By utilizing specific cut-off values, the amalgamation of NLR, PLR and MLR augmented diagnostic sensitivity. Binary logistic regression analysis demonstrated that heightened NLR and MLR act as risk factors for the progression of AE-COPD.Conclusion: The increasing levels of NLR, PLR and MLR could function as biomarkers, akin to CRP, for diagnosis and assessment of acute exacerbations among COPD patients. Further research is required to validate this concept. Keywords: acute exacerbation of chronic obstructive pulmonary disease, AE-COPD, neutrophil-lymphocyte ratio, NLR, platelet-lymphocyte ratio, PLR, monocyte-lymphocyte ratio, MLR

Abstract Background Data related to the characteristics, treatments and clinical outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in China are limited, and sex differences are still a neglected topic. Methods The patients hospitalized for AECOPD were prospectively enrolled from ten medical centers in China between September 2017 and July 2021. Patients from some centers received follow-up for 3 years. Data regarding the characteristics, treatments and in-hospital and long-term clinical outcomes from male and female AECOPD patients included in the cohort were analyzed and compared. Results In total, 14,007 patients with AECOPD were included in the study, and 11,020 (78.7%) were males. Compared with males, female patients were older (74.02 ± 10.79 vs. 71.86 ± 10.23 years, P

Chunyan Yang,&ast; Hao Tian,&ast; Guixing Xu, Qin Luo, Mingsheng Sun, Fanrong Liang Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610075, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fanrong Liang, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shi’er Qiao Road, Chengdu, Sichuan, 610075, People’s Republic of China, Email acuresearch@126.comPurpose: The effect of acupuncture as adjunctive therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was controversial. Thus, we aimed to evaluate the effects of acupuncture for treating AECOPD.Methods: Eight databases were searched from database inception to July 30, 2023. All RCTs compared acupuncture plus conventional western medicine with conventional western medicine alone were included. Outcomes were quality of life, lung function, blood oxygen condition, exercise capacity, daily symptoms, duration of hospitalization, and adverse events. The statistical analyses were conducted using Stata 17.0, and methodological quality was measured by the Cochrane bias risk assessment tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence.Results: Twelve studies including 915 patients were included. Compared with conventional western medicine alone, acupuncture combined with conventional western therapy significantly improved quality of life (CAT: MD: − 3.25; 95% CI: − 3.73 to − 2.78, P< 0.001) and arterial blood gas (PaCO2: MD: − 1.85; 95% CI: − 2.74 to − 0.95, P< 0.001; PaO2: MD: 5.15; 95% CI: 1.22 to 9.07, P = 0.01). And for lung function, statistical benefits were found in FEV1/FVC (MD: 4.66; 95% CI: 2.21 to 7.12, P< 0.001), but no difference was seen for FEV1% (MD: 1.83; 95% CI: − 0.17 to 3.83, P = 0.073). There was no significant improvement in exercise capacity (6MWD: MD: 96.69; 95% CI: − 0.60 to 193.98, P = 0.051), hospitalization duration (MD: − 5.70; 95% CI: − 11.97 to 0.58, P = 0.075), and dyspnea (mMRC: MD: − 0.19; 95% CI: − 0.61 to 0.63, P = 0.376) between two groups. Overall bias for CAT and mMRC was in “high” risk, FEV1%, FEV1/FVC, PaCO2, and PaO2 was in “some concern” and 1 RCT assessing hospitalization duration was in “low” risk. And the overall assessments were either moderate, low or very low certainty. Seven trials performed safety assessment of acupuncture, and no serious adverse events were reported.Conclusion: Acupuncture might have auxiliary effects on AECOPD. However, the quality of the evidence is limited, and more high-quality RCTs are needed to be performed in the future.Keywords: acute exacerbation of chronic obstructive pulmonary disease, acupuncture, systematic review, meta-analysis

Abstract Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure (RF) is a chronic respiratory disease that seriously endangers human health. This study aimed to specifically evaluate the relationship between admission heart rate (AHR) and in-hospital mortality in patients with combined AECOPD and RF to better inform clinical treatment. Methods This retrospective cohort study included 397 patients admitted to a Chinese hospital between January 2021 and March 2023. The primary outcome measure was all-cause in-hospital mortality. Multivariate logistic regression analyses were performed to calculate adjusted hazard ratios (OR) with corresponding 95% confidence intervals (CI), and curve fitting and threshold effect were performed to address nonlinear relationships. Results In total, 397 patients with AECOPD/RF were screened. The mean (± SD) age of the study cohort was 72.6 ± 9.5 years, approximately 49.4% was female, and the overall in-hospital mortality rate was 5%. Multivariate logistic regression analysis and smooth curve fitting revealed a nonlinear association between AHR and in-hospital mortality in the study population, with 100 beats/min representing the inflection point. Left of the inflection point, the effect size (OR) was 0.474 (95% CI 0.016 ~ 13.683; p = 0.6635). On the right side, each 1 beat/min increase in AHR resulted in an effect size (OR) of 1.094 (95% CI 1.01 ~ 1.186; p = 0.0281). Conclusions Results of the present study demonstrated a nonlinear relationship between AHR and in-hospital mortality in patients with AECOPD/RF. When AHR was 100 beats/min was a predictor of potential mortality, which increased by 9.4% for every 1 beat/min increase in AHR.

Min Cai,1,&ast; Yue Deng,2,&ast; Tianyang Hu3 1Department of Nephropathy and Rheumatism, Yongchuan Hospital of Chongqing Medical University (The Fifth Clinical College of Chongqing Medical University), Chongqing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Fifth People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 3Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tianyang Hu, Email hutianyang@stu.cqmu.edu.cnPurpose: Acute kidney injury (AKI) is a common complication of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and inflammation is the potential link between AKI and AECOPD. However, little is known about the incidence and risk stratification of AKI in critically ill AECOPD patients. In this study, we aimed to establish risk model based on white blood cell (WBC)-related indicators to predict AKI in critically ill AECOPD patients.Material and Methods: For the training cohort, data were taken from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) database, and for the validation cohort, data were taken from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The study employed logistic regression analysis to identify the major predictors of WBC-related biomarkers on AKI prediction. Subsequently, a risk model was developed by multivariate logistic regression, utilizing the identified significant indicators.Results: Finally, 3551 patients were enrolled in training cohort, 926 patients were enrolled in validation cohort. AKI occurred in 1206 (33.4%) patients in training cohort and 521 (56.3%) patients in validation cohort. According to the multivariate logistic regression analysis, four WBC-related indicators were finally included in the novel risk model, and the risk model had a relatively good accuracy for AKI in the training set (C-index, 0.764, 95% CI 0.749– 0.780) as well as in the validation set (C-index, 0.738, 95% CI: 0.706– 0.770). Even after accounting for other models, the critically ill AECOPD patients in the high-risk group (risk score > 3.44) still showed an increased risk of AKI (odds ratio: 4.74, 95% CI: 4.07– 5.54) compared to those in low-risk group (risk score ≤ 3.44). Moreover, the risk model showed outstanding calibration capability as well as therapeutic usefulness in both groups for AKI and ICU mortality and in-hospital mortality of critical ill AECOPD patients.Conclusion: The novel risk model showed good AKI prediction performance. This risk model has certain reference value for the risk stratification of AECOPD complicated with AKI in clinically.Keywords: risk model, acute kidney injury, prediction, white blood cell, acute exacerbation of chronic obstructive pulmonary disease

Objective: To explore the influencing factors of occurrence nutritional risk in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with type Ⅱ respiratory failure, and to construct a prediction model. Methods:177 patients with AECOPD combined with type Ⅱ respiratory failure admitted to the Inner Mongolia Autonomous Region People’s Hospital from January 2021 to December 2022 were retrospectively selected, patients were divided into nutritional risk group (122 cases) and non-nutritional risk group (55 cases) according to the Nutritional Risk Screening 2002 (NRS2002) score. The influencing factors of occurrence nutritional risk in patients with AECOPD combined with type Ⅱ respiratory failure who were analyzed by univariate and multivariate Logistic regression, and prediction model was constructed according to the regression model. The predictive performance of the prediction model was verified by receiver operating characteristic (ROC) curve. Results: Univariate analysis showed that the age in nutritional risk group was older than that in non-nutritional risk group (P＜0. 05), the course of COPD was longer than that in non-nutritional risk group (P＜0. 05), chronic gastric disease, number of acute exacerbations≥3 times/year, and the modified British Medical Research Council Dyspnea Questionnaire (m MRC) score of grade 3-4 was higher than that in non-nutritional risk group (P＜0. 05), the forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FVC), body mass index (BMI), albumin, prealbumin, grip strength, and oxygen partial pressure (PO2) were lower than those in non-nutritional risk group (P＜0. 05), the neutrophil count/lymphocyte count ratio (NLR), chronic obstructive pulmonary disease assessment test questionnaire (CAT) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were higher than those in non-nutritional risk group (P＜0. 05) . Multivariate Logistic regression analysis showed that advanced age, high m MRC score, chronic gastric disease, and high NLR were risk factors for occurrence nutritional risk in patients with AECOPD combined with type Ⅱ respiratory failure (P＜0. 05), and high FEV1/FVC was protective factor (P＜0. 05) . The area under the curve based on the regression model to predict the nutritional risk of patients AECOPD combined with type Ⅱ respiratory failure was 0. 820, and the sensitivity and specificity were 81. 97% and 83. 64% respectively, the Hosmer-Lemeshow test P＞0. 05, and the model fitting effect was good. Conclusion: Advanced age, high m MRC score, chronic gastric disease and high NLR are risk factors for occurrence nutritional risk in patients with AECOPD combine with type Ⅱ respiratory failure, and high FEV1/FVC is protective factor. Predicting the nutritional risk of patients AECOPD combine with type Ⅱ respiratory failure base on regression models has high value. [ABSTRACT FROM AUTHOR]

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For patients with chronic obstructive pulmonary disease (COPD), the assessment of the treatment efficacy during hospitalization is of importance to the optimization of clinical treatments. Conventional spirometry might not be sensitive enough to capture the regional lung function development. The study aimed to evaluate the feasibility of using electrical impedance tomography (EIT) as an objective bedside evaluation tool for the treatment of acute exacerbation of COPD (AECOPD). Consecutive patients who required hospitalization due to AECOPD were included prospectively. EIT measurements were conducted at the time of admission and before the discharge simultaneously when a forced vital capacity maneuver was conducted. EIT-based heterogeneity measures of regional lung function were calculated based on the impedance changes over time. Surveys for attending doctors and patients were designed to evaluate the ease of use, feasibility, and overall satisfaction level to understand the acceptability of EIT measurements. Patient-reported outcome assessments were conducted. User's acceptance of EIT technology was investigated with a five-dimension survey. A total of 32 patients were included, and 8 patients were excluded due to the FVC maneuver not meeting the ATS criteria. Spirometry-based lung function was improved during hospitalization but not significantly different (FEV1 %pred.: 35.8% ± 6.7% vs. 45.3% ± 8.8% at admission vs. discharge; p = 0.11. FVC % pred.: 67.8% ± 0.4% vs. 82.6% ± 5.0%; p = 0.15. FEV1/FVC: 0.41 ± 0.09 vs. 0.42 ± 0.07, p = 0.71). The symptoms of COPD were significantly improved, but the correlations between the improvement of symptoms and spirometry FEV1 and FEV1/FVC were low (R = 0.1 and -0.01, respectively). The differences in blood gasses and blood tests were insignificant. All but one EIT-based regional lung function parameter were significantly improved after hospitalization. The results highly correlated with the patient-reported outcome assessment (R > 0.6, p < 0.001). The overall acceptability score of EIT measurement for both attending physicians and patients was high (4.1 ± 0.8 for physicians, 4.5 ± 0.5 for patients out of 5). These results demonstrated that it was feasible and acceptable to use EIT as an objective bedside evaluation tool for COPD treatment efficacy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of serum S100 calcium binding protein A2 (S100A2) combined with S100A11 in predicting ventilator associated pneumonia (VAP) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its relationship with prognosis. Methods: 175 AECOPD patients admitted to Taizhou Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2021 to January 2022 were selected, patients were divided into non VAP group and VAP group according to the occurrence of VAP, and AECOPD patients complicated with VAP were divided into death group and survival group according to the 28 days survival situation. Serum S100A2 and S100A11 levels were detected by enzyme linked immunosorbent assay. The influencing factors of VAP in AECOPD patients were analyzed by multivariate Logistic regression analysis, the value of serum S100A2 combined with S100A11 in predicting VAP in AECOPD patients and predicting the value of death in AECOPD patients with VAP were analyzed by receiver operating characteristic (ROC) curve. Results: The incidence of VAP in 175 AECOPD patients was 41.14 %. The levels of serum S100A2 and S100A11 in VAP group were higher than those in non VAP group (P<0.05). Multivariate Logistic regression analysis showed that, prolonged COPD course, increased clinical pulmonary infection score (CPIS), mechanical ventilation time>4 d, re-intubation after admission and increased S100A2 and S100A11 were independent risk factors for VAP in AECOPD patients(P<0.05). The 28 days mortality rate of 72 AECOPD patients complicated with VAP was 19.44 %. Compared with survival group, the serum levels of S100A2 and S100A11 in death group were increased (P<0.05). The area under the curve (AUC)of serum S100A2 combined with S100A11 for predicting VAP in AECOPD patients was 0.858. The AUC of serum S100A2 combined with S100A11 in predicting the death of patients with AECOPD complicated with VAP was 0.798. The value of serum S100A2 combined with S100A11 in predicting the occurrence of VAP in AECOPD patients and predicting the death of AECOPD patients complicated with VAP was greater than that of each index alone. Conclusion: Elevated serum S100A2 and S100A11 levels are associated with VAP and poor prognosis in AECOPD patients, and the value of serum S100A2 combine with S100A11 in predicting VAP and poor prognosis in AECOPD patients is high. [ABSTRACT FROM AUTHOR]

Background: Data related to the characteristics, treatments and clinical outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in China are limited, and sex differences are still a neglected topic. Methods: The patients hospitalized for AECOPD were prospectively enrolled from ten medical centers in China between September 2017 and July 2021. Patients from some centers received follow-up for 3 years. Data regarding the characteristics, treatments and in-hospital and long-term clinical outcomes from male and female AECOPD patients included in the cohort were analyzed and compared. Results: In total, 14,007 patients with AECOPD were included in the study, and 11,020 (78.7%) were males. Compared with males, female patients were older (74.02 ± 10.79 vs. 71.86 ± 10.23 years, P < 0.001), and had more comorbidities (2.22 ± 1.64 vs. 1.73 ± 1.56, P < 0.001), a higher frequency of altered mental status (5.0% vs. 2.9%, P < 0.001), lower diastolic blood pressure (78.04 ± 12.96 vs. 79.04 ± 12.47 mmHg, P < 0.001). In addition, there were also significant sex differences in a range of laboratory and radiographic findings. Females were more likely to receive antibiotics, high levels of respiratory support and ICU admission than males. The in-hospital and 3-year mortality were not significantly different between males and females (1.4% vs. 1.5%, P = 0.711; 35.3% vs. 31.4%, P = 0.058), while female smokers with AECOPD had higher in-hospital mortality than male smokers (3.3% vs. 1.2%, P = 0.002) and male smokers exhibited a trend toward higher 3-year mortality compared to female smokers (40.7% vs. 33.1%, P = 0.146). Conclusions: In AECOPD inpatients, females and males had similar in-hospital and long-term survival despite some sex differences in clinical characteristics and treatments, but female smokers had significantly worse in-hospital outcomes than male smokers. Clinical Trial Registration: Retrospectively registered, registration number is ChiCTR2100044625, date of registration 21/03/2021. URL: http://www.chictr.org.cn/showproj.aspx?proj=121626. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether an early comprehensive pulmonary rehabilitation intervention initiated during hospital admission is safe and effective for patients with acute exacerbation of chronic obstructive pulmonary disease. Design: Prospective randomized controlled study. Subjects/Patients: Patients with acute exacerbation of chronic obstructive pulmonary disease. Methods: In total, 108 patients were randomized to the early comprehensive pulmonary rehabilitation and usual care groups within 48 hours. The 6-min walking distance, quality of life, breathlessness, and inspiratory muscle strength were measured on admission and discharge. Any adverse events of pulmonary rehabilitation were recorded. Results: On discharge, the patients in the early comprehensive pulmonary rehabilitation group had a more significant improvement in the 6-min walking distance (47.5 vs 23.0, p = 0.04). There was no significant difference in quality of life and breathlessness between the 2 groups. In the early comprehensive pulmonary rehabilitation group, inspiratory muscle strength and peak inspiratory flow were significantly improved, and the changes were much more pronounced than in the usual care group. There were no adverse events. Conclusion: Early comprehensive pulmonary rehabilitation is safe and effective for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, and should be performed during the early stage of hospitalization.

IntroductionThe management of nutritional risk has garnered significant attention in individuals diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) due to the high prevalence of malnutrition and its correlation with unfavorable outcomes. While numerous rating scales exist to assist in assessment for both clinical and research purposes, there is considerable variability in the selection of scales based on the characteristics of the study participants and the study design. The objective of this study was to examine the efficacy of the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) in identifying malnutrition and predicting prognosis in elderly AECOPD patients.MethodsFrom January 2022 to December 2022, a consecutive inclusion of elderly AECOPD patients admitted to the First Affiliated Hospital of Zhengzhou University was conducted. Diagnosing malnutrition in patients using PNI and GNRI, comparing the results with the diagnostic outcomes based on the Global Leadership Initiative on Malnutrition (GLIM) criteria through Receiver Operating Characteristic curves. Logistic regression analysis was employed to assess the risks associated with length of stay (LOS), hospitalization costs, and Charlson Comorbidity Index (CCI) based on GLIM, GNRI, or PNI.ResultsA total of 839 elderly AECOPD patients were investigated in the study. The GNRI and PNI demonstrated a sensitivity of 89.5 and 74.1%, specificity of 77.2 and 66.4%, and an area under the curve of 0.834 and 0.702, respectively. The identification of high malnutrition-risk cases using the GLIM, GNRI and PNI were associated with a significant increase in the risk of LOS over 7 days [odds ratio (95% CI) for GLIM, GNRI, PNI: 1.376 (1.033–1.833); 1.405 (1.070–1.846); 1.875 (1.425–2.468)] and higher hospitalization expenses [OR (95% CI) for GLIM, GNRI: 1.498 (1.080–2.080); 1.510 (1.097–2.079)], but not with the CCI.ConclusionAccording to our study, it is possible to use GNRI and PNI as alternatives to GLIM in the context of AECOPD, which makes it easier to identify malnutrition. The utilization of GNRI and PNI as alternatives to GLIM in the context of AECOPD enables the identification of malnutrition. The presence of malnourished individuals experiencing AECOPD is correlated with higher probabilities of extended hospital stays and escalated in-hospital expenses.

Aim and objectives: This study aimed to identify symptom cluster (SC) patterns and change trajectories in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the correlation of the SCs with laboratory and imaging indicators, and the intrinsic association of the SCs with prognostic outcomes and disease burden. Method: Symptom information was collected using a digital evaluation scoring system at the time of admission, on the third day after admission, and upon discharge. Laboratory and imaging examination data were compiled simultaneously. Exploratory factor analysis was used to identify the AECOPD SCs. The number of factors (clusters) was determined by examining factors with eigenvalues ≥1.0, using 0.50 for factor loadings as the minimum cut-off value. Spearman's correlation analysis was used to explore the link between the SCs and laboratory and imaging indicators, as well as the relationship between the severity of the symptoms in different clusters, prognostic outcomes, and disease burden. Results: This study included 148 patients. Three SCs were identified: activity-nutrition SC, breath-sleep SC and respiratory SC. Correlation analysis indicated a connection between the activity-nutrition SC and the white blood cell count, and serum sodium and potassium levels, whereas the breath-sleep SC was correlated with white blood cells and eosinophil counts, serum potassium level, and pleural effusion. Additionally, the respiratory SC was associated with serum calcium and magnesium levels, the partial pressure of carbon dioxide, and C-reactive protein (CRP) level. There was a positive correlation between the activity-nutrition SC and hospitalization cost, as well as between the breath-sleep SC and both the hospitalization length and cost. Conclusion: Patients with AECOPD presented three SCs that affected the length and cost of hospitalization. Concurrently, the severity of the symptoms in the clusters was related to white blood cell and eosinophil counts; serum sodium, potassium, calcium, and magnesium levels; CRP level; the partial pressure of carbon dioxide; and pleural effusion, indicating that the symptoms in each clusters may share related physiological mechanisms. An in-depth exploration of the pathogenesis and intervention paths of health problems is of great significance for promoting precision nursing.

Objective To investigate the application value of blood lactic acid(Lac) and ROX index in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) by nasal humidification high-flow oxygen therapy(HFNC). Methods A total of 82 patients with AECOPD who visited the Department of Respiratory and Critical Care Medicine of the Second Medical Center of the PLA General Hospital from March 2020 to March 2023 were selected as the study subjects and treated with HFNC.Patients were divided into effective(n=53) and ineffective(n=29) groups according to the continuous treatment of HFNC for 48 h.The clinical data and serum Lac and ROX indices were compared between the two groups,and the related factors affecting the ineffective treatment of HFNC were analyzed by a mlogistic regression model,the predictive value of blood Lac and ROX indices for the ineffective treatment of HFNC was analyzed by ROC curve. Results The age,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score,C-reactive protein(CRP),blood Lac before and 12 h after treatment in the ineffective group were all higher than those in the effective group(P

Background: Acute exacerbations occur with varying frequency and severity and impact the natural course of chronic obstructive pulmonary disease (COPD) patients. Pneumococcal vaccination has been shown to decrease the incidence of community-acquired pneumonia and exacerbation rate in COPD patients. There is a paucity of data on the influence of pneumococcal conjugate vaccination on the severity of COPD exacerbations. Objectives: The objectives of this study were to evaluate the severity of exacerbation in pneumococcal vaccinated (vaccinated with 13-valent conjugate vaccine) versus unvaccinated COPD subjects hospitalized with acute exacerbation. Materials and Methods: This was a post hoc analysis of the severity of exacerbation in the subjects of HOPE COPD study. This involved the collection of clinical, radiological, and laboratory data of 120 COPD patients who were hospitalized with an acute exacerbation, 60 of whom had prior pneumococcal vaccination and 60 were unvaccinated. Data of COPD patients at the time of presentation with acute exacerbation were analyzed. Comparison was made between severity parameters such as presence of fever, leukocytosis, respiratory failure, multilobar consolidation, hypotension needing inotropic support, and presence of sepsis between pneumococcal vaccinated and unvaccinated subjects. Results: The occurrence of multilobar consolidation was substantially less in the vaccinated group (60% vs. 6.7%; P = 0.0001). The incidence of fever, leukocytosis, and elevated C-reactive protein was significantly higher in the unvaccinated group. Need for intensive care unit care was higher in the unvaccinated group (58.3% vs. 30% with P = 0.019). The occurrence of new-onset respiratory failure was similar in both the groups although type 2 failure with respiratory acidosis was more in the unvaccinated group. Patients in the unvaccinated group had a higher incidence of sepsis and need for inotropic support as well as assisted ventilation. Conclusions: Prior immunization with 13-valent pneumococcal conjugate vaccine ameliorates the severity of exacerbation in COPD patients needing hospitalization. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalization with acute exacerbation.

Aiming to optimize the diagnosis of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), we conducted a retrospective study enrolling 185 AECOPD patients, of whom 90 were diagnosed with PE based on computed tomography pulmonary angiography (CTPA). Ten characteristic indicators and 27 blood indicators were extracted for each patient. First, we quantified the importance of each indicator for diagnosing PE in AECOPD using fuzzy rough sets (FRS) and selected the more important indicators to construct a support vector machine (SVM) diagnosis model called FRS-SVM. The performance of the proposed diagnosis model on the test sets was compared to that of the logistic regression model. The average accuracy and area under the curve (AUC) of the proposed model for the test sets in 10 independent trials were 94.67% and 0.944, respectively, compared to 80.41% and 0.809 for the logistic regression model. Thus, we validated the higher accuracy and stability of the FRS-SVM for PE diagnosis in patients with AECOPD. This model improved the prediction probability before CTPA and can be used in clinical practice to help doctors make decisions.

Objective: To explore the relationship between red cell index（RCI), lymphocyte/high density lipoprotein ratio（LHR), neutrophil/lymphocyte ratio（NLR） and type II respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and its predictive value for poor short-term prognosis. Methods: The clinical data of 139 AECOPD patients who visited the Second Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 were collected. Patients were divided into respiratory failure group（n=47） and non respiratory failure group（n=92） according to whether they had type II respiratory failure, the prognosis of above patients within 90 days of discharge were followed up, excluded cases of lost to follow-up and death, patients were divided into poor prognosis group（n=26） and good prognosis group（n=101), the RCI, LHR and NLR ratios were calculated, Multivariate Logistic regression analysis affecting for poor short-term prognosis of AECOPD patients, the research value of RCI, LHR and NLR ratios in short-term prognosis of AECOPD patients were analyzed by receiver operating characteristic（ROC） curve. Results: NLR and RCI in respiratory failure group were higher than those in non respiratory failure group, LHR was lower than that in non respiratory failure group（P＜0.05). The course of COPD in poor prognosis group was longer than that in good prognosis group, NLR and RCI were higher than those in good prognosis group, body mass index（BMI） and LHR were lower than those in good prognosis group（P＜0.05）.Multivariate Logistic regression analysis showed that increased NLR, RCI and decreased LHR were independent risk factors for poor short-term prognosis of AECOPD patients（P＜0.05). ROC curve analysis showed that, the area under the curve（AUC） of RCI, LHR and NLR in predicting for poor short-term prognosis of AECOPD patients were 0.720, 0.681 and 0.770 respectively. The combined AUC of three was 0.863, and the AUC of combined prediction was the largest. Conclusion: RCI, LHR and NLR can evaluate the severity of AECOPD patients to a certain extent, which are risk factors for poor short-term prognosis, and have a high predictive value for poor short-term prognosis. [ABSTRACT FROM AUTHOR]

Objective: To explore the mechanism of dendritic cells (DCs), novel regulatory B cells (B10 cells) and Th17/ Treg imbalance in the pathogenesis of patients with chronic obstructive pulmonary disease (COPD) and their correlation with lung function. Methods: According to the "Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease" a total of 93 COPD patients were prospectively selected from the Ninth People's Hospital of Suzhou from May 2019 to December 2021, and 50 healthy subjects were selected as the control group. The patients were followed up for 1 year to observe the occurrence of acute exacerbation COPD (AECOPD), and divided them into stable COPD group and AECOPD group. The course of disease, modified British Medical Research Society dyspnea index (mMRC) classification, COPD assessment test (CAT) score, BODE index score，6 min walking distance (6MWD), arterial partial pressure of oxygen (PaO2 ), arterial carbon dioxide Partial pressure (PaCO2 ) were compared between the two groups; compared the levels of FEV1, FVC, FEV1/FVC, and the percentage of FEV1 to predicted value (FEV1/Pred) in the three groups with peripheral blood DCs, B10 cells, Th17 cells, Treg cells and Th17/Treg, IL-12, IL-10, IL-17A and TGF-β1 levels. To analyze the correlation between peripheral blood DCs cells, B10 cells and Th17/Treg imbalance and pulmonary function indexes in AECOPD group. Logistic regression analysis of independent risk factors for AECOPD. Results: A total of COPD patients had AECOPD events (40.86%). The course of disease, mMRC grade, CAT score, BODE index score, and PaCO2 in AECOPD group were significantly higher than those in COPD stable group (P<0.05)，6MWD and PaO2 were significantly lower than those in COPD group. The levels of FEV1, FVC, FEV1/FVC and FEV1/Pred in the AECOPD group were significantly lower than those in the stable COPD group and control group (P<0.05); the levels of FEV1, FVC, FEV1/FVC and FEV1/Pred in the stable COPD group were significantly lower than those in control group (P<0.05). DCs, B10 cells and Treg cells in AECOPD group were significantly lower than those in stable COPD group and control group, while Th17 expression level and Th17/Treg were significantly higher than that in stable COPD group and control group (P<0.05). DCs, B10 cells and Treg cells in stable COPD phase were significantly lower than those in control group, while Th17 expression level and Th17/Treg were significantly higher than control group (P<0.05). The expression levels of IL-12, IL-10 and TGF-β1 in the AECOPD group were significantly lower than those in the stable COPD group and control group (P<0.05), while IL-17A was significantly higher than that in the stable COPD group and control group. The expression levels of IL-12, IL-10 and TGF-β1 in patients with stable COPD were significantly lower than control group, while IL-17A was significantly higher than control group (P<0.05). Pearson analysis showed that peripheral blood DCs, B10 cells were positively correlated with FEV1, FVC, FEV1/FVC and FEV1/Pred levels (P<0.05), while Th17/Treg was positively correlated with FEV1, FVC, FEV1/ FVC and FEV1/Pred levels all were negatively correlated (P<0.05). Logistic regression analysis found that mMRC grade and Th17/ Treg were independent risk factors of AECOPD (P<0.05). Conclusion: With the progression of COPD, DCs, B10 cells, Th17 cells, Treg cells and Th17/Treg gradually become unbalanced, resulting in disordered expression levels of pro-inflammatory and anti-inflammatory factors. Peripheral blood DCs and B10 cells were positively correlated with lung function levels, while Th17/Treg were negatively correlated with lung function levels. mMRC grade and Th17/Treg are independent risk factors of AECOPD. Therefore, actively intervening in the imbalanced state of immune function in patients has specific and important clinical significance in reducing the immune damage of lung tissue and promoting the improvement of lung function. [ABSTRACT FROM AUTHOR]

AIM: To investigate the effect of Tongsai granules (TSG) on epithelial barrier dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the underlying mechanism. METHODS: Twenty-four Sprague-Dawley rats were randomly divided into control group, model group, TSG group, and moxifloxacin (MXF) +salbutamol (STL) group. Rat COPD model was established over 8 weeks. On day 3 of week 9, the rats with COPD were intratracheally administered Klebsiella pneumoniae to establish the AECOPD model. On days 1 to 2 and 4 to 7 in week 9, saline was administered via oral gavage to the rats in control and model groups, and the rats in TSG and MXF+ STL groups were treated daily with TSG and MXF+STL by gavage, respectively. Peak expiratory flow (PEF), histopathological changes, and the expression levels of interleukin-1β (IL-Ip), IL-6, tumor necrosis factor-α (TNF-α), matrix metalloproteinase 2 (MMP2), MMP9, zonula occludens-1 (ZO-l), E-cadherin (E-Cad) and occludin (OCC) were deter¬mined. Moreover, human bronchial epithelial BEAS-2B cells were exposed to cigarette smoke extract (CSE) and treated with different TSG fractions, and the protein levels of ZO-l, E-Cad, OCC, epidermal growth factor receptor (EGFR), phosphorylated EGFR (p-EGFR), extracellular signal-regulated kinase (ERK) and phosphorylated ERK (p-ERK) were determined. RESULTS: Treatment with TSG significantly reduced bronchial wall thickness, mean linear intercept, and the levels of IL-1β, IL-6, TNF-α, MMP2 and MMP9 (P<0. 05 or P<0. 01), significantly increased mean alveolar number and PEF (P<0. 01), and up-regulated the ZO-1, E-Cad and OCC protein levels (P<0. 01) in the lungs of AECOPD rats. Treatment with TSG2, the second TSG fraction, increased the protein levels of ZO-1, E-Cad and OCC in a dose-dependent manner in CSE-exposed BEAS-2B cells (P<0. 05 or P<0. 01). Network pharmacology analysis of 328 targets of the com¬pounds in TSG2 and 3 864 genes related to AECOPD suggested that TSG2 relieved AECOPD likely through the regulation of ERBB2, ERK, EGFR, IL and WNT signaling pathways. Treatment with TSG2 also inhibited CSE-induced increases in p-EGFR and p-ERK levels in BEAS-2B cells (P<0. 05 or P<0. 01). CONCLUSION: Treatment with TSG could maintain airway epithelial barrier function in AECOPD rats, likely through the inhibition of EGFR/ERK signaling pathway. [ABSTRACT FROM AUTHOR]

Zhigan Lv,1,2,&ast; Guohua Liang,3,4,&ast; Mengyu Cheng5,6 1Department of Anesthesiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2Department of Anesthesiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 3Department of Intensive Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 4Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mengyu Cheng, Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan, Shanxi, 030032, People’s Republic of China, Tel +8613994237390, Email cmyy1979@163.comObjective: To confirm whether growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity 2 (sST2) are indicators of pulmonary hypertension in acute exacerbation of chronic obstructive pulmonary disease (AECOPD-PH).Methods: All patients admitted to the hospital with AECOPD between July 2020 and October 2021 were enrolled. The patients were then categorized into AECOPD and AECOPD-PH groups according to PH probability, and the differences in GDF-15 and sST2 serum levels in the AECOPD and AECOPD-PH groups were compared. Correlation analysis was carried out to explore the association between GDF-15 and sST2 serum levels and the length of hospital stay of patients with AECOPD-PH. Receiver operating characteristic curve analysis was used to assess the clinical significance of GDF-15 and sST2 in predicting patients with AECOPD-PH.Results: Included in this study were 126 patients with AECOPD, including 69 with AECOPD and 57 with AECOPD-PH. The serum levels of GDF-15 and sST2 in the AECOPD-PH group were significantly higher than those in the AECOPD group (P < 0.05). There was no significant correlation between the length of hospital stay in AECOPD-PH patients and GDF-15 and sST2 serum levels (P > 0.05). The area under the curves of GDF-15, sST2, and GDF-15 + sST2 for predicting AECOPD-PH and AECOPD-PH patients with poor prognosis were > 0.60 and 0.70, respectively. The optimal cutoff values of GDF-15 and sST2 for predicting AECOPD-PH were 1125.33 pg/mL and 80.68 ng/mL and 1309.72 pg/mL and 59.10 ng/mL for predicting AECOPD-PH patients with poor prognosis, respectively.Conclusion: GDF-15 and sST2 levels may be useful in the prediction of AECOPD-PH.Keywords: acute exacerbation of chronic obstructive pulmonary disease, pulmonary hypertension, soluble suppression of tumorigenicity 2, growth differentiation factor-15

Abstract Background Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. Methods Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. Results Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p

Background: Approximately 3.2 million global deaths occur each year due to chronic obstructive pulmonary disease (COPD), in which exacerbations of COPD remain a prevailing cause. Exacerbations requiring hospitalization are associated with high mortality, and mortality risk is increased with higher exacerbation frequencies. Aims and Objectives: This study aimed to prospectively identify the risk factors of COPD that cause readmission within 90 days after admission to the hospital due to acute exacerbations of COPD. Materials and Methods: An observational study conducted at the School of Pulmonary Excellence, NSCB Medical College, Jabalpur, from the duration of March 2021 to August 2022 with a sample size of 140 estimated through 56% prevalence of readmission rate in available literature. Study participants, including all patients, were readmitted within 90 days after admission due to acute exacerbation of COPD (post-bronchodilator FEV1/FVC 10 was 64% and

Li-Li Zheng,1 Sheng Wang,1 Ze-Geng Li,2 Lei Han,2 Chun-Dong Zhu,1 Chun-Ying Li,1 Xing-Xing Zhang,1 Xue Deng1 1Department of Respiratory Medicine of Geriatrics Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230000, People’s Republic of China; 2Anhui University of Traditional Chinese Medicine, Hefei, 230000, People’s Republic of ChinaCorrespondence: Sheng Wang, Department of Respiratory Medicine, Geriatrics Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, 117 Meishan Road, Shushan District, Hefei, 230000, People’s Republic of China, Tel +86 13855182043, Email wangs_sheng@163.comBackground: This study aims to explore the factors influencing the coagulation function of patients with chronic obstructive pulmonary disease (COPD) and its effects on thrombosis.Methods: A total of 155 COPD patients, including 118 patients with acute exacerbation of COPD (AECOPD) and 37 patients with stable COPD (SCOPD), were enrolled in this study. Meanwhile, 50 patients with gastrointestinal polyps found during physical examination and treated with surgery in the same period were enrolled as the control group. The basic data, routine blood tests, C-reactive protein (CRP), procalcitonin (PCT), and coagulation indexes of the three groups were collected, as well as arterial blood gas indexes of AECOPD patients.Results: The differences in erythrocyte count and hemoglobin among groups were not statistically significant. Compared with the SCOPD group and control group, white blood cell (WBC), neutrophil percentage, PCT, CRP, prothrombin time (PT), and fibrinogen (FIB) in the AECOPD group increased significantly, while the international normalized ratio (INR) decreased (P < 0.05). The differences in activated partial thromboplastin time (APTT) and D-dimer among groups were not statistically significant (P > 0.05). Thrombin time (TT) in the AECOPD group was shorter than that of the control group, and PT was longer than that of the SCOPD group (P < 0.05). Five patients with AECOPD and one patient with SCOPD had venous thrombosis.Conclusion: The abnormal coagulation function in AECOPD patients is related to the degree of infection and hypercapnia, which may be a risk factor for thrombosis.Keywords: acute exacerbation of chronic obstructive pulmonary disease, AECOPD, abnormal coagulation function, infection, thrombosis

Xiaoyi Feng,1,&ast; Huaye Xiao,2,&ast; Yishan Duan,1 Qinxue Li,1 Xuemei Ou1 1Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Fushun People’s Hospital, Zigong, Sichuan, 643200, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xuemei Ou, Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China, Email ouxuemei@163.comObjective: This study aimed to evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) for poor outcomes within 90-day in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods: A retrospective study including 503 AECOPD patients was performed, and the subjects’ clinical characteristics were collected. Binary logistic regression analysis was used to identify risk factors for 90-day poor outcomes in patients with AECOPD. Receiver-operating characteristic curves (ROC) and areas under the curves (AUC) were used to assess the ability of different biomarkers to predict the risk of 90-day mortality, readmission and re-exacerbation in patients with AECOPD.Results: During the follow-up, 188 patients (38.4%) redeveloped exacerbations, 112 patients (22.9%) were readmitted, and 20 patients (4.1%) died directly resulted from COPD or COPD-related causes. Multivariate analysis demonstrated that age> 72 years (OR: 14.817, 95% CI: 1.561– 140.647), NLR> 14.17 (OR: 9.611, 95% CI: 2.303– 40.113), EOS< 0.15% (OR: 8.621, 95% CI: 3.465– 34.913) and BNP> 2840ng/L (OR: 5.291, 95% CI: 1.367– 20.474) at discharge were independent risk factors for 90-day mortality in AECOPD patients. NLR was the optimal biomarker for predicting 90-day mortality with an AUC of 0.802 (95% CI: 0.631– 0.973). Using 14.17 as the critical value of NLR, the sensitivity was 76.7%, and the specificity was 88.9%. Compared with mortality, NLR had no significant advantage in predicting risk of short-term re-exacerbation (AUC=0.580, 95% CI:0.529– 0.632, p=0.001) and readmission (AUC=0.555, 95% CI:0.497– 0.614, p=0.045), with AUCs less than 0.6. In contrast, the predictive value of EOS (AUC=0.561, 95% CI:0.502– 0.621, p=0.038) was slightly better than NLR in terms of readmission within 90 days. CRP did not serve as a well predictive biomarker for the risk of readmission and re-deterioration (p> 0.05).Conclusion: NLR is of great value in predicting the risk of poor outcomes, especially COPD associated mortality, in hospitalized patients with AECOPD within 90 days after discharge.Keywords: acute exacerbation of chronic obstructive pulmonary disease, neutrophil to lymphocyte ratio, mortality, readmission, eosinophil count, C-reactive protein, biomarker

Objective: To explore the value of serum s PLA2-X, 8-hydroxy-2’-deoxyguanosine, and hs CRP levels in diagnosing acute exacerbation of chronic obstructive pulmonary disease. Methods: A total of 128 COPD patients who underwent treatment in our hospital from March 2021 to November 2023 were randomly selected. The patients were divided into a stable group and an AECOPD group based on whether they experienced acute exacerbation. Among them, 29 were in the stable group and 99 were in the AECOPD group. Compare the differences in peripheral blood s PLA2-X, 8-OHd G, and hs CRP levels between the two groups of study subjects; The COX proportional risk factor regression model is used to analyze the influencing factors of AECOPD, and the ROC curve is used to analyze the value of related indicators for individual and combined detection and diagnosis of AECOPD. Results: The FEV1 index in the AECOPD group was significantly lower than that in the stable group, with a statistically significant difference （P＜0. 05）. Compared with the stable group, the peripheral blood s PLA2-X, 8-OHd G, and hs CRP levels in the AECOPD group were significantly increased, with statistical significance （P＜0. 01）. The levels of s PLA2-X, 8-Ohd G, and hs CRP in peripheral blood were positively correlated with GOLD grading （P＜0. 05）, while the levels of s PLA2-X, 8-Ohd G, and hs CRP in peripheral blood were negatively correlated with FEV1/FVC （%）and FEV1%pred（P＜0. 05）. Using the COX proportional risk factor regression model analysis, peripheral blood s PLA2-X, 8-Ohd G, and hs CRP were all independent risk factors affecting AECOPD. The area under the curve （AUC） of peripheral blood s PLA2-X, 8-Ohd G, and hs CRP in diagnosing AECOPD using ROC curve analysis were 0. 689, 0. 708, 0. 642, and 0. 875, respectively. The combined predictive value of each indicator was significantly higher than that of individual detection. Conclusion: The peripheral blood s PLA2-X, 8-Ohd G, and hs CRP levels in AECOPD patients are highly expressed. The levels of s PLA2-X, 8-Ohd G, and hs CRP in peripheral blood are correlated with the severity of lung function and lung function indicators, and can be used as potential predictive indicators for diagnosing acute exacerbation in COPD patients. The combination of the three has higher diagnostic value. [ABSTRACT FROM AUTHOR]

Background: Although many acute exacerbations of COPD (AECOPD) are triggered by non-bacterial causes, they are often treated with antibiotics. Preliminary research suggests that the Chinese herbal medicine “Shufeng Jiedu” (SFJD), may improve recovery and therefore reduce antibiotic use in patients with AECOPD. Aims: To assess the feasibility of conducting a randomised placebo-controlled clinical trial of SFJD for AECOPD in UK primary care. Methods: GPs opportunistically recruited patients experiencing an AECOPD. Participants were randomised 1:1 to usual care plus SFJD or placebo for 14 days. Participants, GPs and research nurses were blinded to treatment allocation. GPs could prescribe immediate, delayed or no antibiotics, with delayed prescribing encouraged where appropriate. Participants were asked to complete a participant diary, including EXACT-PRO and CAT™ questionnaires for up to 4 weeks. Outcomes included recruitment rate and other measures of study feasibility described using only descriptive statistics and with no formal comparisons between groups. We also conducted qualitative interviews with recruited and non-recruited COPD patients and clinicians, analysed using framework analysis. Results: Over 6 months, 19 participants (6 SFJD, 13 placebo) were recruited. Sixteen (84%) participants returned diaries or provided a diary by recall. Overall, 1.3 participants were recruited per 1,000 patients on the COPD register per month open. Median duration of treatment was 9.8 days in the intervention group vs 13.3 days in the placebo group. The main reason for discontinuation in both groups was perceived side-effects. in both groups. Point estimates for both the EXACT-PRO and CAT™ outcomes suggested possible small benefits of SFJD. Most patients and clinicians were happy to try SFJD as an alternative to antibiotics for AECOPD. Recruitment was lower than expected because of the short recruitment period, the lower incidence of AECOPD during the COVID-19 pandemic, patients starting antibiotics from “rescue packs” before seeing their GP, and workforce challenges in primary care. Conclusion: Recruitment was impaired by the COVID-19 pandemic. Nevertheless, we were able to demonstrate the feasibility of recruiting and randomising participants and identified approaches to address recruitment challenges such as including the trial medication in COPD patients’ “rescue packs” and delegating recruitment to a central trials team. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. Methods: Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. Results: Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01). Conclusion: We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD. [ABSTRACT FROM AUTHOR]

Objective To investigate the expression changes of serum microRNA-181a (miR-181a) and Smad homolog 7 (Smad7) expression in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and their relationships with disease severity and airway remodeling. Methods Totally 121 patients with AECOPD were selected (AECOPD group), with severity of disease：52 mild, 46 moderate and 23 severe cases, while 45 patients with stable chronic obstructive pulmonary disease (SCOPD) (SCOPD group) and 42 healthy volunteers (control group) were selected during the same period. Fasting peripheral venous blood was collected from all study subjects, serum was centri⁃ fuged, and serum miR-181a and Smad7 mRNA expression levels were detected by RT-qPCR; 16-row spiral CT was used to perform chest high-resolution scanning, and airway lumen inner diameter, airway lumen outer diameter (D), airway lumen area (WA), and total airway cross-sectional area were measured, and airway wall thickness (T) to D ratio (T/D) and airway wall area as a percentage of total bronchial cross-sectional area (WA%) were calculated. We compared serum miR-181a and Smad7 mRNA expression as well as T/D, WA% in three groups and serum miR-181a and Smad7 mRNA expression as well as T/D, WA% in AECOPD patients with different severity of disease. We analyzed the relationship between serum miR-181a expression and Smad7 mRNA expression and the relationships between serum miR-181a and Smad7 mRNA expression and disease severity and airway remodeling in AECOPD patients. Results Serum miR-181a and Smad7 mRNA expression levels in the AECOPD group were significantly lower than those in the SCOPD and control groups, and T/D and WA% were significantly higher than those in the SCOPD and control groups (all P<0. 05) ; serum miR-181a and Smad7 mRNA expression in the SCOPD group were significantly lower than those in the control group, and T/D and WA% were significantly higher than those in the control group (all P<0. 05) . As the degree of disease grew worse, serum miR-181a and Smad7 mRNA expression levels gradually decreased and T/D and WA% gradually increased in patients with AECOPD (all P<0. 05) . Pearson correlation analysis showed that serum miR-181a expression was positively correlated with Smad7 mRNA expression in patients with AECOPD (P<0. 01) . Spearman correlation analysis showed that serum miR-181a and Smad7 mRNA expression levels in AECOPD patients were negatively correlated with disease severity and WA% and T/D (all P<0. 01) . Conclusion Serum miR-181a and Smad7 mRNA expression was significantly reduced in patients with AECOPD, and their reduced expression was closely associated with disease severity and airway remodeling. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically review the efficacy and safety of fudosteine in the treatment of acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) based on Meta-analysis method. METHODS: CNKI, SinoMed, Wanfang Data, VIP, PubMed, the Cochrane Library, Web of Science and Embase were retrieved for relevant randomized controlled clinical trial of AECOPD (intervention of observation group was conventional therapy combined with fudosteine, intervention of control group was conventional therapy). The retrieval time was from the establishment of the database to Dec. 10th, 2022. The Cochrane risk of bias assessment was used to assess the quality of the included literature, and Meta-analysis was performed by using RevMan 5. 4 software. RESULTS: A total of 15 randomized controlled trials were enrolled, including 1 145 patients with AECOPD. Meta-analysis showed that the total effective rate of observation group was significantly higher than that of control group, and the percentage of forced expiratory volume at one second to forced expiratory capacity ( FEV1 / FVC) and the percentage of forced expiratory volume at one second to predicted (FEV1%Pred) were significantly higher than those of control group, the differences were statistically significant (P<0. 05). There was no significant difference in the incidence of adverse events between two groups (P = 0. 05). CONCLUSIONS: Conventional therapy combined with fudosteine in the treatment of AECOPD can improve the total clinical effective rate, increase the level of FEV1 / FVC and FEV1%Pred, and no severe adverse drug reactions have been observed, with significant efficacy and safety. [ABSTRACT FROM AUTHOR]

Background: Approximately 3.2 million global deaths occur each year due to chronic obstructive pulmonary disease (COPD), in which exacerbations of COPD remain a prevailing cause. Exacerbations requiring hospitalization are associated with high mortality, and mortality risk is increased with higher exacerbation frequencies. Aims and Objectives: This study aimed to prospectively identify the risk factors of COPD that cause readmission within 90 days after admission to the hospital due to acute exacerbations of COPD. Materials and Methods: An observational study conducted at the School of Pulmonary Excellence, NSCB Medical College, Jabalpur, from the duration of March 2021 to August 2022 with a sample size of 140 estimated through 56% prevalence of readmission rate in available literature. Study participants, including all patients, were readmitted within 90 days after admission due to acute exacerbation of COPD (post-bronchodilator FEV1/FVC <0.70). Data analysis was performed using IBM software SPSS 22.0 and statistical association with the confidence interval of 95% and P<0.05. Results: The majority of COPD cases were male (84%) and belonged to the 50–60 years of age group. There was a statistically significant (P=0.001) association between grades of dyspnea and readmission cases. Dyspnea among readmission patients was found to be 100%. The prevalence of CAT score >10 was 64% and <10 is 36% among readmission patients the association was highly significant and more exacerbation leads to more readmission. Conclusion: In the study, various clinical parameters were found statistically significant between the admission and readmission groups. These parameters were CAT score, previous hospitalization history, previous exacerbation history, SpO2, dyspnea grading, and co-morbidities. The lung function test was difficult to do due to many of readmitted patients were not in a condition to do spirometry. [ABSTRACT FROM AUTHOR]

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Xiaojie Su,1,2 Ting Lei,1,2 Haichuan Yu,1,2 Lu Zhang,1,2 Zhouzhou Feng,1,2 Tiankui Shuai,1,2 Hong Guo,1,2 Jian Liu1,2 1The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China; 2Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of ChinaCorrespondence: Jian Liu, Department of Clinical Medicine, the First Clinical Medical College of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou City, Gansu Province, People’s Republic of China, Tel +86 136 0935 4197, Email medecinliu@sina.comPurpose: NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD.Methods: The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients.Results: A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p=0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV1) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV1 ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p=0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p=0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p=0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p< 0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p< 0.0001] showed higher NT-proBNP level.Conclusion: NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.Keywords: amino-terminal pro-brain natriuretic peptide, chronic obstructive pulmonary disease, acute exacerbation of chronic obstructive pulmonary disease, chronic heart failure, meta-analysis

Abstract Background Early prediction of non-invasive ventilation failure by using clinical parameters and scoring systems is a promising strategy for reducing mortality in acute exacerbation of chronic obstructive pulmonary disease patients. Our aim was to assess predictors of non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease and the prognostic role of mid-regional proadrenomedullin. Results Forty-five patients were enrolled, comprising thirty-six males and nine females with mean age 63.4 ± 9.22 years. Mid-regional proadrenomedullin could not predict non-invasive ventilation outcome, while acute physiology and chronic health evaluation score, blood pH, arterial carbon dioxide and platelet count had predictive value. Conclusion Prediction of non-invasive ventilation outcome in acute exacerbation of chronic obstructive pulmonary disease patients is multifactorial and mid-regional proadrenomedullin alone could not predict this outcome.

BackgroundThe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common respiratory disease among older adults, which imposes a significant burden on individuals and society and poses a major challenge to the global public health system due to its high morbidity and mortality. Acupuncture is effective for AECOPD, but its efficacy has been questioned due to the limited methodological quality. Thus, we aim to investigate the efficacy of acupuncture as adjunctive therapy for AECOPD and determine whether the efficacy of acupuncture differs with the type of acupoint combinations.Methods and analysisThis study proposes a prospective, multicenter randomized controlled trial that will comprise four groups, including two acupuncture treatment groups, one sham acupuncture group, and one basic treatment group. The acupuncture treatment groups will be distinguished by their focus on different patterns of acupoint combination, namely the Xi-cleft and He-sea acupoint combination and the Eight Confluence points acupoint combination, which may vary in clinical efficacy based on traditional acupuncture theories. The study aims to randomize 556 patients in a 1:1:1:1 ratio across the four groups. Each patient in acupuncture group or sham acupuncture group will receive routine drug therapy and 7 sessions of acupuncture treatment over 1 week. Participants in the basic treatment group will only receive routine drug therapy. The trial will be conducted in seven hospitals located in China. The primary outcomes in this trial will include differences in the Breathlessness, Cough, and Sputum Scale (BCSS) before randomization, 7 days after randomization, 5 and 9 weeks after randomization.Ethics and disseminationEthical approval was obtained from the Sichuan Regional Ethics Review of Committee on Traditional Chinese Medicine (Approval ID: 2022KL-068). The results of this study will be distributed through peer-reviewed journals.Clinical Trial Registration: ClinicalTrials.gov, identifier ChiCTR2200064484.

Background: Although many acute exacerbations of COPD (AECOPD) are triggered by non-bacterial causes, they are often treated with antibiotics. Preliminary research suggests that the Chinese herbal medicine “Shufeng Jiedu” (SFJD), may improve recovery and therefore reduce antibiotic use in patients with AECOPD.Aims: To assess the feasibility of conducting a randomised placebo-controlled clinical trial of SFJD for AECOPD in UK primary care.Methods: GPs opportunistically recruited patients experiencing an AECOPD. Participants were randomised 1:1 to usual care plus SFJD or placebo for 14 days. Participants, GPs and research nurses were blinded to treatment allocation. GPs could prescribe immediate, delayed or no antibiotics, with delayed prescribing encouraged where appropriate. Participants were asked to complete a participant diary, including EXACT-PRO and CAT™ questionnaires for up to 4 weeks. Outcomes included recruitment rate and other measures of study feasibility described using only descriptive statistics and with no formal comparisons between groups. We also conducted qualitative interviews with recruited and non-recruited COPD patients and clinicians, analysed using framework analysis.Results: Over 6 months, 19 participants (6 SFJD, 13 placebo) were recruited. Sixteen (84%) participants returned diaries or provided a diary by recall. Overall, 1.3 participants were recruited per 1,000 patients on the COPD register per month open. Median duration of treatment was 9.8 days in the intervention group vs 13.3 days in the placebo group. The main reason for discontinuation in both groups was perceived side-effects. in both groups. Point estimates for both the EXACT-PRO and CAT™ outcomes suggested possible small benefits of SFJD. Most patients and clinicians were happy to try SFJD as an alternative to antibiotics for AECOPD. Recruitment was lower than expected because of the short recruitment period, the lower incidence of AECOPD during the COVID-19 pandemic, patients starting antibiotics from “rescue packs” before seeing their GP, and workforce challenges in primary care.Conclusion: Recruitment was impaired by the COVID-19 pandemic. Nevertheless, we were able to demonstrate the feasibility of recruiting and randomising participants and identified approaches to address recruitment challenges such as including the trial medication in COPD patients’ “rescue packs” and delegating recruitment to a central trials team.Clinical Trial Registration: Identifier, ISRCTN26614726

Objectives: To compare the nebulized salbutamol alone with combination of nebulized salbutamol and ipratropium for acute exacerbation of chronic obstructive pulmonary disease in terms of mean length of stay. Study Design: Quasi-experimental study Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi Pakistan. Study was carried out over a period of six months from May to Nov 2017. Methodology: A total of 300 patients of chronic obstructive pulmonary disease (150 in each group) were recruited in the study. Group A received nebulized salbutamol (5mg) alone and Group B received a combination of nebulized salbutamol (5mg) and ipratropium bromide (0.5mg). Results: Mean age of the patients was 66.4±6.4 years and 65.7±6.8 years in Group-A and B, respectively. In Group-A, there were 136(90.7%) and in Group-B 134(89.3%) were males while 14(9.3%) and 16(10.7%) were females in Group-A and B, respectively. Mean duration of disease in Group-A was 5.2±2.4 years and in group-B 6.0±1.6 years. Comparison of mean length of stay (days) revealed in hospital between nebulized Salbutamol alone 5.0±0.5 days with combination of nebulized Salbutamol and Ipratropium 4.3±0.6 days with p-value <0.001. Conclusion: In conclusion, the routine addition of nebulized ipratropium bromide to salbutamol appears to be of benefit in the treatment of acute exacerbations of chronic obstructive pulmonary disease and in terms of mean length of hospital stay. [ABSTRACT FROM AUTHOR]