P21 Predicting exacerbation frequency in patients with COPD using established risk factors
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Abstract:
Introduction and Objectives
Exacerbations in COPD significantly affect quality of life and mortality. Predicting which patients are likely to exacerbate most frequently could provide opportunities to introduce treatment strategies to reduce future exacerbations. To determine whether established exacerbation risk factors can predict future exacerbation frequency and to assess the severity of an exacerbation risk factor on exacerbation outcomes.Methods
From the literature we identified risk factors associated with COPD exacerbations and categorised these into 'moderate' and 'severe'. We identified all patients who presented with a severe exacerbation of COPD to our unit from 01 January 2018 to 31 December 2018 and recorded their number of exacerbations over 18 months. Patients were divided into 8 groups based on exacerbation frequency. Standard statistical methods were applied.Results
A total of 213 patients were studied. Across all 8 patient groups there is a positive association between number of exacerbation risk factors and exacerbation frequency. The highest exacerbation frequency group has on average 5.0 severe risk factors compared to 2.3 severe risk factors for the lowest frequency group (p<0.001), and 2.7 moderate risk factors compared to 1.8 moderate risk factors for the lowest frequency group (p<0.05).Conclusions
The study demonstrates that it is possible to predict future exacerbation frequency amongst patients with COPD. Identifying which patients are at most risk of exacerbations may help clinicians to introduce pre-emptive individualised treatment strategies to reduce future exacerbation frequency.Keywords:
Copd exacerbation
BACKGROUND:
Adrenomedullin (ADM) is a regulatory peptide with many biological actions, but little is known about its role in patients with COPD exacerbation. The purpose of this study was to evaluate the diagnostic and prognostic value of plasma ADM levels on hospital admission in patients with COPD exacerbation.METHODS:
Consecutive subjects admitted to the hospital for COPD exacerbation were included and were followed up for 1 y; in addition, subjects with stable COPD from an out-patient clinic and healthy volunteers were recruited as controls.RESULTS:
Compared with healthy subjects (145 pg/mL [interquartile range {IQR} 103–290 pg/mL]), plasma ADM levels were significantly higher in subjects with COPD exacerbation (270 pg/mL [IQR 170–510 pg/mL], P = .001) and in subjects with stable COPD (400 pg/mL [IQR 210–525 pg/mL], P < .001). In subjects with COPD exacerbation, ADM levels were significantly elevated during exacerbation (560 pg/mL [IQR 495–630 pg/mL]) compared with the recovery phase (470 pg/mL [IQR 393–553 pg/mL], P = .01) and the stable phase (200 pg/mL [IQR 143–308 pg/mL], P < .001). In receiver operating characteristic analysis, in subjects with COPD exacerbation, ADM had high diagnostic accuracy in differentiating between exacerbation and the stable phase (area under the curve 0.97, 95% CI 0.93–1.02, P < .001). In Cox regression analysis, plasma ADM was not independently associated with 1-y survival (P = .97), but it could accurately predicted the need for ICU care (hazard ratio 1.37, 95% CI 1.09–1.72, P = .008).CONCLUSIONS:
Plasma ADM is a valuable biomarker to confirm COPD exacerbation; furthermore, plasma ADM independently predicts the need of ICU care, although it is not associated with long-term mortality in patients with COPD exacerbation.Interquartile range
Copd exacerbation
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Background/aim: Respiratory and peripheral muscle strength are reduced in chronic obstructive pulmonary disease (COPD). There is a well-known correlation between handgrip strength (HGS) and strenght extremity muscles. Our aim in this study was to measure HGS and investigate the related factors in COPD patients with exacerbation.Materials and methods: Subjects with COPD exacerbation (n = 101) and stable COPD (n = 22), and subjects without COPD (n = 201), were enrolled in this study. Age, sex, and body mass index were similar. HGS was measured using a Vigorimeter. Pulmonary function tests and 6-min walk tests were performed.Results: The mean HGS was significantly lower in subjects with COPD exacerbation than those with stable COPD and subjects without COPD. The mean HGS was similar between stable COPD and non-COPD subjects. The mean 6-min walk distance (6MWD) was significantly lower in subjects with COPD exacerbation than stable COPD. There was a significant correlation between HGS and 6MWD but no correlation between HGS and pulmonary function tests.Conclusion: In subjects with COPD exacerbation, the HGS was lower than that of stable COPD patients, and this difference was not explained by age, comorbidities, severity of obstruction, or smoking. Physical inactivity and steroid use during exacerbation might be possible factors affecting HGS. HGS was moderately correlated with 6MWD in cases of exacerbation. It may be used as a measure of muscle performance in COPD exacerbation, especially when the 6-min walk test cannot be performed
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