RESUMEN
This study aimed to develop nomograms to predict high hospitalization costs and prolonged stays in hospitalized acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with community-acquired pneumonia (CAP), also known as pAECOPD. A total of 635 patients with pAECOPD were included in this observational study and divided into training and testing sets. Variables were initially screened using univariate analysis, and then further selected using a backward stepwise regression. Multivariable logistic regression was performed to establish nomograms. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curve, and decision curve analysis (DCA) in both the training and testing sets. Finally, the logistic regression analysis showed that elevated white blood cell count (WBC>10 × 109 cells/l), hypoalbuminemia, pulmonary encephalopathy, respiratory failure, diabetes, and respiratory intensive care unit (RICU) admissions were risk factors for predicting high hospitalization costs in pAECOPD patients. The AUC value was 0.756 (95% CI: 0.699-0.812) in the training set and 0.792 (95% CI: 0.718-0.867) in the testing set. The calibration plot and DCA curve indicated the model had good predictive performance. Furthermore, decreased total protein, pulmonary encephalopathy, reflux esophagitis, and RICU admissions were risk factors for predicting prolonged stays in pAECOPD patients. The AUC value was 0.629 (95% CI: 0.575-0.682) in the training set and 0.620 (95% CI: 0.539-0.701) in the testing set. The calibration plot and DCA curve indicated the model had good predictive performance. We developed and validated two nomograms for predicting high hospitalization costs and prolonged stay, respectively, among hospitalized patients with pAECOPD. This trial is registered with ChiCTR2000039959.
Asunto(s)
Infecciones Comunitarias Adquiridas , Hospitalización , Tiempo de Internación , Nomogramas , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Anciano , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/economía , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/terapia , Infecciones Comunitarias Adquiridas/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Persona de Mediana Edad , Neumonía/economía , Neumonía/epidemiología , Costos de Hospital/estadística & datos numéricos , Curva ROC , Factores de Riesgo , Anciano de 80 o más Años , Modelos Logísticos , Recuento de LeucocitosRESUMEN
The purpose of this study was to establish a nomogram for predicting community-acquired pneumonia (CAP) in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The retrospective cohort study included 1249 hospitalized patients with AECOPD between January 2012 and December 2019. The patients were divided into pneumonia-complicating AECOPD (pAECOPD) and non-pneumonic AECOPD (npAECOPD) groups. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were utilized to identify prognostic factors. A prognostic nomogram model was established, and the bootstrap method was used for internal validation. Discrimination and calibration of the nomogram model were evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Logistic and LASSO regression analysis showed that C-reactive protein (CRP) >10 mg/L, albumin (Alb) <40 g/L, alanine transferase (ALT) >50 U/L, fever, bronchiectasis, asthma, previous hospitalization for pAECOPD in the past year (Pre-H for pAECOPD), and age-adjusted Charlson score (aCCI) ≥6 were independent predictors of pAECOPD. The area under the ROC curve (AUC) of the nomogram model was 0.712 (95% CI: 0.682-0.741). The corrected AUC of internal validation was 0.700. The model had well-fitted calibration curves and good clinical usability DCA curve. A nomogram model was developed to assist clinicians in predicting the risk of pAECOPD.China Clinical Trials Registry: ChiCTR2000039959.
Asunto(s)
Asma , Infecciones Comunitarias Adquiridas , Neumonía , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Nomogramas , Estudios Retrospectivos , Infecciones Comunitarias Adquiridas/diagnóstico , Neumonía/diagnósticoRESUMEN
BACKGROUND: Pulmonary thromboembolism (PTE) is a common disease which may be a serious condition and has high mortality. Recently, it has been shown that circRNAs play an important role in the development of various diseases, including thromboembolic disease. However, circRNAs expression profiling is not clear in PTE, this study aims to identify the circRNAs expressed in PTE and to elucidate their possible role in pathophysiology of PTE. METHODS: A total of 5 patients with CTPA-confirmed PTE and 5 healthy controls were recruited for the present study. The circRNAs expression profile was analyzed by microarray. RESULTS: In total, 256 differentially expressed circRNAs (up 142, down114) and 1162 mRNA (up 446, down 716) were summarized by analyzing the circRNAs microarray data. The top 3 up-regulated and 3 down-regulated circRNAs were validated by Real-Time Polymerase Chain Reaction (qRT-PCR). Two differentially expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) were selected for further analysis. Finally, we construct a circRNA-miRNA-mRNA ceRNA network with a bioinformatic prediction tool. Pathway analysis shows that the enriched mRNAs targets take part in Protein processing in endoplasmic reticulum, Systemic lupus erythematosus, Endocytosis, Spliceosome, HTLV-I infection and Ubiquitin mediated proteolysis. CONCLUSION: Our findings indicated that aberrantly expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) may be involved in the development of PTE.
RESUMEN
BACKGROUND: Increasingly, studies have shown that application of pulmonary rehabilitation (PR) may improve the quality of life (QOL) of patients with COPD. However, some studies remain controversial and were limited to small number of participants. We designed a systematic review and meta-analysis to evaluate the efficacy of PR in improving the QOL for subjects with COPD. METHODS: We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to March 29, 2018, to identify relevant randomized controlled trials that analyzed and evaluated the efficacy of PR in subjects with COPD. Participants were randomly assigned to receive PR (intervention group) or usual care (control group). We used Chronic Respiratory Questionnaire scores, which include 4 important domains (ie, Fatigue, Emotion, Mastery, and Dyspnea) as the evaluating indicators of QOL. Mean differences with 95% CI were estimated to compare the outcomes of the groups. We also performed subgroup analysis for the pooled results of PR effects in subjects with COPD. In addition, a sensitivity analysis was performed to examine the stability of the combined results. Two reviewers assessed trial quality and extracted data independently. RESULTS: Seventeen randomized controlled trials (N = 1,649 participants) were identified for the present analysis. In comparing PR groups with usual care groups, we identified significant effects in QOL improvement as measured by the Chronic Respiratory Questionnaire scores for fatigue (Mean difference 0.60, 95% CI 0.36-0.84, P < .001), mastery (Mean difference 0.59, 95% CI 0.32-0.85, P < .001), and dyspnea (Mean difference 0.70, 95% CI 0.46-0.94, P < .001), but no clinically important improvement was found in emotion (Mean difference 0.45, 95% CI 0.23-0.67, P < .001) according to the minimal clinically important difference that we defined as mean difference ≥ 0.5 units. CONCLUSION: PR may constitute an important component of COPD management and may be beneficial in improving QOL.