Dear Editor, Hypertrophic osteoarthropathy (HOA) as a paraneoplastic disorder is most often associated with pulmonary malignancies1. Bone scintigraphy (BS) is known to be useful for detecting HOA1,2. Here, we present a lung cancer patient who demonstrated findings consistent with HOA on BS and somatostatin receptor scintigraphy (SRS). To the best of our knowledge, this is the first report of HOA visualized by SRS. A female aged 67 years, smoker (47 pack-years), presented with a 3-month history of generalized arthralgia, painful edema of the limps, and finger clubbing. BS using 99mTc-MDP demonstrated increased linear periosteal uptake in the long bones of the legs (Figure 1A), a characteristic scintigraphic pattern of HOA. A chest X-ray was done (given her history of smoking) and showed a mass in the right posterior hemithorax confirmed by computed tomography (CT) scan (Figure 2C). Further functional imaging with SRS using 99mTc-octreotide revealed that the pulmonary lesion was positive for somatostatin receptors (Figure 2D). Also, it showed mildly increased tracer uptake along the periosteum of both lower extremities (Figure 1B). Ultimately, histopathological examination revealed lung adenocarcinoma. ΗΟΑ, also named Marie–Bamberger syndrome was first described in the 1890s and is characterized clinically by periostitis of tubular bones, digital clubbing, and arthritic symptoms1. It can be classified as primary (very rare) or secondary (approximately 95% to 97% of cases). Secondary HOA is associated with a wide spectrum of diseases, including a variety of pulmonary disorders, also known as ‘hypertrophic pulmonary osteoarthropathy’ (e.g. primary and metastatic lung cancer, lung abscess, tuberculosis, sarcoidosis, emphysema, bronchiectasis, pulmonary fibrosis, and mesothelioma), cardiovascular disorders (e.g. cyanotic congenital heart disease, infective endocarditis), gastrointestinal disorders (inflammatory bowel disease and hepatic cirrhosis) and various other disorders. Secondary HOA is more frequently related to pulmonary malignancies (in up to 90%), especially lung cancer1. According to published reports, 4% to 32% of lung cancer patients develop HOA3. The clinical manifestations of HOA may precede the diagnosis of the underlying disease. BS is a sensitive imaging modality for evaluating a wide variety of skeletal disorders, including HOA1,2. This modality has higher sensitivity for detecting bone metastases in patients with lung cancer compared to SRS4,5. The exact mechanism of pathogenesis of HOA and clubbing remains unknown. Two models have been proposed: a neurogenic pathway and a humoral pathway. In the neurogenic pathway, diseased organs innervated by the vagus nerve induce a neural reflex leading to vasodilatation and increased blood flow to the extremities6. In the humoral pathway cytokines and growth factors (platelet-derived growth factor, prostaglandin E, and vascular endothelial growth factor) induce connective tissue and periosteal
{"title":"Hypertrophic pulmonary osteoarthropathy on bone scintigraphy and somatostatin receptor scintigraphy","authors":"G. Meristoudis, I. Ilias, V. Giannakopoulos","doi":"10.18332/pne/141590","DOIUrl":"https://doi.org/10.18332/pne/141590","url":null,"abstract":"Dear Editor, Hypertrophic osteoarthropathy (HOA) as a paraneoplastic disorder is most often associated with pulmonary malignancies1. Bone scintigraphy (BS) is known to be useful for detecting HOA1,2. Here, we present a lung cancer patient who demonstrated findings consistent with HOA on BS and somatostatin receptor scintigraphy (SRS). To the best of our knowledge, this is the first report of HOA visualized by SRS. A female aged 67 years, smoker (47 pack-years), presented with a 3-month history of generalized arthralgia, painful edema of the limps, and finger clubbing. BS using 99mTc-MDP demonstrated increased linear periosteal uptake in the long bones of the legs (Figure 1A), a characteristic scintigraphic pattern of HOA. A chest X-ray was done (given her history of smoking) and showed a mass in the right posterior hemithorax confirmed by computed tomography (CT) scan (Figure 2C). Further functional imaging with SRS using 99mTc-octreotide revealed that the pulmonary lesion was positive for somatostatin receptors (Figure 2D). Also, it showed mildly increased tracer uptake along the periosteum of both lower extremities (Figure 1B). Ultimately, histopathological examination revealed lung adenocarcinoma. ΗΟΑ, also named Marie–Bamberger syndrome was first described in the 1890s and is characterized clinically by periostitis of tubular bones, digital clubbing, and arthritic symptoms1. It can be classified as primary (very rare) or secondary (approximately 95% to 97% of cases). Secondary HOA is associated with a wide spectrum of diseases, including a variety of pulmonary disorders, also known as ‘hypertrophic pulmonary osteoarthropathy’ (e.g. primary and metastatic lung cancer, lung abscess, tuberculosis, sarcoidosis, emphysema, bronchiectasis, pulmonary fibrosis, and mesothelioma), cardiovascular disorders (e.g. cyanotic congenital heart disease, infective endocarditis), gastrointestinal disorders (inflammatory bowel disease and hepatic cirrhosis) and various other disorders. Secondary HOA is more frequently related to pulmonary malignancies (in up to 90%), especially lung cancer1. According to published reports, 4% to 32% of lung cancer patients develop HOA3. The clinical manifestations of HOA may precede the diagnosis of the underlying disease. BS is a sensitive imaging modality for evaluating a wide variety of skeletal disorders, including HOA1,2. This modality has higher sensitivity for detecting bone metastases in patients with lung cancer compared to SRS4,5. The exact mechanism of pathogenesis of HOA and clubbing remains unknown. Two models have been proposed: a neurogenic pathway and a humoral pathway. In the neurogenic pathway, diseased organs innervated by the vagus nerve induce a neural reflex leading to vasodilatation and increased blood flow to the extremities6. In the humoral pathway cytokines and growth factors (platelet-derived growth factor, prostaglandin E, and vascular endothelial growth factor) induce connective tissue and periosteal","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"7 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84122338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ioannis Kopsidas, Evangelia Chorianopoulou, Eleni Kourkouni, C. Triantafyllou, Nafsika-Maria Molocha, Markela Koniordou, S. Maistreli, Christina-Grammatiki Tsopela, S. Maroudi-Manta, Dimitrios K Filippou, T. Zaoutis, G. Kourlaba
E. Chousein, Demet Turan, E. Tanrıverdi, B. Yıldırım, Mustafa Çörtük, H. Çınarka, M. Özgül, E. Çetinkaya
INTRODUCTION Adenoid cystic carcinoma (ACC) of the lung is a rare tumor with a propensity to cause central airway obstruction. Prolonged patient survival with high recurrence rates despite surgery, oncologic treatment or interventional bronchoscopic procedures (IBPs) poses long-term management challenges. With this study we aimed to review IBPs and their outcome in patients with ACC. METHODS We retrospectively reviewed the demographics, bronchoscopic findings, IBP treatment modalities and outcomes of patients with a diagnosis of ACC between January 2009 and December 2020. RESULTS There were 13 patients (9 male, 69.2%) with a mean age of 54.61±8.7 years. Trachea was the most involved site (10 cases, 76.9%) and percentage of obstruction was 77±13.9%. Bronchoscopy most commonly identified an endoluminal lesion (84.6%). There was a total of 77 procedures, including 44 rigid and 31 flexible bronchoscopies. Seven patients underwent a single procedure and 6 patients more than one procedure. Most common interventional bronchoscopic treatment modalities used were argon plasma coagulation (40.2%) and mechanical resection (38.9%). Airway stents were inserted in 4 (30.7%) patients. Airway patency was restored following first-line IBP in 93% of patients. The rate of early complications within the first 24 hours was 6.8%. Late complications were seen in 33.7% and were all stent related. No procedure related mortality was observed. CONCLUSIONS ACC affects central airways and most frequently the trachea. IBPs can be repeatedly used in the treatment of ACC because of their low early complication rates. Patients treated with airway stents should be closely followed up for late complications. ABBREVIATIONS ACC: adenoid cystic carcinoma, APC: argon plasma coagulation, CAO: central airway obstruction, COPD: chronic obstructive pulmonary disease, EBUS: endobronchial ultrasonographies, FB: flexible bronchoscopies, IBP: interventional bronchoscopic procedure, IP: interventional pulmonology, RB: rigid bronchoscopies. INTRODUCTION Adenoid cystic carcinomas (ACC) are rarely encountered tumors with a propensity for frequent recurrences originating from secretory glands of the tracheobronchial system that comprise 0.04–0.2% of all lung cancers. Previously classified as benign tumoral lesions, they are currently grouped under low-grade malignant tumors1. Although uncommonly encountered, they can lead to life threatening central airway obstruction (CAO). They progress insidiously, slowly growing longitudinally within the airways. Frequently patients are incorrectly diagnosed with and treated for asthma or chronic obstructive pulmonary disease (COPD). In patients who have already been diagnosed with ACC, worsening respiratory symptoms can be erroneously attributed to comorbidities or side effects of oncologic treatments. Consequently, both the initial diagnosis and the detection of disease progression can be delayed1,2. The treatment of choice is surgical resection. The longter
肺腺样囊性癌(ACC)是一种罕见的肿瘤，有引起中央气道阻塞的倾向。尽管手术、肿瘤治疗或介入支气管镜手术(IBPs)，但高复发率的延长患者生存带来了长期管理挑战。在这项研究中，我们旨在回顾ACC患者的ibp及其预后。方法回顾性分析2009年1月至2020年12月期间诊断为ACC的患者的人口统计学、支气管镜检查结果、IBP治疗方式和结局。结果13例患者中，男性9例，占69.2%，平均年龄54.61±8.7岁。气管为最主要受累部位(10例，76.9%)，梗阻率为77±13.9%。支气管镜检查最常发现腔内病变(84.6%)。总共进行了77次手术，包括44次刚性支气管镜检查和31次柔性支气管镜检查。7例患者接受了单一手术，6例患者接受了不止一次手术。最常见的介入支气管镜治疗方式是氩等离子凝固(40.2%)和机械切除(38.9%)。4例(30.7%)患者植入气道支架。93%的患者在一线IBP后恢复气道通畅。24小时内早期并发症发生率为6.8%。晚期并发症占33.7%，均与支架相关。未观察到手术相关死亡率。结论:ACC累及中央气道，最常累及气管。ibp可反复用于治疗ACC，因为其早期并发症发生率低。接受气道支架治疗的患者应密切随访，以防出现晚期并发症。缩写:ACC:腺样囊性癌，APC:氩浆凝固，CAO:中央气道阻塞，COPD:慢性阻塞性肺疾病，EBUS:支气管内超声检查，FB:柔性支气管镜检查，IBP:介入支气管镜检查，IP:介入肺脏学，RB:刚性支气管镜检查。腺样囊性癌(ACC)是一种罕见的肿瘤，起源于气管支气管系统的分泌腺，有频繁复发的倾向，占所有肺癌的0.04-0.2%。以前被归类为良性肿瘤病变，目前被归为低级别恶性肿瘤1。虽然不常见，但它们可导致危及生命的中央气道阻塞(CAO)。它们在不知不觉中发展，在气道内纵向缓慢生长。患者经常被错误地诊断为哮喘或慢性阻塞性肺疾病(COPD)并接受治疗。在已经被诊断为ACC的患者中，呼吸系统症状的恶化可能被错误地归因于合并症或肿瘤治疗的副作用。因此，初始诊断和疾病进展的检测都可以延迟1,2。治疗的选择是手术切除。如果手术完全切除，远期预后良好。如果在切除边缘发现残留肿瘤，则需要术后放疗或/和化疗。尽管有这些治疗方法，复发率和局部侵袭率仍然很高。IBP在不适合手术或肿瘤复发的患者中被考虑，当需要紧急治疗气道阻塞时。通过IBP固定气道可以快速缓解症状，有时可以让患者在手术前有更多的时间。一些研究报道IBP可长期存在1土耳其伊斯坦布尔卫生科学大学Yedikule胸病与胸外科培训与研究医院肺科Efsun G. Uğur Chousein通讯。哈萨克斯坦卫生科学大学Yedikule胸部疾病和胸外科培训与研究医院肺病科，Belgrat Kapi yolu Cad No . 1, 34020 Zeytinburnu，伊斯坦布尔，土耳其。电子邮件:efsungoncachousein@yahoo.com或ID: https://orcid.org/0000-0002-8029-6627
{"title":"Interventional bronchoscopic management of recalcitrant adenoid cystic carcinoma obstructing central airways","authors":"E. Chousein, Demet Turan, E. Tanrıverdi, B. Yıldırım, Mustafa Çörtük, H. Çınarka, M. Özgül, E. Çetinkaya","doi":"10.18332/pne/136174","DOIUrl":"https://doi.org/10.18332/pne/136174","url":null,"abstract":"INTRODUCTION Adenoid cystic carcinoma (ACC) of the lung is a rare tumor with a propensity to cause central airway obstruction. Prolonged patient survival with high recurrence rates despite surgery, oncologic treatment or interventional bronchoscopic procedures (IBPs) poses long-term management challenges. With this study we aimed to review IBPs and their outcome in patients with ACC. METHODS We retrospectively reviewed the demographics, bronchoscopic findings, IBP treatment modalities and outcomes of patients with a diagnosis of ACC between January 2009 and December 2020. RESULTS There were 13 patients (9 male, 69.2%) with a mean age of 54.61±8.7 years. Trachea was the most involved site (10 cases, 76.9%) and percentage of obstruction was 77±13.9%. Bronchoscopy most commonly identified an endoluminal lesion (84.6%). There was a total of 77 procedures, including 44 rigid and 31 flexible bronchoscopies. Seven patients underwent a single procedure and 6 patients more than one procedure. Most common interventional bronchoscopic treatment modalities used were argon plasma coagulation (40.2%) and mechanical resection (38.9%). Airway stents were inserted in 4 (30.7%) patients. Airway patency was restored following first-line IBP in 93% of patients. The rate of early complications within the first 24 hours was 6.8%. Late complications were seen in 33.7% and were all stent related. No procedure related mortality was observed. CONCLUSIONS ACC affects central airways and most frequently the trachea. IBPs can be repeatedly used in the treatment of ACC because of their low early complication rates. Patients treated with airway stents should be closely followed up for late complications. ABBREVIATIONS ACC: adenoid cystic carcinoma, APC: argon plasma coagulation, CAO: central airway obstruction, COPD: chronic obstructive pulmonary disease, EBUS: endobronchial ultrasonographies, FB: flexible bronchoscopies, IBP: interventional bronchoscopic procedure, IP: interventional pulmonology, RB: rigid bronchoscopies. INTRODUCTION Adenoid cystic carcinomas (ACC) are rarely encountered tumors with a propensity for frequent recurrences originating from secretory glands of the tracheobronchial system that comprise 0.04–0.2% of all lung cancers. Previously classified as benign tumoral lesions, they are currently grouped under low-grade malignant tumors1. Although uncommonly encountered, they can lead to life threatening central airway obstruction (CAO). They progress insidiously, slowly growing longitudinally within the airways. Frequently patients are incorrectly diagnosed with and treated for asthma or chronic obstructive pulmonary disease (COPD). In patients who have already been diagnosed with ACC, worsening respiratory symptoms can be erroneously attributed to comorbidities or side effects of oncologic treatments. Consequently, both the initial diagnosis and the detection of disease progression can be delayed1,2. The treatment of choice is surgical resection. The longter","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"161 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74306573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kipourou, Konstantinos Karozis, S. Lampridis, Stergios Gkintikas, Dimitrios Molyvas, P. Koutoukoglou, E. Kaitalidou, Irina Giannopoulou, I. Tsanaktsidis, D. Karapiperis
F. Sampsonas, M. Katsaras, O. Papaioannou, T. Karampitsakos, L. Kakoullis, A. Tzouvelekis
METHODS A 26-year-old male presented with a 3-week history of dyspnea on exertion, chest tightness and productive cough with excretion of copious purulent secretions. The patient did not report fever, weight loss or haemoptysis. He had no history of asthma or atopy. Physical examination revealed a respiratory rate of 19/min and SpO2 of 95% on room air, polyphonic wheezing, crackles in middle lung zones and significant digital clubbing.
{"title":"Concomitant diagnosis of asthma and allergic bronchopulmonary aspergillosis in a previously healthy 26-year old Afghani male","authors":"F. Sampsonas, M. Katsaras, O. Papaioannou, T. Karampitsakos, L. Kakoullis, A. Tzouvelekis","doi":"10.18332/PNE/135957","DOIUrl":"https://doi.org/10.18332/PNE/135957","url":null,"abstract":"METHODS A 26-year-old male presented with a 3-week history of dyspnea on exertion, chest tightness and productive cough with excretion of copious purulent secretions. The patient did not report fever, weight loss or haemoptysis. He had no history of asthma or atopy. Physical examination revealed a respiratory rate of 19/min and SpO2 of 95% on room air, polyphonic wheezing, crackles in middle lung zones and significant digital clubbing.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"42 1","pages":"1-2"},"PeriodicalIF":0.7,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78501246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Poberezhets, S. Skoczyński, A. Demchuk, A. Oraczewska, Ewelina Tobiczyk, Y. Mostovoy, A. Barczyk
INTRODUCTION Taking into consideration multifactorial origin of sarcopenia and extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD), our study aimed to determine the prevalence and predictive factors for sarcopenia among COPD patients. METHODS We examined 190 patients with COPD in Ukraine and Poland using bioelectric impedance analysis, hand-grip dynamometry, 6MWT and several questionnaires to assess clinical characteristics of the patients. RESULTS Sarcopenia was detected in 25.3% of all patients with COPD. There was a significant difference between patients with and without sarcopenia in age, acute exacerbations of COPD, CAT, FEV1, BODE and CCI, Borg scope (post 6MWT), hand-grip strength, BMI, fat mass index, level of visceral fat, fat percentage, skeletal muscle index, gait speed, and 6MWT distance. According to regression analysis, factors related to sarcopenia were body mass index, visceral fat level, daily physical activity, percentage of fat and GOLD 3 airflow limitation. CONCLUSIONS Sarcopenia affected almost every fourth COPD patient and was associated with low BMI, high level of visceral fat and percentage of body fat, limited physical activity, and severe airflow limitation. Abbreviations 6MWT: the 6-minute walk test, BMI: body mass index, BODE index: body mass index, airflow obstruction, dyspnoea, exercise capacity index, CAT: the COPD assessment test, CCI: Charlson comorbidity index, COPD: chronic obstructive pulmonary disease, FEV1: forced expiratory volume in one second, mMRC: modified Medical Research Council, SaO2: oxygen saturation, SGRQ: St. George’s respiratory questionnaire. INTRODUCTION Chronic obstructive pulmonary disease (COPD) as a systemic disease is usually present with numerous comorbidities. One of the most common overlapping diseases is a skeletal muscle dysfunction. According to the GOLD 2020 Report, skeletal muscle dysfunction is characterized by loss of muscle cells and dysfunction of the remaining cells1. This definition is similar to the definition of the sarcopenia from the latest revision of European Working Group on Sarcopenia in Older People (EWGSOP2), according to which sarcopenia should be defined as low muscle strength combined with low muscle quantity or quality2. EWGSOP2 highlighted the role of sarcopenia as an important factor responsible for the impairment of daily physical activity, development of the cardiometabolic syndrome, and other complications. Presence of sarcopenia should be considered as being associated with an overall mortality and COPD-related mortality risk factor3, increased length of hospital stay, risk for hospitalization, lower probability of being discharged home4 and independently increasing hospital costs at hospital admission from 34% to 58.5% depending on the age of the population5. According to Goates et al.6, sarcopenia results in a great economic burden on the US healthcare system with total costs of hospitalizations amounting to more than US$ 19 bi
{"title":"Sarcopenia in COPD patients: Prevalence, patients’ characteristics and predictive factors","authors":"V. Poberezhets, S. Skoczyński, A. Demchuk, A. Oraczewska, Ewelina Tobiczyk, Y. Mostovoy, A. Barczyk","doi":"10.18332/PNE/135711","DOIUrl":"https://doi.org/10.18332/PNE/135711","url":null,"abstract":"INTRODUCTION Taking into consideration multifactorial origin of sarcopenia and extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD), our study aimed to determine the prevalence and predictive factors for sarcopenia among COPD patients. METHODS We examined 190 patients with COPD in Ukraine and Poland using bioelectric impedance analysis, hand-grip dynamometry, 6MWT and several questionnaires to assess clinical characteristics of the patients. RESULTS Sarcopenia was detected in 25.3% of all patients with COPD. There was a significant difference between patients with and without sarcopenia in age, acute exacerbations of COPD, CAT, FEV1, BODE and CCI, Borg scope (post 6MWT), hand-grip strength, BMI, fat mass index, level of visceral fat, fat percentage, skeletal muscle index, gait speed, and 6MWT distance. According to regression analysis, factors related to sarcopenia were body mass index, visceral fat level, daily physical activity, percentage of fat and GOLD 3 airflow limitation. CONCLUSIONS Sarcopenia affected almost every fourth COPD patient and was associated with low BMI, high level of visceral fat and percentage of body fat, limited physical activity, and severe airflow limitation. Abbreviations 6MWT: the 6-minute walk test, BMI: body mass index, BODE index: body mass index, airflow obstruction, dyspnoea, exercise capacity index, CAT: the COPD assessment test, CCI: Charlson comorbidity index, COPD: chronic obstructive pulmonary disease, FEV1: forced expiratory volume in one second, mMRC: modified Medical Research Council, SaO2: oxygen saturation, SGRQ: St. George’s respiratory questionnaire. INTRODUCTION Chronic obstructive pulmonary disease (COPD) as a systemic disease is usually present with numerous comorbidities. One of the most common overlapping diseases is a skeletal muscle dysfunction. According to the GOLD 2020 Report, skeletal muscle dysfunction is characterized by loss of muscle cells and dysfunction of the remaining cells1. This definition is similar to the definition of the sarcopenia from the latest revision of European Working Group on Sarcopenia in Older People (EWGSOP2), according to which sarcopenia should be defined as low muscle strength combined with low muscle quantity or quality2. EWGSOP2 highlighted the role of sarcopenia as an important factor responsible for the impairment of daily physical activity, development of the cardiometabolic syndrome, and other complications. Presence of sarcopenia should be considered as being associated with an overall mortality and COPD-related mortality risk factor3, increased length of hospital stay, risk for hospitalization, lower probability of being discharged home4 and independently increasing hospital costs at hospital admission from 34% to 58.5% depending on the age of the population5. According to Goates et al.6, sarcopenia results in a great economic burden on the US healthcare system with total costs of hospitalizations amounting to more than US$ 19 bi","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"76 4 1","pages":"1-7"},"PeriodicalIF":0.7,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77506494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Apollonatou, G. Verykokou, Aggeliki Lazaratou, A. Papaioannou, Mirto Kardara, I. Papadiochos, Veroniki Papakosta, S. Vassiliou, E. Koursoumi, Panteleimon Messaropoulos, C. Kontopoulou, S. Loukides, E. Manali, S. Papiris
Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries. Pulmonary contusions are the most common identified entities after trauma, and they result in alveolar hemorrhage without loss of the physiological structure of lung parenchyma. On the other hand, pulmonary lacerations, which are often associated with contusions, result in rupture of the alveoli causing formation of cavities. Patients present symptoms ranging from minimal to severe, including cough, chest pain, hemoptysis, dyspnea, tachypnea, and hypoxemia. Findings may not be apparent immediately after injury and chest CT is the most sensitive imaging technique for diagnosis. Contusions usually resolve with supportive care in 5–7 days. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. INTRODUCTION Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries1,2. Pulmonary contusion is the most common identified entity after trauma and usually results from blunt chest trauma (traffic accidents, falls from great heights), shock waves associated with penetrating chest injury, or explosion injuries3,4. Unlike contusion, pulmonary laceration results in disruption of the architecture of the lung and could potentially cause more serious damage. Pulmonary lacerations are commonly caused by penetrating trauma and result in formation of one or multiple cavities filled with air, blood, or both5. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. CASE PRESENTATION A 19-year-old patient, non-smoker, without previous medical history, presented to the emergency room due to fever and pain at the right periorbital area of the face after a motorcycle collision twenty-four hours ago. The patient was examined initially by general surgeons. He was febrile (38°C) and hemodynamically stable. His oxygen saturation was normal (SatO2: 98% breathing room air) and he had normal breath sounds in auscultation. From physical examination, he presented with bruise injuries in the right side of the face and a right periorbital hematoma. His laboratory examinations revealed normal hemoglobin (15.9 g/dL), elevated white blood cell count (14.90 K/μL with 78.7% neutrophils), elevated creatine kinase (956 U/L) and elevated C reactive protein (96.9 mg/L). After exclusion of SARS-Cov-2 infection, he underwent computed tomography (CT) of the head which showed fracture displacement AFFILIATION 1 2nd Pulmonary Medicine Department, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 2 Western Attica General Hospital Agia Barbara, Athens, Greece 3 Clinic of Oral & Maxillofacial Su
胸部外伤是年轻人死亡的主要原因之一，包括肺挫伤、撕裂伤、气胸、血胸、肋骨骨折和气管支气管损伤。肺挫伤是创伤后最常见的症状，可导致肺泡出血，但不会破坏肺实质的生理结构。另一方面，肺撕裂伤，往往与挫伤有关，导致肺泡破裂，导致空腔的形成。患者的症状从轻微到严重不等，包括咳嗽、胸痛、咯血、呼吸困难、呼吸急促和低氧血症。损伤后的表现可能不立即明显，胸部CT是诊断最敏感的成像技术。挫伤通常在5-7天内通过支持性护理解决。在这个报告中，我们提出一个病例肺挫伤和撕裂伤在一个19岁的病人摩托车事故后。胸部外伤是年轻人死亡的主要原因之一，包括肺挫伤、撕裂伤、气胸、血胸、肋骨骨折和气管支气管损伤1,2。肺挫伤是外伤后最常见的症状，通常是由钝性胸部外伤(交通事故、从高处坠落)、穿透性胸部损伤相关的冲击波或爆炸造成的。与挫伤不同，肺撕裂伤会导致肺结构的破坏，并可能造成更严重的损害。肺撕裂伤通常是由穿透性创伤引起的，导致形成一个或多个充满空气、血液或两者的空腔。在这个报告中，我们提出一个病例肺挫伤和撕裂伤在一个19岁的病人摩托车事故后。病例介绍一名19岁的患者，非吸烟者，无既往病史，24小时前摩托车碰撞后，因面部右侧眶周区域发热和疼痛而就诊于急诊室。病人最初由普通外科医生检查。患者发热(38°C)，血流动力学稳定。他的血氧饱和度正常(呼吸室内空气SatO2: 98%)，听诊呼吸音正常。体格检查显示，他右侧面部有瘀伤，右侧眼眶周围有血肿。实验室检查显示血红蛋白正常(15.9 g/dL)，白细胞计数升高(14.90 K/μL，中性粒细胞78.7%)，肌酸激酶升高(956 U/L)， C反应蛋白升高(96.9 mg/L)。排除SARS-Cov-2感染后，行头部计算机断层扫描(CT)，显示骨折移位。附属于1希腊雅典阿提孔大学医学院阿提孔大学总医院第二肺内科2希腊雅典阿提孔大学阿提卡总医院阿基亚芭芭拉3希腊雅典阿提孔大学总医院医学院口腔颌面外科门诊雅典国立和卡波迪斯特里大学，希腊雅典4雅典国立和卡波迪斯特里大学医学院阿提孔大学综合医院第二麻醉科，希腊雅典5雅典国立和卡波迪斯特里大学医学院阿提孔大学综合医院第二放射科，希腊雅典*与Effrosyni D. Manali肺医学第二科也有同样的通信。雅典国立和Kapodistrian大学医学院，阿提孔大学总医院，雅典里米尼街1号，希腊，12462。电子邮件:fmanali@otenet.gr
{"title":"Pulmonary laceration and contusion in a young male patient due to a motorcycle accident","authors":"V. Apollonatou, G. Verykokou, Aggeliki Lazaratou, A. Papaioannou, Mirto Kardara, I. Papadiochos, Veroniki Papakosta, S. Vassiliou, E. Koursoumi, Panteleimon Messaropoulos, C. Kontopoulou, S. Loukides, E. Manali, S. Papiris","doi":"10.18332/PNE/136153","DOIUrl":"https://doi.org/10.18332/PNE/136153","url":null,"abstract":"Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries. Pulmonary contusions are the most common identified entities after trauma, and they result in alveolar hemorrhage without loss of the physiological structure of lung parenchyma. On the other hand, pulmonary lacerations, which are often associated with contusions, result in rupture of the alveoli causing formation of cavities. Patients present symptoms ranging from minimal to severe, including cough, chest pain, hemoptysis, dyspnea, tachypnea, and hypoxemia. Findings may not be apparent immediately after injury and chest CT is the most sensitive imaging technique for diagnosis. Contusions usually resolve with supportive care in 5–7 days. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. INTRODUCTION Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries1,2. Pulmonary contusion is the most common identified entity after trauma and usually results from blunt chest trauma (traffic accidents, falls from great heights), shock waves associated with penetrating chest injury, or explosion injuries3,4. Unlike contusion, pulmonary laceration results in disruption of the architecture of the lung and could potentially cause more serious damage. Pulmonary lacerations are commonly caused by penetrating trauma and result in formation of one or multiple cavities filled with air, blood, or both5. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. CASE PRESENTATION A 19-year-old patient, non-smoker, without previous medical history, presented to the emergency room due to fever and pain at the right periorbital area of the face after a motorcycle collision twenty-four hours ago. The patient was examined initially by general surgeons. He was febrile (38°C) and hemodynamically stable. His oxygen saturation was normal (SatO2: 98% breathing room air) and he had normal breath sounds in auscultation. From physical examination, he presented with bruise injuries in the right side of the face and a right periorbital hematoma. His laboratory examinations revealed normal hemoglobin (15.9 g/dL), elevated white blood cell count (14.90 K/μL with 78.7% neutrophils), elevated creatine kinase (956 U/L) and elevated C reactive protein (96.9 mg/L). After exclusion of SARS-Cov-2 infection, he underwent computed tomography (CT) of the head which showed fracture displacement AFFILIATION 1 2nd Pulmonary Medicine Department, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 2 Western Attica General Hospital Agia Barbara, Athens, Greece 3 Clinic of Oral & Maxillofacial Su","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"289 1","pages":"1-6"},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72765702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Dimopoulos, A. Sakelliou, A. Flevari, K. Tzannis, E. Giamarellos‐Bourboulis
Dear Editor, The severe form of Coronavirus Disease 2019 (COVID-19) is a systemic disease associated with high mortality rate1,2. Elderly, mainly men with comorbidities, are at increased risk of death. Νevertheless, younger individuals, without underlying diseases, may also develop lethal complications (myocarditis, disseminated intravascular coagulopathy, neurological complications etc.)3,4. In the ICU of ATTIKON University Hospital (one of the 5 Reference Hospitals for COVID-19 in Athens, Greece), from 5 August to 30 September 2020, 16 (100%) critically ill patients with COVID-19 were admitted (median age 70.5 years, IQR 58–79). The patients were divided into survivors [Group A: 9 (56.3%)] and non-survivors [Group B: 7 (43.7%)](Table1). At the time of ICU admission, the viral load of coronavirus (expressed in Circles trough: Ct) was significantly higher in non-survivors [Group A: 23 (IQR 21–25) vs Group B: 21 (IQR 20–22), p=0.042], while ferritin levels were similar in both groups [Group A: 1290 ng/mL (IQR 550–3572) vs Group B: 980 (IQR 543–3915), p=0.71]. During ICU stay, the viral load remained permanently high in non-survivors [Group A: 32 (IQR 32–37) vs Group B: 22 (IQR 19–24), p=0.001], but it was gradually diminished among survivors [Group A: 39.1% (IQR 30.4–42.9) vs Group B: 0 (IQR -4.8–14.30), p=0.001]. In parallel, ferritin levels were increased by 109.7% (IQR 25.7–382), whatever was higher in non-survivors [Group A: 55.7% (IQR 13.3–85) vs Group B: 486.1% (IQR 137.2–761.9), p=0.007] (Table 1). The HScore, which is an indicator of macrophage activation, was higher in non-survivors [Group A: 54 (IQR 19–70) vs Group B: 87 (IQR 68–99), p=0.048)]. Finally, in this cohort, 9 (56.3%) patients survived and 7 (43.7%) died because of ARDS/Multiple Organ Failure (MOF) (one of the patients developed myocarditis). A consistent proportion of COVID-19 patients will develop acute respiratory distress syndrome (ARDS) related to increased production of cytokines (the so-called cytokine storm) and a small subset secondary haemophagocytic lymphohistiocytosis (sHLH), a T-cell driven hyperinflammatory, ‘hyperferritinemic syndrome’5. These are the two main causes of mortality in the severe form of COVID-19. The sHLH development reflects the ability of coronavirus to bind TLRs and to activate inflammasome through IL-1β release, but the relationship is not clear since many COVID-19 patients, even with bad prognosis, do not meet the classification criteria of HScore (Table 2)6,7. In light of the absence of highly increased HScore, ferritin remains high and reveals constant macrophage activation albeit not to such an extent as to be the full-blown sHLH8-10. In our cohort, high viral load and ferritin levels have been observed in non-survivors indicating a relation between the activity of the disease and the outcome of the patients. A future research perspective could be focused on the following three questions: a) ‘Is COVID-19 a hyperferritinemic syndrome withou
尊敬的编辑，2019冠状病毒病(COVID-19)的严重形式是一种高死亡率的全身性疾病1,2。老年人，主要是有合并症的男性，死亡风险增加。Νevertheless，没有基础疾病的年轻人也可能出现致命的并发症(心肌炎、弥散性血管内凝血病、神经系统并发症等)3,4。在ATTIKON大学医院(希腊雅典5家COVID-19参考医院之一)的ICU, 2020年8月5日至9月30日，16例(100%)COVID-19危重患者入院(中位年龄70.5岁，IQR 58-79)。患者分为幸存者[A组:9例(56.3%)]和非幸存者[B组:7例(43.7%)](表1)。入院时，非幸存者冠状病毒载量(圆环谷:Ct)明显高于对照组[A组:23 (IQR 21 - 25) vs B组:21 (IQR 20-22)， p=0.042]，而两组铁蛋白水平相似[A组:1290 ng/mL (IQR 550-3572) vs B组:980 (IQR 543-3915)， p=0.71]。在ICU住院期间，非幸存者的病毒载量一直很高[A组:32 (IQR 32 - 37) vs B组:22 (IQR 19-24)， p=0.001]，但幸存者的病毒载量逐渐降低[A组:39.1% (IQR 30.4-42.9) vs B组:0 (IQR -4.8-14.30)， p=0.001]。与此同时，铁蛋白水平升高109.7% (IQR 25.7-382)，无论非幸存者中是否较高[A组:55.7% (IQR 13.3-85) vs B组:486.1% (IQR 137.2-761.9)， p=0.007](表1)。作为巨噬细胞激活指标的HScore在非幸存者中较高[A组:54 (IQR 19-70) vs B组:87 (IQR 68-99)， p=0.048)]。最后，在该队列中，9例(56.3%)患者存活，7例(43.7%)患者死于ARDS/多器官衰竭(MOF)(1例患者发生心肌炎)。一致比例的COVID-19患者将出现与细胞因子(所谓的细胞因子风暴)产生增加相关的急性呼吸窘迫综合征(ARDS)，以及一小部分继发性噬血细胞淋巴组织细胞增多症(sHLH)，这是一种t细胞驱动的高炎症，“高铁素血症综合征”5。这是导致COVID-19重症患者死亡的两个主要原因。sHLH的发展反映了冠状病毒结合tlr并通过IL-1β释放激活炎性体的能力，但由于许多COVID-19患者即使预后不良，也不符合HScore的分类标准，因此两者之间的关系尚不清楚(表2)6,7。由于HScore没有高度升高，铁蛋白仍然保持高水平，并显示出持续的巨噬细胞激活，尽管没有达到成熟的sHLH8-10的程度。在我们的队列中，在非幸存者中观察到高病毒载量和高铁蛋白水平，这表明疾病的活动性与患者的预后之间存在关联。未来的研究视角可以集中在以下三个问题上:A)“COVID-19是一种高铁素血症综合征，而不是完全的sHLH吗?”b)“是否需要重新验证这些患者的sHLH和HScore临界值?”c)“在COVID-19感染过程中，临床医生何时可以考虑开始免疫调节治疗?”1雅典国立和卡波迪斯特里亚大学医学院，阿提孔大学综合医院，希腊，雅典2雅典国立和卡波迪斯特里亚大学医学院，阿提孔大学综合医院，希腊，雅典，内科，第4科
{"title":"Ferritin levels in critically ill patients with COVID-19: A marker of outcome?","authors":"G. Dimopoulos, A. Sakelliou, A. Flevari, K. Tzannis, E. Giamarellos‐Bourboulis","doi":"10.18332/PNE/135958","DOIUrl":"https://doi.org/10.18332/PNE/135958","url":null,"abstract":"Dear Editor, The severe form of Coronavirus Disease 2019 (COVID-19) is a systemic disease associated with high mortality rate1,2. Elderly, mainly men with comorbidities, are at increased risk of death. Νevertheless, younger individuals, without underlying diseases, may also develop lethal complications (myocarditis, disseminated intravascular coagulopathy, neurological complications etc.)3,4. In the ICU of ATTIKON University Hospital (one of the 5 Reference Hospitals for COVID-19 in Athens, Greece), from 5 August to 30 September 2020, 16 (100%) critically ill patients with COVID-19 were admitted (median age 70.5 years, IQR 58–79). The patients were divided into survivors [Group A: 9 (56.3%)] and non-survivors [Group B: 7 (43.7%)](Table1). At the time of ICU admission, the viral load of coronavirus (expressed in Circles trough: Ct) was significantly higher in non-survivors [Group A: 23 (IQR 21–25) vs Group B: 21 (IQR 20–22), p=0.042], while ferritin levels were similar in both groups [Group A: 1290 ng/mL (IQR 550–3572) vs Group B: 980 (IQR 543–3915), p=0.71]. During ICU stay, the viral load remained permanently high in non-survivors [Group A: 32 (IQR 32–37) vs Group B: 22 (IQR 19–24), p=0.001], but it was gradually diminished among survivors [Group A: 39.1% (IQR 30.4–42.9) vs Group B: 0 (IQR -4.8–14.30), p=0.001]. In parallel, ferritin levels were increased by 109.7% (IQR 25.7–382), whatever was higher in non-survivors [Group A: 55.7% (IQR 13.3–85) vs Group B: 486.1% (IQR 137.2–761.9), p=0.007] (Table 1). The HScore, which is an indicator of macrophage activation, was higher in non-survivors [Group A: 54 (IQR 19–70) vs Group B: 87 (IQR 68–99), p=0.048)]. Finally, in this cohort, 9 (56.3%) patients survived and 7 (43.7%) died because of ARDS/Multiple Organ Failure (MOF) (one of the patients developed myocarditis). A consistent proportion of COVID-19 patients will develop acute respiratory distress syndrome (ARDS) related to increased production of cytokines (the so-called cytokine storm) and a small subset secondary haemophagocytic lymphohistiocytosis (sHLH), a T-cell driven hyperinflammatory, ‘hyperferritinemic syndrome’5. These are the two main causes of mortality in the severe form of COVID-19. The sHLH development reflects the ability of coronavirus to bind TLRs and to activate inflammasome through IL-1β release, but the relationship is not clear since many COVID-19 patients, even with bad prognosis, do not meet the classification criteria of HScore (Table 2)6,7. In light of the absence of highly increased HScore, ferritin remains high and reveals constant macrophage activation albeit not to such an extent as to be the full-blown sHLH8-10. In our cohort, high viral load and ferritin levels have been observed in non-survivors indicating a relation between the activity of the disease and the outcome of the patients. A future research perspective could be focused on the following three questions: a) ‘Is COVID-19 a hyperferritinemic syndrome withou","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"18 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83705022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Galani, A. Kyriakoudi, Efrosyni Filiou, M. Kompoti, Gabriel Lazos, Sofia-Antiopi Gennimata, I. Vasileiadis, M. Daganou, A. Koutsoukou, N. Rovina
INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in ‘Sotiria’ Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04–1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04–1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25–2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14–18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients. INTRODUCTION Chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease leading to irreversible airflow limitation, is the third leading cause of death and a substantial source of disability, worldwide1. Acute exacerbations of COPD (AECOPD) contribute at large to the progressive decline in the quality of life and the functional status of these patients2. Moreover, moderate to severe AECOPD may lead to respiratory failure, requiring invasive mechanical ventilation and admission to the intensive care unit (ICU). Critically ill patients with AECOPD admitted to the ICU have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support3-7. The severity of the disease per se, the co-existence of multiple co-morbidities, as well as the ICUrelated complications may justify, in part, this fact8-11. Infectious exacerbations or end-stage disease have been identified as major causes of ICU admittance12-14. As yet, many studies have attempted to identify independent predictors of the outcomes of these patients in the ICU, however, the results are not consistent across studies, except for Acute Physiology a
{"title":"Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with COPD exacerbation","authors":"M. Galani, A. Kyriakoudi, Efrosyni Filiou, M. Kompoti, Gabriel Lazos, Sofia-Antiopi Gennimata, I. Vasileiadis, M. Daganou, A. Koutsoukou, N. Rovina","doi":"10.18332/pne/139637","DOIUrl":"https://doi.org/10.18332/pne/139637","url":null,"abstract":"INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in ‘Sotiria’ Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04–1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04–1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25–2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14–18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients. INTRODUCTION Chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease leading to irreversible airflow limitation, is the third leading cause of death and a substantial source of disability, worldwide1. Acute exacerbations of COPD (AECOPD) contribute at large to the progressive decline in the quality of life and the functional status of these patients2. Moreover, moderate to severe AECOPD may lead to respiratory failure, requiring invasive mechanical ventilation and admission to the intensive care unit (ICU). Critically ill patients with AECOPD admitted to the ICU have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support3-7. The severity of the disease per se, the co-existence of multiple co-morbidities, as well as the ICUrelated complications may justify, in part, this fact8-11. Infectious exacerbations or end-stage disease have been identified as major causes of ICU admittance12-14. As yet, many studies have attempted to identify independent predictors of the outcomes of these patients in the ICU, however, the results are not consistent across studies, except for Acute Physiology a","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"25 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83415446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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