This corrects the article, "Clinical Implications of Pseudomonas Aeruginosa Colonization in Chronic Obstructive Pulmonary Disease Patients," published in Volume 12, Issue 2, pp. 137-145.
This corrects the article, "Clinical Implications of Pseudomonas Aeruginosa Colonization in Chronic Obstructive Pulmonary Disease Patients," published in Volume 12, Issue 2, pp. 137-145.
Background: Psychological stress is elevated in individuals with chronic medical conditions, including those with chronic obstructive pulmonary disease (COPD). Nail cortisol may have utility as a marker for testing the biologic effects of stress reduction interventions. The aim of this pilot study is to explore the use of nail cortisol as a marker of chronic psychological stress in individuals with COPD.
Methods: Pearson's correlation was used to test if nail cortisol was correlated with perceived stress, serum cortisol, or inflammatory biomarkers. A multivariable linear regression model was used to evaluate the association between perceived stress and nail cortisol. Stepwise logistic regression modeling was used to determine associations of psychobiologic measures of stress with demographic, clinical, and psychological variables.
Results: A total of 50 participants were included in the study. The mean (standard deviation [SD]) perceived stress score was 12 (+/-6) and mean (SD) nail cortisol level was 0.05 (+/-0.09) nmol/g. Nail cortisol was not correlated with perceived stress, serum cortisol, or inflammatory markers. There was no association between nail cortisol and perceived stress after controlling for confounders. Suboptimal health status and grit score were associated with perceived stress. Higher levels of serum fibrinogen were associated with higher levels of serum cortisol. Experiencing 3 or more negative lifetime events was associated with a decrease in nail cortisol.
Conclusion: We found no correlation between nail cortisol and levels of perceived stress, serum cortisol, or inflammatory biomarkers and there were no similar associations of variables across psychobiologic measures of stress.
Virtual pulmonary rehabilitation (PR) is a proven yet underutilized intervention in chronic obstructive pulmonary disease (COPD) patients. However, neither the safety nor the effectiveness of virtual PR is established for patients with advanced disease and higher disease severity, particularly those requiring supplemental oxygen. We performed a retrospective review of 167 patients to evaluate the feasibility, safety, and effectiveness of virtual PR in oxygen-dependent versus nonoxygen-dependent COPD patients. Our primary outcome, attendance, was high (88% of sessions were attended by both groups). Adverse events occurred in only 2 (1%) participants, one in each group. Both groups showed significant postintervention improvements in dyspnea and depression scores (COPD Assessment Test [CAT], modified Medical Research Council [mMRC], Patient Health Questionnaire-9 [PHQ-9]) and functional exercise capacity (1-minute sit-to-stand [1MSTS]), with the improvements approaching or exceeding the established minimal clinically important difference values. When comparing the oxygen-dependent and nonoxygen groups, there were no significant differences in the degree of improvement for CAT, PHQ-9, and 1MSTS. For mMRC, those on oxygen did improve by 0.3 less than those not on oxygen (P=0.052). These findings suggest virtual PR is safe and effective for COPD patients requiring oxygen. To our knowledge, this is the first study to compare outcomes of virtual PR in patients on and off oxygen. Future research should explore patient-specific factors that can further individualize care.
Objective: Acute exacerbations of COPD(AECOPD) can have severe impacts on patients with the disease and a heavy burden on health care resources. Electronic health records (EHRs) are a valuable resource for identifying cases of AECOPD and research. Studies have attempted to validate case definitions of AECOPD and this review aims to summarize validated AECOPD definitions in EHRs and to provide guidance on the best algorithms to use to ensure accurate cohorts of AECOPD cases are available for researchers using EHRs.
Methods: MEDLINE and Embase were searched and studies that met the inclusion criteria were reviewed by ≥2 reviewers. Data extracted included the algorithms used to identify AECOPD, the reference standards used to compare against the algorithm, and measures of validity. The risk of bias was assessed using QUADAS-2 adapted for this review.
Results: Out of 2784 studies found by the search strategy, 12 met the inclusion criteria. The clinical terminology used to build algorithms to detect AECOPD included codes from the International Classification of Diseases (ICD) Ninth Revision, Clinical Modification and Tenth Revision (ICD-9-CM and ICD-10), along with the Read codes from United Kingdom general practices. AECOPD can be identified within EHRs using validated definitions, however, the validity of AECOPD definitions varies considerably depending on the algorithm used and the settings to which they are applied.
Conclusion: Although there are validated definitions that can be used to identify AECOPD, there is no clear consensus on which provides the highest validity or the most sensitive and specific definition to use.
This study aimed to evaluate the performance of machine learning models for predicting readmission of patients with chronic obstructive pulmonary disease (COPD) based on administrative data and chart review data. The study analyzed 4327 patient encounters from the University of Chicago Medicine to assess the risk of readmission within 90 days after an acute exacerbation of COPD. Two random forest prediction models were compared. One was derived from chart review data, while the other was derived using administrative data. The data were randomly partitioned into training and internal validation sets using a 70% to 30% split. The 2 models had comparable accuracy (administrative data area under the curve [AUC]=0.67, chart review AUC=0.64). These results suggest that despite its limitations in precisely identifying COPD admissions, administrative data may be useful for developing effective predictive tools and offer a less labor-intensive alternative to chart reviews.
Background: Individuals with chronic obstructive pulmonary disease (COPD) are disproportionately affected by social determinants of health that have been associated with worse respiratory outcomes. This study evaluates the association of perceived stress with respiratory outcomes and distinct biological mechanisms among former smokers with COPD.
Methods: Participants were assessed in an observational study at baseline, 3-months, and 6-months. Questionnaires assessed perceived stress (Perceived Stress Scale, [PSS]), respiratory symptoms, and incidence of COPD exacerbations. Generalized linear mixed models evaluated the association of PSS score with COPD outcomes and biomarkers of platelet activation (urine 11-dehydro-thromboxane B2 [11dTxB2]), oxidative stress (urine thiobarbituric acid reactive substances [TBARS], 8- hydroxydeoxyguanosine, and 8-isoprostane), and inflammation.
Results: Among 99 participants, the median PSS score was 13 (interquartile range 8-18) across all visits. Compared with low perceived stress (PSS 0-13), moderate (PSS 14-26) and high perceived stress (PSS 27-40) were associated with worse respiratory health status and respiratory-related quality of life, with point estimates for high perceived stress exceeding clinically important differences. Only high PSS was associated with increased moderate/severe exacerbations (odds ratio 4.15, 95% confidence interval [CI]: 1.28-13.47). Compared to low stress, high stress was associated with lower TBARS (β=-25.5%, 95%CI: -43.8- -1.2%) and higher 8-isoprostane (β=40.1%, 95%CI: 11.5-76.0%). Among individuals with mild-moderate COPD, compared to low stress, moderate (β=20.1%, 95%CI: 3.1-40.0%) and high (β=52.9%, 95%CI: 22.1-91.6%) stress were associated with higher 11dTxB2.
Conclusion: Among former smokers with COPD, higher perceived stress is associated with worse respiratory outcomes. Platelet activation and oxidative stress may be biological pathways through which perceived stress plays a role in COPD.
Background: Nontuberculous mycobacteria pulmonary disease (NTM-PD) is an emerging public health concern with increasing incidence and prevalence. Despite its chronic and progressive nature, there is a notable gap in research on the factors influencing hospital outcomes in this patient population.
Materials and methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) to analyze hospitalizations of adult patients diagnosed with NTM-PD. We examined patient demographics, comorbidities, and hospital characteristics to identify predictors of hospital length of stay (LOS) and discharge disposition. Multivariate negative binomial regression and logistic regression models were employed to assess the impact of these variables.
Results: The study included 1167 hospitalized NTM-PD patients, with a mean age of 66.9 years. The overall mean LOS was 7.4 days, with an average hospital cost of $15,606. Discharge to a nursing home was associated with a 78% longer LOS (incidence rate ratio=1.78, p<0.0001). Key predictors of extended LOS included male gender, private insurance status, higher comorbidity burden, and increased number of procedures. Patients discharged to nursing homes were more likely to be older males with complex medical profiles. Interestingly, conditions such as malignancy and COPD, while linked to longer LOS, were associated with a decreased likelihood of discharge to a nursing home.
Conclusion: Our study highlights significant predictors of LOS and discharge outcomes in NTM-PD patients, emphasizing the need for personalized and proactive management. These findings underscore the importance of targeted interventions in the outpatient setting to reduce hospital admissions and improve patient outcomes.
Background: The objective of this study was to construct a prediction model to assess the onset of acute heart failure (AHF) in patients with chronic obstructive pulmonary disease (COPD) without a history of heart failure and to evaluate the predictive value of the nomogram.
Methods: This study involved 3730 patients with COPD and no history of heart failure. Clinical and laboratory data were collected from the Medical Information Mart for Intensive Care IV database. The patients were divided into a training set (2611 cases) and a validation set (1119 cases) in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was used to identify potential risk factors for AHF in patients with COPD. These factors were then subjected to multivariate logistic regression analysis to develop a prediction model for the risk of AHF. The model's differentiation, consistency, and clinical applicability were evaluated using receiver operating characteristic analysis, a calibration curve, and decision curve analysis (DCA), respectively.
Results: LASSO regression identified 10 potential predictors. The concordance index was 0.820. The areas under the curves for the training and validation sets were 0.8195 and 0.8035, respectively. The calibration curve demonstrated strong concordance between the nomogram's predictions and the actual outcomes. DCA confirmed the clinical applicability of the nomogram.
Conclusion: Our nomogram is a reliable and convenient tool for predicting acute heart failure in patients with COPD.
Background: Pseudomonas aeruginosa is an important pathogen in patients with chronic respiratory diseases. It can colonize the airways and could have prognostic value in bronchiectasis and cystic fibrosis. Its role in chronic obstructive pulmonary disease (COPD) is less well-defined.
Methods: A prospective study was conducted in Hong Kong to investigate the possible association between Pseudomonas aeruginosa colonization and acute exacerbation of COPD (AECOPD) risks.
Results: Among 327 Chinese patients with COPD, 33 (10.1%) of the patients had Pseudomonas aeruginosa colonization. Patients with or without Pseudomonas aeruginosa colonization had similar background characteristics. Patients with Pseudomonas aeruginosa colonization had increased risks of moderate to severe AECOPD, severe AECOPD, and pneumonia with an adjusted odds ratio (aOR) of 3.15 (95% CI 1.05-9.48, p=0.042), 2.59 (95% CI 1.01₋6.64, p=0.048), and 4.19 (95% CI 1.40₋12.54, p=0.011) respectively. Patients with Pseudomonas aeruginosa colonization also had increased annual frequency of moderate to severe AECOPDs, median 0 (0₋0.93) in the non-Pseudomonas aeruginosa colonization group and 1.35 (0₋3.39) in the Pseudomonas aeruginosa colonization group, with a p-value of 0.005 in multivariate linear regression.
Conclusion: Pseudomonas aeruginosa colonization is a potential independent risk factor for moderate to severe AECOPD and pneumonia among patients with COPD without coexisting bronchiectasis.
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