Heart & Lung最新文献

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory illness. Pentraxin-3 (PTX3) is abnormally elevated in the plasma of patients with acute exacerbation of COPD. However, the role and significance of PTX3 in the clinical diagnosis of COPD remain unclear.

Objectives: This study was to explore the functional role of plasma PTX3 in COPD and its relationship with lung function metrics and influence on the severity of the disease.

Methods: We prospectively recruited 170 patients with stable-stage COPD admitted to our hospital between June 2020 and May 2023 and healthy study participants as study participants. Based on their smoking history, all participants were classified into those with a history of smoking and those without a smoking history.

Results: Stable-stage smoking-related COPD patients exhibited lower values for FEV1(% predicted) and reduced FEV1/FVC ratios, with increased values for smoking index, red cell distribution width, fibrinogen, d-dimer, white blood cell counts, neutrophil to lymphocyte ratio (NLR), Medical Research Council (mMRC) scores, COPD assessment test (CAT) score, and plasma PTX3 level. There was a positive correlation of PTX3 levels with mMRC and CAT scores and a negative correlation with FEV1 % predicted and FEV1/FVC. Increased smoking index and plasma PTX3 and NLR were independent risk factors for exacerbation in stable smoking-related COPD patients. The area under the curve (AUC) for plasma PTX3 in predicting severe COPD was 0.831.

Conclusions: A plasma PTX3 level > 246.2 ng/mL could be a valuable indicator for predicting exacerbations in patients with stable-stage smoking-associated COPD exacerbation.

Background: Mechanical ventilation (MV) is crucial for managing critically ill patients; however, extubation failure, associated with adverse outcomes, continues to pose a significant challenge.

Objective: The purpose of this prospective observational study was to develop and validate a predictive numerical model utilizing bedside ultrasound to forecast extubation outcomes in ICU patients.

Methods: We enrolled 300 patients undergoing MV, from whom clinical variables, biomarkers, and ultrasound parameters were collected. Patients were randomly assigned to two groups at a 6:4 ratio: the derivation cohort (n = 180) and the validation cohort (n = 120). A nomogram prediction model was developed using significant predictors identified through multivariate analysis and its performance was assessed and validated by evaluating its discrimination, calibration, and clinical utility.

Results: A total of 300 patients (mean age 72 years; 57.3 % male) were included, with an extubation failure rate of 26.7 %. The model, including diaphragm thickening fraction (OR: 0.890, P = 0.009), modified lung ultrasound score (OR: 1.371, P < 0.001), peak relaxation velocity (OR: 1.515, P = 0.015), and APACHE II (OR: 1.181, P = 0.006), demonstrated substantial discriminative capability, as indicated by an area under the receiver operating characteristic curve (AUC) of 0.886 (95 % CI: 0.830-0.942) for the derivation cohort and 0.846 (95 % CI: 0.827-0.945) for the validation cohort. Hosmer-Lemeshow tests yielded P-values of 0.224 and 0.212 for the derivation and validation cohorts.

Conclusions: We have established a risk prediction model for extubation failure in mechanically ventilated ICU patients. This risk model base on bedside ultrasound parameters provides valuable insights for identifying high-risk patients and preventing extubation failure.

Background: Obesity is a risk factor for COVID-19 mortality; a BMI >35 increases the risk of death up to 12-fold; two previous studies have examined the association between visceral fat quantified by tomography and the risk of severe COVID-19, but not its association with mortality.

Objective: Examine whether tomographic findings differentiated data from patients who died of COVID-19 pneumonia from those who survived in a cohort of patients at a tertiary hospital.

Methods: This was a case-control study (1:1) in which we recruited data from patients at a tertiary care hospital in Mexico. Cases (N = 213) were data from patients with COVID-19 pneumonia discharged due to death, and controls (N = 216) were data from patients discharged due to improvement. All had chest computed tomography (CT) scans in the Picture Archiving and Communication System (PACS) platform. Multivariate analysis was used to identify tomographic variables associated with mortality, and odds ratios were calculated. As tomographic variables, we refer to the total severity score, the total percentage of pulmonary involvement, the pattern of involvement, the location of the lesions, and subcutaneous and visceral fat.

Results: A total of 429 sets of data from Mexican patients were analyzed, with an overall age of 57 years (18-93). Sixty-three percent were male, and arterial hypertension was the most common comorbidity in 48.3 %. An odds ratio (OR) of 8.79 (95 % CI 1.44-53.73) was found for visceral fat and mortality; the rest of the tomographic variables did not show a statistically significant association.

Conclusion: Visceral fat was the most significant tomographic risk factor for mortality in patients with COVID-19 pneumonia.

Background: There is still insufficient longitudinal evidence regarding the risk of mortality in older patients with chronic heart failure (CHF) and social frailty (SF).

Objectives: The purpose of study was to describe the incidence rate of non-SF, pre-SF, and SF in older patients with CHF and explore its impact on mortality.

Methods: The observational study was conducted at a tertiary hospital in China. According on the Help, Participation, Loneliness, Financial, Talk scale (HALFT) scores, they were divided into three groups: non-SF (0 points), pre-SF(1-2points), and SF groups(≥3points). Follow up for 6 months, observation indicator was mortality. Kaplan Meier survival analysis and the Log-rank test were used to compare the mortality of the three groups of patients. Apply the Cox proportional hazards regression model to analyze the related factors associated with mortality.

Results: A total of 297 patients completed the baseline survey.The average age was 69.99±6.47, with 59.26 % men and 40.74 % women. In the 6-month follow-up, nine patients were lost to follow-up, and 35 patients died. The mortality rate of the SF group was higher than that of the non-SF group (χ²=14.805, P < 0.01). Using a multivariate Cox proportional hazards regression model, our results showed that SF, age, and marital status were risk factors for mortality.

Conclusion: SF can increase the risk of mortality in older patients with CHF and is a risk factor for mortality. Healthcare providers should enhance patients' social adjustment to aid early prevention and intervention in the occurrence and development of SF to reduce the risk of mortality in older patients with CHF.

Background: Intention is an important factor in encouraging patients to receive cardiac rehabilitation. Illness perceptions of patients and individuals around them, such as family caregivers, may influence intention. However, no study has explored how family caregivers' illness perceptions enhance older coronary heart disease (CHD) patients' phase II cardiac rehabilitation intentions.

Objectives: To describe older CHD patients' phase II cardiac rehabilitation intentions and their relationship with family caregivers' illness perceptions and to examine the mediating role of patients' illness perceptions.

Methods: A descriptive cross-sectional study was conducted among 202 older CHD patient‒family caregiver dyads. The Chinese versions of the Revised Illness Perception Questionnaire, Willingness to Participate in Cardiac Rehabilitation Questionnaire (WPCRQ), and Cardiac Rehabilitation Inventory (CRI) were adopted. Data analysis included descriptive statistics, Pearson correlations, and structural equation modeling. Reporting followed the STROBE checklist.

Results: Patients were 69.81 years and mostly male (64.85 %); family caregivers were 52.58 years and mostly female (55.94 %). Family caregivers' personal control had a direct effect on patients' phase II cardiac rehabilitation intentions (β_WPCRQ = -0.217, β_CRI = -0.228; P = 0.001). Family caregivers' personal control, treatment control, and timeline acute/chronic had indirect effects on patients' cardiac rehabilitation intentions through patients' corresponding dimensions of illness perceptions (|β|_WPCRQ = 0.086∼0.098, |β|_CRI = 0.062∼0.097; P < 0.05).

Conclusion: Family caregivers' illness perceptions can affect patients' phase II cardiac rehabilitation intentions directly and indirectly through patients' illness perceptions. Interventions targeting illness perceptions in both older CHD patients and their family caregivers could be provided to improve patients' phase II cardiac rehabilitation intentions.

Background: Assessing functional capacity in hospitalized patients with COVID-19 may have been neglected due to a great demand for resources at the height of pandemic and the lack of specific assessment instruments for this population.

Objectives: To identify the instruments used to evaluate functional capacity in COVID-19 patients hospitalized in COVID-19 wards and ICUs and the associations between use of assessment instruments and physiotherapist characteristics METHODS: The survey was conducted using REDCap web-based application, following the Consensus-Based Checklist for Reporting of Survey Studies guidelines. A non-probability recruitment approach aimed at physiotherapists who had treated hospitalized patients with COVID-19 in Brazil. The instruments were classified into four domains: muscle strength, mobility, activities of daily living, and physical performance, as for the International Classification of Functioning, Disability, and Health RESULTS: Overall, 485 physiotherapists responded to the survey, 81.9% of whom used one or more instruments to assess functional capacity. The Medical Research Council (59.6%) and the Six-Minute Walk Test (21.7%) were the most commonly used instruments in COVID-19 wards; the MRC (63.9%) and the Intensive Care Mobility Scale (33.1%), in ICUs. In COVID-19 wards, higher probability of using assessment instruments was associated with being male, having training on COVID-19 management, and working > 50 h/week. In ICUs, having training on COVID-19 management and working in university hospitals were associated with higher probability of using these instruments CONCLUSIONS: Most physiotherapists used one or more instruments to assess functional capacity, assessed more than one physical domain, and used the obtained results to plan interventions.

Background: Mindfulness-based interventions (MBI) benefit adults with chronic obstructive pulmonary disease (COPD) by helping them manage their symptoms and improve their quality of life. Little is known about their baseline mindfulness knowledge and practice and how these may relate to symptom management.

Objectives: To 1) compare symptom severity scores of depression, anxiety, dyspnea, fatigue, and insomnia between those who know and practice mindfulness and those who do not, and 2) construct phenotype profile characteristics of COPD patients based on their levels of mindfulness.

Methods: 339 community-dwelling adults (mean age 53.43±13.48 years, 61.28 % male, and 48.21 % White) completed an online cross-sectional survey study indicating their mindfulness knowledge, practice, level, and COPD symptom severity. After adjusting for multiple comparisons among the three groups, we used Kruskal-Wallis, Fisher's exact, and Chi-squared tests to compare variables' differences among these three mindfulness levels.

Results: Participants who self-identified as knowledgeable about mindfulness (n = 315) reported significantly lower severity of dyspnea and fatigue. Participants who self-identified as current practitioners of mindfulness (n = 282) reported substantially lower symptom severity. Among the different mindfulness groups, levels of phenotype profile analysis showed statistically significant differences in demographic and clinical characteristics, including depressive symptoms, age, ethnicity, education level, and years living with COPD. We found no differences in gender or disease severity levels.

Conclusions: Community-dwelling adults with COPD who practiced mindfulness reported lower symptom severity than those who did not. This suggests the potential benefits of MBI integration as a complementary health approach to symptom management. The mindfulness level phenotype profile is critical to tailoring MBIs. It can guide the design and delivery of MBIs with optimal feasibility, acceptability, effectiveness, and sustained adherence for adults with COPD according to their mindfulness level profiles.

Background: The incidence of out-of-hospital cardiac arrest (OHCA) in China is high, yet the treatment rate remains low. Research on the current state of the public's awareness of and willingness to provide cardiopulmonary resuscitation (CPR) in Hubei Province is scarcer.

Objectives: The objective of this research was to explore the general public's knowledge, confidence, and willingness to perform CPR in Hubei Province, China.

Methods: In this descriptive study we used convenience sampling to select 1, 849 permanent residents of Hubei Province as survey respondents. A self-designed questionnaire included four sections: demographic information, knowledge about CPR, confidence in skill implementation, willingness to implement it, factors that may influence CPR use.

Results: Four hundred ten individuals (22 %) had a knowledge score of moderate or higher. The following factors were statistically significant in CPR knowledge scores: gender, age, education, place of residence (last three years), presence of a cohabitant over age sixty years, occupation related to medicine, and participation in CPR training (p < 0.05). Only 81 (9.8 %) were confident in performing CPR. There were 708 (77.2 %) members of the public who were willing to perform CPR on strangers. Gender, age, education, place of residence (last three years), and having a medically-related occupation were associated with willingness to perform CPR (p < 0.05).

Conclusions: Public knowledge of CPR in Hubei needs improvement, with a strong willingness but inadequate background knowledge for rescue. Government should broaden CPR training paths to enhance survival rates of OHCA patients.

Background: Predicting and reducing the 28-day mortality in sepsis remains a challenge in this research field.

Objective: This study aimed to explore the association between hypertension and 28-day mortality in sepsis.

Methods: This study is a cross-sectional approach with Mendelian Randomization (MR). We used GWAS data for hypertension as the exposure and 28-day mortality in sepsis as the outcome and employed the main inverse variance weighted method along with other supplementary MR techniques to verify the causal association between hypertension and 28-day mortality in sepsis. We used sensitivity analyses to ensure the robustness of the research findings. Finally, we utilized clinical data from the Medical Information Mart for Intensive Care-IV database to assess the risk association between hypertension and 28-day mortality in sepsis using difference analysis and multivariate logistic regression analysis.

Results: According to MR, hypertension increased the 28-day mortality in sepsis in both two datasets (FinnGen: odds ratio [OR] = 1.61, 95 % confidence interval [CI] = 1.15-2.26, p = 0.006; Medical Research Council-Integrative Epidemiological Unit: OR = 160, 95 % CI = 2.76-9250, p = 0.014). In our observational study, we included a total of 2012 sepsis patients, of which 60.5 % were male, and the average age was 55.4 years. By applying univariate and multivariate logistic regression models (univariate analysis p = 0.02, multivariate analysis p = 0.02), we observed a significantly increased risk of 28-day mortality due to hypertension in sepsis patients.

Conclusion: This study confirmed the causal relationship between hypertension and the 28-day mortality in sepsis.

Background: Treatment burden is a significant barrier to patient adherence that may lead to deterioration of health.

Objectives: The purpose of this study was to understand the treatment burden of Chinese patients with coronary heart disease (CHD) and its associations with demographic, capacity, and workload-related factors.

Methods: We conducted an observational cross-sectional study. We recruited 396 patients with CHD in a tertiary hospital in Shandong Province, China. Self-report questionnaires were used to measure patients' sociodemographic information, clinical information, treatment burden, health literacy, illness perception, and chronic illness resources. Descriptive statistics and t-tests, one-way analysis of variance, Pearson's correlation analysis, and multiple linear regression analysis were used for data analysis.

Results: A total of 396 participants were included, of whom 273 were male (68.9 %) and 123 were female (31.1 %). The mean age of the participants was 63.10 ± 9.75. The predictors for treatment burden included smoking, taking ≥ 6 kinds of medications/day, health literacy, illness perception, and chronic illness resources, which explained 50.9 % of the variance (p < 0.05).

Conclusion: Our findings indicate an association between treatment burden and factors such as smoking, taking ≥ 6 kinds of medications/day, health literacy, illness perception, and chronic illness resource survey. Healthcare staff should develop targeted interventions based on relevant factors and optimize treatment strategies to improve patient adherence.