Archivos De Bronconeumologia最新文献

Objectives: (i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45-85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients.

Methods: First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test.

Results: 568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV₁ 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations.

Conclusions: The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.

Objectives: To investigate the microbiota and metabolome of patients with ABO compared with bronchiectasis and asthma, and determine the relevance with clinical characteristics, inflammatory endotype and exacerbation risks.

Methods: In this prospective cohort study, patients underwent comprehensive assessments, including sputum differential cell count, and sputum collection at baseline. Sputum microbiota was profiled via 16S rRNA gene sequencing and metabolome via liquid chromatography/mass spectrometry. Shannon-Wiener Diversity Index (SWDI) was used to reflect dysbiosis. Patients were followed-up to record exacerbations. ABO patients were stratified by the SWDI and sputum eosinophilia to determine the exacerbation risks.

Results: Two hundred forty-seven patients were recruited, including 99 ABO (median age: 53.2 years, 65.7% female), 61 asthma (median age: 39.5 years, 50.8% female) and 87 bronchiectasis patients (median age: 52.3 years, 55.2% female). Both microbiota compositions and metabolites differed among asthma, ABO and bronchiectasis, and between eosinophilic and non-eosinophilic ABO at steady-state. Baseline SWDI of microbiota was highest in asthma, followed by ABO. Both Pseudomonadaceae and Rothia most effectively discriminated ABO from asthma and bronchiectasis. Pseudomonas exhibited a more pronounced negative correlation with other taxa in nonEos-ABO. ABO patients with low SWDI with sputum eosinophilia, or those with high SWDI without sputum eosinophilia, had a shorter time to the first exacerbation. Metabolomic compositions in Eos-ABO separated from nonEos-ABO. The relative abundance of Enterobacteriaceae correlated negatively with 15-hydroxylated eicosatetraenoic acid, whose concentrations were higher in Eos-ABO.

Conclusions: Integrating microbiota and metabolome profiles, together with eosinophilic inflammatory endotyping, can inform exacerbation risk and personalized management of ABO.

Background: Polymicrobial pneumonia is a concern for clinicians due to its association with increased disease severity. Determining the prevalence of polymicrobial pneumonia and identifying patients who have an increased risk of this aetiology is important for the management of CAP patients. Here we describe the clinical characteristics and outcomes of adult hospitalized patients with CAP, and identify the risk factors related to polymicrobial pneumonia and specifically to 30-day mortality.

Methods: Real-life retrospective study from a prospectively collected data including 5114 consecutive adult patients hospitalized with CAP; 1703 patients had an established aetiology.

Results: Polymicrobial infection was present in 14% of the CAP patients with defined microbial aetiology (64% of ward patients and 28% of ICU patients). The most frequent polymicrobial infections were: Streptococcus pneumoniae+respiratory virus (32%), S. pneumoniae+Haemophilus influenzae (7%) and S. pneumoniae+Staphylococcus aureus (7%). Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial aetiology group than in the monomicrobial aetiology group (14% vs. 7%, p=0.001). In-hospital (12% vs. 7%, p=0.012), 30-day (11% vs. 6%, p=0.008) and 1-year mortality (16% vs. 8%, p=0.001) were higher in the polymicrobial group. Multilobar pneumonia (OR 1.34, 95% CI 1.00-1.80) was an independent risk factor for polymicrobial aetiology in the multivariable analysis, while fever (OR 0.59, 95% CI 0.43-0.80) was independently associated with a lower risk for this condition. Polymicrobial infection was an independent predictor of 30-day mortality in the multivariable analysis (HR 1.83, 95% CI 1.17-2.87; p=0.008).

Conclusions: Polymicrobial infection was related to poor outcomes in adults hospitalized with CAP, especially in elderly patients with chronic comorbidities. Polymicrobial infection was a risk factor for 30-day mortality.