| 1. |
|
|
| 2. |
- Becher, Tobias H., et al.
(författare)
-
Prolonged Continuous Monitoring of Regional Lung Function in Infants with Respiratory Failure
- 2022
-
Ingår i: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 19:6, s. 991-999
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Electrical impedance tomography (EIT) allows instantaneous and continuous visualization of regional ventilation and changes in end-expiratory lung volume at the bedside. There is particular interest in using EIT for monitoring in critically ill neonates and young children with respiratory failure. Previous studies have focused only on short-term monitoring in small populations. The feasibility and safety of prolonged monitoring with EIT in neonates and young children have not been demonstrated yet.Objectives: To evaluate the feasibility and safety of long-term EIT monitoring in a routine clinical setting and to describe changes in ventilation distribution and homogeneity over time and with positioning in a multicenter cohort of neonates and young children with respiratory failure.Methods: At four European University hospitals, we conducted an observational study (NCT02962505) on 200 patients with postmenstrual ages (PMA) between 25 weeks and 36 months, at risk for or suffering from respiratory failure. Continuous EIT data were obtained using a novel textile 32-electrode interface and recorded at 48 images/s for up to 72 hours. Clinicians were blinded to EIT images during the recording. EIT parameters and the effects of body position on ventilation distribution were analyzed offline. Results: The average duration of FAT measurements was 53 +/- 20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during a median of 92% (interquartile range, 77-98%) of examination time. EIT examinations were well tolerated, with minor skin irritations (temporary redness or imprint) occurring in 10% of patients and no moderate or severe adverse events. Higher ventilation amplitude was found in the dorsal and right lung areas when compared with the ventral and left regions, respectively. Prone positioning resulted in an increase in the ventilation-related EIT signal in the dorsal hemithorax, indicating increased ventilation of the dorsal lung areas. Lateral positioning led to a redistribution of ventilation toward the dependent lung in preterm infants and to the nondependent lung in patients with PMA > 37 weeks.Conclusions: EIT allows continuous long-term monitoring of regional lung function in neonates and young children for up to 72 hours with minimal adverse effects. Our study confirmed the presence of posture-dependent changes in ventilation distribution and their dependency on PMA in a large patient cohort.
|
|
| 3. |
|
|
| 4. |
- Blomberg, Anders, et al.
(författare)
-
Chronic Airflow Limitation, Emphysema and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-Aged Population.
- 2024
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621.
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Chronic obstructive pulmonary disease (COPD) includes respiratory symptoms and chronic airflow limitation (CAL). In some cases, emphysema and impaired diffusing capacity for carbon monoxide (DLCO) are present, but characteristics and symptoms vary with smoking exposure.OBJECTIVES: To study the prevalence of CAL, emphysema and impaired DLCO in relation to smoking and respiratory symptoms in a middle-aged population.METHODS: We investigated 28,746 randomly invited individuals (52% women) aged 50-64 years across six Swedish sites. We performed spirometry, DLCO, high-resolution computed tomography (HRCT) and asked for smoking habits and respiratory symptoms. CAL was defined as post-bronchodilator forced expiratory volume in 1 second divided by forced expiratory volume (FEV1/FVC)<0.7.RESULTS: The overall prevalence was for CAL 8.8%, for impaired DLCO (DLCOCONCLUSIONS: In this large population-based study of middle-aged people, CAL and impaired DLCO were associated with common respiratory symptoms. Self-reported asthma was not associated with CAL in never-smokers. Our findings suggest that CAL in never-smokers signifies a separate clinical phenotype that may be monitored and, possibly, treated differently from smoking-related COPD. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
|
|
| 5. |
- Buschur, Kristina L., et al.
(författare)
-
Peripheral Blood Mononuclear Cell Gene Expression Associated with Pulmonary Microvascular Perfusion: The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease
- 2024
-
Ingår i: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 21:6, s. 884-894
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Chronic obstructive pulmonary disease (COPD) and emphysema are associated with endothelial damage and altered pulmonary microvascular perfusion. The molecular mechanisms underlying these changes are poorly understood in patients, in part because of the inaccessibility of the pulmonary vasculature. Peripheral blood mononuclear cells (PBMCs) interact with the pulmonary endothelium. Objectives: To test the association between gene expression in PBMCs and pulmonary microvascular perfusion in COPD. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited two independent samples of COPD cases and controls with ⩾10 pack-years of smoking history. In both samples, pulmonary microvascular blood flow, pulmonary microvascular blood volume, and mean transit time were assessed on contrast-enhanced magnetic resonance imaging, and PBMC gene expression was assessed by microarray. Additional replication was performed in a third sample with pulmonary microvascular blood volume measures on contrast-enhanced dual-energy computed tomography. Differential expression analyses were adjusted for age, gender, race/ethnicity, educational attainment, height, weight, smoking status, and pack-years of smoking. Results: The 79 participants in the discovery sample had a mean age of 69 ± 6 years, 44% were female, 25% were non-White, 34% were current smokers, and 66% had COPD. There were large PBMC gene expression signatures associated with pulmonary microvascular perfusion traits, with several replicated in the replication sets with magnetic resonance imaging (n = 47) or dual-energy contrast-enhanced computed tomography (n = 157) measures. Many of the identified genes are involved in inflammatory processes, including nuclear factor-κB and chemokine signaling pathways. Conclusions: PBMC gene expression in nuclear factor-κB, inflammatory, and chemokine signaling pathways was associated with pulmonary microvascular perfusion in COPD, potentially offering new targetable candidates for novel therapies.
|
|
| 6. |
- Ekström, Magnus, et al.
(författare)
-
Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing
- 2024
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621. ; 21:1, s. 56-67
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0–10 category ratio) response in men and women aged >40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged >40 years undergoing symptom-limited incremental cycle CPET (10 W/ min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories ,5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0–10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression.Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42–91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81–0.92, C statistic for women = 0.81–0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Lytras, T., et al.
(författare)
-
Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts
- 2021
-
Ingår i: Annals of the American Thoracic Society. - New York : American Thorax Society. - 1546-3222 .- 2329-6933 .- 2325-6621 .- 1943-5665. ; 18:2, s. 238-246
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts. Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
|
|
| 10. |
- Torén, Kjell, et al.
(författare)
-
Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population 50-64 Years.
- 2024
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621.
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Knowledge regarding prevalence and shared and unique characteristics of Restrictive spirometric pattern (RSP) and Preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs.OBJECTIVES: To investigate shared and unique features for RSP and PRISm.METHODS: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50 - 64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score (CACS). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using adjusted logistic regression. RSP was defined as FEV1/FVC≥0.70 and FVC<80%. PRISm was defined as FEV1/FVC≥0.70 and FEV1<80%. A local reference equation was applied.MEASUREMENTS AND RESULTS: The prevalence of RSP and PRISm were 5.1% (95% CI 4.9 - 5.4) and 5.1% (95% CI 4.8 - 5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease (IHD), bronchial wall thickening, interstitial lung abnormalities (ILA), and bronchiectasis. Emphysema was uniquely linked to PRISm (OR 1.69, 1.36-2.10) vs 1.10 (0.84-1.43) for RSP. CACS≥300 was related to PRISm, but not among among never-smokers.CONCLUSIONS: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
|
|
| 11. |
- Björklund, Filip, et al.
(författare)
-
Adverse Effects, Smoking, Alcohol Consumption, and Quality of Life during Long-Term Oxygen Therapy : A Nationwide Study
- 2022
-
Ingår i: Annals of the American Thoracic Society. - 2325-6621. ; 19:10, s. 1677-1686
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Long-term oxygen therapy (LTOT) is prescribed for at least 15 hours per day and often used by patients for several years, but knowledge is limited regarding adverse effects, risk exposures, and health-related quality of life (HrQoL) among those treated. Objectives: To determine the prevalence of adverse effects, smoking, and alcohol consumption and their relations to HrQoL among patients treated with LTOT. Methods: This was a cross-sectional survey of a randomized sample of adults with ongoing LTOT in the Swedish National Registry for Respiratory Failure (Swedevox). Patient characteristics and the prevalence of 26 prespecified adverse effects, smoking, and alcohol consumption, were compared between respondents with better and worse HrQoL on the chronic obstructive pulmonary disease assessment test. Results: A total of 151 respondents were included (mean age, 74.7 yr [standard deviation, 8.6 yr]; 58.9% women; median LTOT duration, 2.2 yr [interquartile range, 1.0-3.8 yr]). Characteristics upon starting LTOT were similar between respondents and nonrespondents. Active smoking was very rare (n = 4, 2.6%). For alcohol use, 67.2% of participants reported no consumption during an average week, whereas risk use was reported by 25.8% of men and 16.9% of women. The most prevalent adverse effects were reduced mobility or physical activity (70.9%), dry mouth (69.5%), congestion or nasal drip (61.6%), increased tiredness (57.0%), and dry nose (53.0%). Patients with higher numbers of total and systemic adverse effects experienced worse HrQoL, whereas no associations were found for smoking status or alcohol consumption. The majority (54.8%) of adverse effects were untreated and unreported to health professionals. Conclusions: Adverse effects are common among patients with LTOT and are associated with worse HrQoL. As the majority of adverse effects had not been discussed or treated, structured assessment and management of risk exposures and adverse effects is warranted.
|
|
| 12. |
- Chen, B. X., et al.
(författare)
-
Effect of Continuous Positive Airway Pressure on Weight and Local Adiposity in Adults with Obstructive Sleep Apnea A Meta-Analysis
- 2021
-
Ingår i: Annals of the American Thoracic Society. - 1546-3222 .- 2329-6933. ; 18:10, s. 1717-1727
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Evidence suggests that continuous positive airway pressure (CPAP) treatment promotes weight gain in patients with obstructive sleep apnea (OSA). It is unclear whether weight gain is influenced by CPAP adherence or comorbid disorders. Objectives: To examine the CPAP effects on body mass index (BMI) and local adiposity and the potential moderators of CPAP effects on BMI in patients with OSA. Methods: We searched PubMed/Medline, Embase, and Cochrane through December 2019. Randomized controlled trials of CPAP versus control treatment with >4 weeks' treatment were included. Results: A total of 39 randomized controlled trials with 6,954 subjects were included. In intention-to-treat analysis, the BMI increased significantly after CPAP treatment compared with control treatment (weighted mean difference [WMD], 0.148 kg/m(2); 95% confidence interval, 0.04-0.26; P = 0.001). In studies demonstrating an increase in the BMI, waist and neck circumferences were also significantly increased. Subgroup analyses revealed that an increased BMI was attributable to CPAP use of <5 h/night (WMD, 0.231) but was not attributable to CPAP use of.5 h/night (WMD, 0.001; between-group P value = 0.049). Furthermore, the BMI increased significantly in patients without cardiovascular disease (CVD; WMD, 0.200), whereas it decreased significantly in those with CVD at baseline (WMD, 20.188; between-group P value, 0.001). Moreover, the BMI increased significantly in patients with dysglycemia (WMD, 0.499) but did not increase in those without dysglycemia at baseline (WMD, 0.100; between-group P value = 0.032). Meta-regression confirmed the subgroup findings. Conclusions: The BMI increased significantly in patients with OSA after CPAP treatment, especially in those with CPAP use of <5 h/night, without CVD and/or with dysglycemia at baseline. CPAP use of at least 5 h/night seems to be necessary in mitigating the risk for weight gain in patients with OSA.
|
|
| 13. |
- Eulenburg, C., et al.
(författare)
-
Cardiovascular Outcomes in Adults with Coronary Artery Disease and Obstructive Sleep Apnea with versus without Excessive Daytime Sleepiness in the RICCADSA Cinical Trial
- 2023
-
Ingår i: Annals of the American Thoracic Society. - 1546-3222 .- 2329-6933. ; 20:7, s. 1048-1056
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Recent randomized controlled trials did not show cardiovascular benefits of continuous positive airway pressure (CPAP) in adults with coronary artery disease (CAD) and obstructive sleep apnea (OSA) in intention-to-treat analyses. It has been argued that exclusion of patients with OSA with excessive daytime sleepiness (EDS), who may be most likely to benefit from CPAP treatment, may be a reason for the null results. Objectives: We addressed 1) the effect of concomitant EDS on adverse outcomes in patients with CAD and OSA; and 2) whether the cardiovascular benefit of CPAP adherence differs between individuals with versus without EDS. Methods: This was a secondary analysis of the RICCADSA (Randomized Intervention with CPAP in CAD and Obstructive Sleep Apnea) trial, conducted in Sweden between 2005 and 2013. Data were analyzed from 155 patients with CAD with OSA (apnea-hypopnea index> 15/h) and EDS (Epworth Sleepiness Scale score> 10), who were allocated to CPAP and 244 patients without EDS (ESS, 10), who were randomized to CPAP or no CPAP. Patients who were allocated to no CPAP or were nonadherent (CPAP usage, 4 h/night) were compared with adherent patients (CPAP usage> 4 h/night) at 1-year follow-up. Inverse probability of treatment weighting was applied to mimic randomization of EDS. The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Results: The median follow-up was 52.2 months. The incidence of the primary endpoint did not differ significantly between the EDS versus no-EDS groups in the entire cohort. Within the adherent group, patients without EDS had a significantly decreased risk compared with patients with EDS (adjusted hazard ratio, 0.41; 95% confidence interval, 0.20-0.85; P = 0.02). Conclusions: Adverse cardiovascular outcomes did not differ by degrees of EDS for patients with CAD with OSA who were untreated or nonadherent to treatment. CPAP use, at least 4 h/night, was associated with reduced adverse outcomes in participants without EDS. Clinical trial registered with www.
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Peker, Yuksel, et al.
(författare)
-
Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019
- 2021
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933. ; 18:9, s. 1548-1559
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Coronavirus disease (COVID-19) is an ongoing pandemic, in which obesity, hypertension, and diabetes have been linked to poor outcomes. Obstructive sleep apnea (OSA) is associated with these conditions and may influence the prognosis of adults with COVID-19. Objectives: To determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: The current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as high-risk or low-risk OSA according to the Berlin questionnaire that was administered in the out-patient clinic, in hospital, or shortly after discharge from hospital blinded to the clinical outcomes. A modified high-risk (mHR)–OSA score based on the snoring patterns (intensity and/or frequency), breathing pauses, and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: The primary outcome was the clinical improvement defined as a decline of two categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death) on Days 7, 14, 21, and 28, respectively. Secondary outcomes included clinical worsening (an increase of 1 category), need for hospitalization, supplemental oxygen, and intensive care. In total, 320 eligible patients (median [interquartile range] age, 53.2 [41.3–63.0] yr; 45.9% female) were enrolled. In all, 121 (37.8%) were categorized as known (n = 3) or high-risk OSA (n = 118). According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4% of the mHR-OSA group compared with 88.4% of the modified low-risk–OSA group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted odds ratio [OR], 0.42; 95% confidence interval [CI], 0.19–0.92) and male sex (OR, 0.39; 95% CI, 0.17–0.86) predicted the delayed clinical improvement. In the entire study population (n = 320), including the nonhospitalized patients, mHR-OSA was associated with clinical worsening (adjusted hazard ratio, 1.55; 95% CI, 1.00–2.39) and with the need for supplemental oxygen (OR, 1.95; 95% CI, 1.06–3.59). Snoring patterns, especially louder snoring, significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: Adults with mHR-OSA in our COVID-19 cohort had poorer clinical outcomes than those with modified low-risk OSA independent of age, sex, and comorbidities. Clinical trial registered with www.clinicaltrials.gov (NCT04363333).
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
- Torén, Kjell, 1952, et al.
(författare)
-
Inhaled corticosteroids use and risk of invasive pneumococcal disease in a population-based study
- 2020
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933. ; 17:12, s. 1570-1575
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: The use of inhaled corticosteroids (ICS) is associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) associated with ICS is not characterized. Objectives: The aim was to test the hypothesis that the use of ICS increases the risk of IPD. Methods: Cases were persons 20-65 years of age included in a Swedish national registry of invasive infection caused by Streptococcus pneumoniae classified as any IPD as well as the subset of IPD with pneumonia. The case index date was the day the infection was diagnosed. Six control subjects for each case (matched for sex, age, and region) were selected from the Swedish National Population Registry and were assigned the index date of their corresponding case. Current and past users of ICS were defined by the last prescriptions dispensed within 60 or 61-365 days of the index date. Nonusers were defined as those with no dispensed prescription the last 365 days. Current users were characterized by use of fluticasone or budesonide. We used conditional logistic analysis, including matching and covariates, to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of IPD, IPD with pneumonia, and IPD without pneumonia associated with current or past use of ICS. Results: Current use of ICS increased the risk for IPD and IPD with pneumonia (OR, 1.71; 95% CI, 1.39-2.10 and OR, 1.94; 95% CI, 1.53-2.47, respectively), but there was no statistical association between current use of ICS and IPD without pneumonia (OR, 1.18; 95% CI 0.78-1.80). Past use of ICS increased the risk for IPD and IPD with pneumonia but not for IPD without pneumonia. Among current ICS users, the odds for IPD were similar for budesonide (OR, 1.34; 95% CI, 1.14-1.57) and fluticasone (OR, 1.41; 95% CI, 1.04-1.90). Among current ICS users, the odds for IPD with pneumonia were slightly higher but of similar magnitude for both budesonide and for fluticasone. Conclusions: ICS use is associated with an increased risk of IPD and IPD with pneumonia. The risk is driven by IPD with pneumonia. We found similar risks for budesonide and fluticasone. Copyright © 2020 by the American Thoracic Society
|
|
| 22. |
|
|
| 23. |
- Zadeh, Ali Vaeli, et al.
(författare)
-
Risk of 30-Day All-Cause Readmission in Interstitial Lung Disease Patients after COVID-19 National-Level Data
- 2024
-
Ingår i: ANNALS OF THE AMERICAN THORACIC SOCIETY. - 1546-3222 .- 2325-6621. ; 21:3, s. 428-437
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset. Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital. Methods: This study is a nested cohort study that used the PearlDiver patient records database. Adult patients (age >= 18 yr) who were admitted to hospitals in 28 states in the United States with COVID-19 or ILD diagnoses were included. We defined and analyzed two separate cohorts in this study. The first cohort consisted of patients with COVID-19 and was later divided into two groups with or without a history of ILD. The second cohort consisted of patients with ILD and was later divided into groups with COVID-19 or with a non-COVID-19 pneumonia diagnosis at admission. We also studied two other subcohorts of patients with and without idiopathic pulmonary fibrosis within the second cohort. Propensity score matching was employed to match confounders between groups. The Kaplan-Meier log rank test was applied to compare the probabilities of outcomes. Results: We assessed the data of 2,286,775 patients with COVID-19 and 118,892 patients with ILD. We found that patients with COVID-19 with preexisting ILD had an odds ratio of 1.6 for 30-day all-cause readmission. Similarly, an odds ratio of 2.42 in readmission rates was observed among hospitalized individuals with ILD who contracted COVID-19 compared with those who were hospitalized for non-COVID-19 pneumonia. Our study also found a significantly higher probability of intensive care admission among patients in both cohorts. Conclusions: Patients with ILD face heightened rates of hospital readmissions, particularly when ILD is combined with COVID-19, resulting in adverse outcomes such as decreased quality of life and increased healthcare expenses. It is imperative to prioritize preventive measures against COVID-19 and establish effective postdischarge care strategies for patients with ILD.
|
|
