Epicardial fat in patients with chronic obstructive pulmonary disease as a marker of high cardiovascular risk — review

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) are commonly interconnected, and this coincidence negatively influences patients’ mortality and morbidity. On the basis of the current available data originating mainly from cardiovascular studies epicardial fat (EF) has been proposed as a marker of cardiovascular risk. This review is focused on a potential role of epicardial fat as a new biomarker for risk stratification of COPD patients. Epicardial fat may present an important link between chronic obstructive pulmonary disease and cardiovascular diseases, mainly coronary artery disease

Nasierdziowa tkanka tłuszczowa u chorych na przewlekłą obturacyjną chorobę płuc jako wskaźnik wysokiego ryzyka zachorowania na choroby układu sercowo-naczyniowego

Przewlekła obturacyjna choroba płuc (POChP) i choroby układu krążenia (CVD) są ze sobą powiązane i fakt ten powoduje wzrost zachorowalności i umieralności. Na podstawie nowych danych pochodzących głównie z badań nad układem krążenia, nasierdziowa tkanka tłuszczowa (EF) została zaproponowana jako marker ryzyka zachorowania na choroby sercowo-naczyniowe. W przedstawionej pracy poglądowej autorzy skupili się na potencjalnym znaczeniu nasierdziowej tkanki tłuszczowej jako nowego biomarkera stratyfikacji ryzyka chorych na POChP. Nasierdziowa tkanka tłuszczowa może stanowić ważny element łączący przewlekłą obturacyjną chorobę płuc i choroby sercowo- -naczyniowe, a zwłaszcza chorobą wieńcową.Przewlekła obturacyjna choroba płuc (POChP) i choroby układu krążenia (CVD) są ze sobą powiązane i fakt ten powoduje wzrost zachorowalności i umieralności. Na podstawie nowych danych pochodzących głównie z badań nad układem krążenia, nasierdziowa tkanka tłuszczowa (EF) została zaproponowana jako marker ryzyka zachorowania na choroby sercowo-naczyniowe. W przedstawionej pracy poglądowej autorzy skupili się na potencjalnym znaczeniu nasierdziowej tkanki tłuszczowej jako nowego biomarkera stratyfikacji ryzyka chorych na POChP. Nasierdziowa tkanka tłuszczowa może stanowić ważny element łączący przewlekłą obturacyjną chorobę płuc i choroby sercowo- -naczyniowe, a zwłaszcza chorobą wieńcową

Network analysis for uncovering the relationship between host response and clinical factors to virus pathogen: Lessons from SARS-CoV-2

Analysing complex datasets while maintaining the interpretability and explainability of outcomes for clinicians and patients is challenging, not only in viral infections. These datasets often include a variety of heterogeneous clinical, demographic, laboratory, and personal data, and it is not a single factor but a combination of multiple factors that contribute to patient characterisation and host response. Therefore, multivariate approaches are needed to analyse these complex patient datasets, which are impossible to analyse with univariate comparisons (e.g., one immune cell subset versus one clinical factor). Using a SARS-CoV-2 infection as an example, we employed a patient similarity network (PSN) approach to assess the relationship between host immune factors and the clinical course of infection and performed visualisation and data interpretation. A PSN analysis of similar to 85 immunological (cellular and humoral) and similar to 70 clinical factors in 250 recruited patients with coronavirus disease (COVID-19) who were sampled four to eight weeks after a PCR-confirmed SARS-CoV-2 infection identified a minimal immune signature, as well as clinical and laboratory factors strongly associated with disease severity. Our study demonstrates the benefits of implementing multivariate network approaches to identify relevant factors and visualise their relationships in a SARS-CoV-2 infection, but the model is generally applicable to any complex dataset.Web of Science1411art. no. 242

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Pulmonary Complications after COVID-19

Coronavirus disease 2019 (COVID-19) is a threat to patients not only because of its acute course, but also because of various complications occurring in the following period, that is, more than 28 days after the onset of acute infection. The present study identified a total of 121 patients hospitalized 29 or more days after the first positive result of a PCR test for SARS-CoV-2, of whom 98 patients were included in the study. Patients were divided into two groups by the time interval between the positive COVID-19 test result and hospitalization date. The time intervals were week 5–11 in an ongoing-COVID group (57.1% of patients) and 12 or more weeks in a post-COVID-group (42.9%). The most frequent reason for hospitalization was respiratory tract infection (58.2%). Pneumonia accounted for 77.2% of these cases. Other reasons for hospitalization were interstitial lung disease (22.4%), pulmonary embolism (8.2%), and sarcoidosis (6.1%). The study group was further divided according to the causes of hospitalization into subgroups with infections and other causes. In the group with infectious diseases, there was a shorter time period between PCR positivity and hospitalization and there were significantly more frequent non-respiratory complications. In the entire sample, the in-hospital mortality was 5.1%

Adherence of obstructive sleep apnoea syndrome patients to positive airway pressure therapy - 10-year follow-up

Purpose. Continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnoea syndrome (OSAS). Long-term adherence is necessary; however, it may be widely variable based on current literature, where the predicting factors are also not well defined. The aim of this study was to assess ten-year adherence to CPAP and to define factors influencing it. Methods. In total, 107 patients (91 males) were enrolled in this study, with an average age of 53.5 years (SD 10.1), with CPAP therapy being indicated (Apnoea-Hypopnoea Index - AHI &gt; 15). Anthropometric and social status data have been obtained as well as the average use of CPAP through device memory. Results. Sufficient adherence (&gt; 4 h per night) was found in 57% of patients in the first year with no subsequent significant change during the next ­9 years. Adherence correlated significantly with the severity of OSAS - AHI (r = 0.321 over 5 years) and Epworth Sleepiness Scale (r = 0.317 over ten years) but did not correlate with the pressure used or the age of the patient. No statistically significant differences have been found between the sexes, the different mask groups, or the social status groups. Conclusion. Good adherence to CPAP therapy in OSAS patients is essential. According to our results, patients with more severe OSAS or more severe sleepiness seem to have better adherence

High incidence of masked hypertension in patients with obstructive sleep apnoea despite normal automatedoffice blood pressure measurement results

Introduction: Obstructive sleep apnoea (OSA) is a well-known risk factor for masked hypertension (MH) and masked uncontrolled hypertension (MUCH). Automated ambulatory office blood pressure measurement (AOBP) might better correlate with the results of ambulatory blood pressure measurements (ABPM) compared to routine office blood pressure measurement (OBPM). The aim of this study was to compare the diagnostic rate of MH/MUCH when using OBPM and AOBP in combination with ABPM. Material and methods: 65 OSA patients, of which 58 were males, (AHI &gt; 5, mean 44.4; range 5–103) of average age 48.8 ± 10.7 years were involved in this study. Following MH/MUCH criteria were used; Criteria I: OBPM &lt; 140/90 mm Hg and daytime ABPM &gt; 135/85 mm Hg; Criteria II: AOBP &lt; 140/90 mm Hg and daytime ABPM &gt; 135/85 mm Hg; Criteria III: AOBP &lt; 135/85 mm Hg and daytime ABPM &gt; 135/85 mm Hg. Results: MH/MUCH criteria I was met in 16 patients (24.6%) with criteria II being met in 37 patients (56.9%), and criteria III in 33 (51.0%), p &lt; 0.0001. Both systolic and diastolic OBPM were significantly higher than AOBP; Systolic (mm Hg): 135.3 ± 12.3 vs 122.1 ± 10.1 (p &lt; 0.0001); Diastolic (mm Hg): 87.4 ± 8.9 vs 77.1 ± 9.3 (p &lt; 0.0001). AOBP was significantly lower than daytime ABPM; Systolic (mm Hg): 122.1 ± 10.1 vs 138.9 ± 10.5 (p &lt; 0.0001); Diastolic (mm Hg): 77.1 ± 9.3 vs 81.6 ± 8.1 (p &lt; 0.0001). Non-dipping phenomenon was present in 38 patients (58.4%). Nocturnal hypertension was present in 55 patients (84.6%). Conclusions: In patients with OSA there is a much higher prevalence of MH/MUCH despite normal AOBP, therefore it is necessary to perform a 24-hour ABPM even if OBPM and AOBP are normal

High Incidence of Masked Hypertension in Patients with Obstructive Sleep Apnoea Despite Normal Automated Office Blood Pressure Measurement Results

Introduction: Obstructive sleep apnoea (OSA) is a well-known risk factor for masked hypertension (MH) and masked uncontrolled hypertension (MUCH). Automated ambulatory office blood pressure measurement (AOBP) might better correlate with the results of ambulatory blood pressure measurements (ABPM) compared to routine office blood pressure measurement (OBPM). The aim of this study was to compare the diagnostic rate of MH/MUCH when using OBPM and AOBP in combination with ABPM. Material and methods: 65 OSA patients, of which 58 were males, (AHI &gt; 5, mean 44.4; range 5–103) of average age 48.8 ± 10.7 years were involved in this study. Following MH/MUCH criteria were used; Criteria I: OBPM &lt; 140/90 mm Hg and daytime ABPM &gt; 135/85 mm Hg; Criteria II: AOBP &lt; 140/90 mm Hg and daytime ABPM &gt; 135/85 mm Hg; Criteria III: AOBP &lt; 135/85 mm Hg and daytime ABPM &gt; 135/85 mm Hg. Results: MH/MUCH criteria I was met in 16 patients (24.6%) with criteria II being met in 37 patients (56.9%), and criteria III in 33 (51.0%), p &lt; 0.0001. Both systolic and diastolic OBPM were significantly higher than AOBP; Systolic (mm Hg): 135.3 ± 12.3 vs. 122.1 ± 10.1 (p &lt; 0.0001); Diastolic (mm Hg): 87.4 ± 8.9 vs. 77.1 ± 9.3 (p &lt; 0.0001). AOBP was significantly lower than daytime ABPM; Systolic (mm Hg): 122.1 ± 10.1 vs. 138.9 ± 10.5 (p &lt; 0.0001); Diastolic (mm Hg): 77.1 ± 9.3 vs. 81.6 ± 8.1 (p &lt; 0.0001). Non-dipping phenomenon was present in 38 patients (58.4%). Nocturnal hypertension was present in 55 patients (84.6%). Conclusions: In patients with OSA there is a much higher prevalence of MH/MUCH despite normal AOBP, therefore it is necessary to perform a 24-hour ABPM even if OBPM and AOBP are normal

Epicardial Fat in Patients with Chronic Obstructive Pulmonary Disease as a Marker of High Cardiovascular Risk

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) are commonly interconnected, and this coincidence negatively influences patients’ mortality and morbidity. On the basis of the current available data originating mainly from cardiovascular studies epicardial fat (EF) has been proposed as a marker of cardiovascular risk. This review is focused on a potential role of epicardial fat as a new biomarker for risk stratification of COPD patients. Epicardial fat may present an important link between chronic obstructive pulmonary disease and cardiovascular diseases, mainly coronary artery disease