The estimation of comorbidities and serum concentration of cardiac biomarkers in patients with chronic obstructive pulmonary disease treated with invasive or nonivasive ventilation

Cilj: Utvrditi najčešće komorbiditete u pacijenata s akutnom egzcerbacijom kronične opstruktivne plućne bolesti (KOPB) koji su liječeni neinvazivnom ili invazivnom ventilacijom, ispitati serumske koncentracije N-terminalnog fragmenta moždanog natriuretskog peptida (NT-proBNP) i troponina u tih pacijenata te utvrditi utječe li vrsta ventilacije na vrijednosti srčanih biomarkera. Ispitanici i metode: Istraživanje se sastojalo od pregleda medicinske dokumentacije 41 pacijenta s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ili invazivnom ventilacijom u Sveučilišnoj bolnici za plućne bolesti i alergije Golnik. Rezultati: Najčešći komorbiditeti pacijenata s akutnom egzacerbacijom KOPB-a bili su arterijska hipertenzija, srčano zatajenje i ishemijska bolest srca. U pacijenata s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 23 pacijenta (100 %), a troponina u 3 pacijenta (14 %). U pacijenata s akutnom egzacerbacijom KOPB-a liječenih invazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 17 (94 %) pacijenata, a troponina u 7 pacijenata (39 %). Nije uočena statistički značajna razlika u serumskoj koncentraciji NT-proBNP-a i troponina između pacijenata koji su liječeni neinvazivnom, odnosno invazivnom ventilacijom. Rasprava i zaključak: S obzirom na anatomsku i funkcijsku povezanost koja postoji između srca i pluća te zajedničke čimbenike rizika u pacijenata s KOPB-om se učestalo javljaju bolesti kardiovaskularnog sustava, osobito ishemijska bolest srca i srčano zatajenje. Naši rezultati pokazuju da se srčano zatajenje i ishemija miokarda učestalo javljaju u pacijenata s akutnom egzacerbacijom KOPB-a. Uzevši u obzir da se ove dijagnoze prezentiraju sličnom kliničkom slikom potrebno je pratiti serumske koncentracije srčanih biomarkera (NT-proBNP-a i troponina) kako bi se ovim pacijentima osiguralo optimalno liječenje.Aim: To determine the most common comorbidities in patients with chronic obstructive pulmonary disease (COPD) treated with invasive or nonivasive ventilation, investigate serum concentration of cardiac biomarkers (N-terminal pro-brain natriuretic peptide or NT-proBNP and troponin) in these patients and analyze if type of ventilation affects serum concentrations of cardiac biomarkers. Patients and methods: We analyzed 41 medical records of patients with acute exacerbation of COPD treated with nonivasive or invasive ventilation in University hospital for pulmonary disease and alergies Golnik. Results: The most common comorbidities were arterial hypertension, chronic heart failure and ischemic heart disease. In COPD patients with acute exacerbation treated with nonivasive ventilation NT-proBNP levels were elevated in 23 (100 %) patient and troponin levels were elevated in 3 (14 %) patients. In COPD patients with acute exacerbation treated with invasive ventilation NT-proBNP levels were elevated in 17 (94 %) patients and troponin levels were elevated in 7 (39 %) patients. When comparing NT-proBNP and troponin levels between COPD patients with acute exacerbation treated with noninvasive ventilation and those treated with invasive ventilation the statistically significant difference was not found. Discussion and conclusion: Taking into consideration the common risk factors for development od COPD and cardiovascular diseases, in combination with anatomical and functional relation that exists between cardiovascular and pulmonary system, it is not unusual that this two conditions occur with high prevalence in the same patients. Because of the similar clinical manifestations it is important to actively search for these conditions in order to achieve optimal treatment for the patients

The estimation of comorbidities and serum concentration of cardiac biomarkers in patients with chronic obstructive pulmonary disease treated with invasive or nonivasive ventilation

Cilj: Utvrditi najčešće komorbiditete u pacijenata s akutnom egzcerbacijom kronične opstruktivne plućne bolesti (KOPB) koji su liječeni neinvazivnom ili invazivnom ventilacijom, ispitati serumske koncentracije N-terminalnog fragmenta moždanog natriuretskog peptida (NT-proBNP) i troponina u tih pacijenata te utvrditi utječe li vrsta ventilacije na vrijednosti srčanih biomarkera. Ispitanici i metode: Istraživanje se sastojalo od pregleda medicinske dokumentacije 41 pacijenta s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ili invazivnom ventilacijom u Sveučilišnoj bolnici za plućne bolesti i alergije Golnik. Rezultati: Najčešći komorbiditeti pacijenata s akutnom egzacerbacijom KOPB-a bili su arterijska hipertenzija, srčano zatajenje i ishemijska bolest srca. U pacijenata s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 23 pacijenta (100 %), a troponina u 3 pacijenta (14 %). U pacijenata s akutnom egzacerbacijom KOPB-a liječenih invazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 17 (94 %) pacijenata, a troponina u 7 pacijenata (39 %). Nije uočena statistički značajna razlika u serumskoj koncentraciji NT-proBNP-a i troponina između pacijenata koji su liječeni neinvazivnom, odnosno invazivnom ventilacijom. Rasprava i zaključak: S obzirom na anatomsku i funkcijsku povezanost koja postoji između srca i pluća te zajedničke čimbenike rizika u pacijenata s KOPB-om se učestalo javljaju bolesti kardiovaskularnog sustava, osobito ishemijska bolest srca i srčano zatajenje. Naši rezultati pokazuju da se srčano zatajenje i ishemija miokarda učestalo javljaju u pacijenata s akutnom egzacerbacijom KOPB-a. Uzevši u obzir da se ove dijagnoze prezentiraju sličnom kliničkom slikom potrebno je pratiti serumske koncentracije srčanih biomarkera (NT-proBNP-a i troponina) kako bi se ovim pacijentima osiguralo optimalno liječenje.Aim: To determine the most common comorbidities in patients with chronic obstructive pulmonary disease (COPD) treated with invasive or nonivasive ventilation, investigate serum concentration of cardiac biomarkers (N-terminal pro-brain natriuretic peptide or NT-proBNP and troponin) in these patients and analyze if type of ventilation affects serum concentrations of cardiac biomarkers. Patients and methods: We analyzed 41 medical records of patients with acute exacerbation of COPD treated with nonivasive or invasive ventilation in University hospital for pulmonary disease and alergies Golnik. Results: The most common comorbidities were arterial hypertension, chronic heart failure and ischemic heart disease. In COPD patients with acute exacerbation treated with nonivasive ventilation NT-proBNP levels were elevated in 23 (100 %) patient and troponin levels were elevated in 3 (14 %) patients. In COPD patients with acute exacerbation treated with invasive ventilation NT-proBNP levels were elevated in 17 (94 %) patients and troponin levels were elevated in 7 (39 %) patients. When comparing NT-proBNP and troponin levels between COPD patients with acute exacerbation treated with noninvasive ventilation and those treated with invasive ventilation the statistically significant difference was not found. Discussion and conclusion: Taking into consideration the common risk factors for development od COPD and cardiovascular diseases, in combination with anatomical and functional relation that exists between cardiovascular and pulmonary system, it is not unusual that this two conditions occur with high prevalence in the same patients. Because of the similar clinical manifestations it is important to actively search for these conditions in order to achieve optimal treatment for the patients

The estimation of comorbidities and serum concentration of cardiac biomarkers in patients with chronic obstructive pulmonary disease treated with invasive or nonivasive ventilation

Cilj: Utvrditi najčešće komorbiditete u pacijenata s akutnom egzcerbacijom kronične opstruktivne plućne bolesti (KOPB) koji su liječeni neinvazivnom ili invazivnom ventilacijom, ispitati serumske koncentracije N-terminalnog fragmenta moždanog natriuretskog peptida (NT-proBNP) i troponina u tih pacijenata te utvrditi utječe li vrsta ventilacije na vrijednosti srčanih biomarkera. Ispitanici i metode: Istraživanje se sastojalo od pregleda medicinske dokumentacije 41 pacijenta s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ili invazivnom ventilacijom u Sveučilišnoj bolnici za plućne bolesti i alergije Golnik. Rezultati: Najčešći komorbiditeti pacijenata s akutnom egzacerbacijom KOPB-a bili su arterijska hipertenzija, srčano zatajenje i ishemijska bolest srca. U pacijenata s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 23 pacijenta (100 %), a troponina u 3 pacijenta (14 %). U pacijenata s akutnom egzacerbacijom KOPB-a liječenih invazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 17 (94 %) pacijenata, a troponina u 7 pacijenata (39 %). Nije uočena statistički značajna razlika u serumskoj koncentraciji NT-proBNP-a i troponina između pacijenata koji su liječeni neinvazivnom, odnosno invazivnom ventilacijom. Rasprava i zaključak: S obzirom na anatomsku i funkcijsku povezanost koja postoji između srca i pluća te zajedničke čimbenike rizika u pacijenata s KOPB-om se učestalo javljaju bolesti kardiovaskularnog sustava, osobito ishemijska bolest srca i srčano zatajenje. Naši rezultati pokazuju da se srčano zatajenje i ishemija miokarda učestalo javljaju u pacijenata s akutnom egzacerbacijom KOPB-a. Uzevši u obzir da se ove dijagnoze prezentiraju sličnom kliničkom slikom potrebno je pratiti serumske koncentracije srčanih biomarkera (NT-proBNP-a i troponina) kako bi se ovim pacijentima osiguralo optimalno liječenje.Aim: To determine the most common comorbidities in patients with chronic obstructive pulmonary disease (COPD) treated with invasive or nonivasive ventilation, investigate serum concentration of cardiac biomarkers (N-terminal pro-brain natriuretic peptide or NT-proBNP and troponin) in these patients and analyze if type of ventilation affects serum concentrations of cardiac biomarkers. Patients and methods: We analyzed 41 medical records of patients with acute exacerbation of COPD treated with nonivasive or invasive ventilation in University hospital for pulmonary disease and alergies Golnik. Results: The most common comorbidities were arterial hypertension, chronic heart failure and ischemic heart disease. In COPD patients with acute exacerbation treated with nonivasive ventilation NT-proBNP levels were elevated in 23 (100 %) patient and troponin levels were elevated in 3 (14 %) patients. In COPD patients with acute exacerbation treated with invasive ventilation NT-proBNP levels were elevated in 17 (94 %) patients and troponin levels were elevated in 7 (39 %) patients. When comparing NT-proBNP and troponin levels between COPD patients with acute exacerbation treated with noninvasive ventilation and those treated with invasive ventilation the statistically significant difference was not found. Discussion and conclusion: Taking into consideration the common risk factors for development od COPD and cardiovascular diseases, in combination with anatomical and functional relation that exists between cardiovascular and pulmonary system, it is not unusual that this two conditions occur with high prevalence in the same patients. Because of the similar clinical manifestations it is important to actively search for these conditions in order to achieve optimal treatment for the patients

The estimation of comorbidities and serum concentration of cardiac biomarkers in patients with chronic obstructive pulmonary disease treated with invasive or nonivasive ventilation

Cilj: Utvrditi najčešće komorbiditete u pacijenata s akutnom egzcerbacijom kronične opstruktivne plućne bolesti (KOPB) koji su liječeni neinvazivnom ili invazivnom ventilacijom, ispitati serumske koncentracije N-terminalnog fragmenta moždanog natriuretskog peptida (NT-proBNP) i troponina u tih pacijenata te utvrditi utječe li vrsta ventilacije na vrijednosti srčanih biomarkera. Ispitanici i metode: Istraživanje se sastojalo od pregleda medicinske dokumentacije 41 pacijenta s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ili invazivnom ventilacijom u Sveučilišnoj bolnici za plućne bolesti i alergije Golnik. Rezultati: Najčešći komorbiditeti pacijenata s akutnom egzacerbacijom KOPB-a bili su arterijska hipertenzija, srčano zatajenje i ishemijska bolest srca. U pacijenata s akutnom egzacerbacijom KOPB-a liječenih neinvazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 23 pacijenta (100 %), a troponina u 3 pacijenta (14 %). U pacijenata s akutnom egzacerbacijom KOPB-a liječenih invazivnom ventilacijom vrijednosti NT-proBNP-a bile su povišene u 17 (94 %) pacijenata, a troponina u 7 pacijenata (39 %). Nije uočena statistički značajna razlika u serumskoj koncentraciji NT-proBNP-a i troponina između pacijenata koji su liječeni neinvazivnom, odnosno invazivnom ventilacijom. Rasprava i zaključak: S obzirom na anatomsku i funkcijsku povezanost koja postoji između srca i pluća te zajedničke čimbenike rizika u pacijenata s KOPB-om se učestalo javljaju bolesti kardiovaskularnog sustava, osobito ishemijska bolest srca i srčano zatajenje. Naši rezultati pokazuju da se srčano zatajenje i ishemija miokarda učestalo javljaju u pacijenata s akutnom egzacerbacijom KOPB-a. Uzevši u obzir da se ove dijagnoze prezentiraju sličnom kliničkom slikom potrebno je pratiti serumske koncentracije srčanih biomarkera (NT-proBNP-a i troponina) kako bi se ovim pacijentima osiguralo optimalno liječenje.Aim: To determine the most common comorbidities in patients with chronic obstructive pulmonary disease (COPD) treated with invasive or nonivasive ventilation, investigate serum concentration of cardiac biomarkers (N-terminal pro-brain natriuretic peptide or NT-proBNP and troponin) in these patients and analyze if type of ventilation affects serum concentrations of cardiac biomarkers. Patients and methods: We analyzed 41 medical records of patients with acute exacerbation of COPD treated with nonivasive or invasive ventilation in University hospital for pulmonary disease and alergies Golnik. Results: The most common comorbidities were arterial hypertension, chronic heart failure and ischemic heart disease. In COPD patients with acute exacerbation treated with nonivasive ventilation NT-proBNP levels were elevated in 23 (100 %) patient and troponin levels were elevated in 3 (14 %) patients. In COPD patients with acute exacerbation treated with invasive ventilation NT-proBNP levels were elevated in 17 (94 %) patients and troponin levels were elevated in 7 (39 %) patients. When comparing NT-proBNP and troponin levels between COPD patients with acute exacerbation treated with noninvasive ventilation and those treated with invasive ventilation the statistically significant difference was not found. Discussion and conclusion: Taking into consideration the common risk factors for development od COPD and cardiovascular diseases, in combination with anatomical and functional relation that exists between cardiovascular and pulmonary system, it is not unusual that this two conditions occur with high prevalence in the same patients. Because of the similar clinical manifestations it is important to actively search for these conditions in order to achieve optimal treatment for the patients

Mnenje za spremljanje bolnikov po preboleli covidni pljučnici

Pljučnica je najpogostejši vzrok za težji potek okužbe z virusom SARS-CoV-2 in s hospitalizacijo. Potek covidne pljučnice je lahko različen; infiltrati, vidni na rentgenski sliki, se lahko resorbirajo spontano, včasih pa je potrebno zdravljenje s sistemskimi glukokortikoidi. Ob odpustu iz bolnišnice zdravljenje običajno še ni končano, zato je Združenje pulmologov Slovenije v želji po enotnem obravnavanju bolnikov s covidno pljučnico izdelalo mnenje za obravnavo in sledenje bolnikov po odpustu iz bolnišnice. Zavedamo se, da ob novi bolezni ne gre za dokončno mnenje, saj bodo nova spoznanja o covidni pljučnici zanesljivo zahtevala obnavljanje mnenj

THE ROLE OF ECHOCARDIOGRAPHY AND NT-proBNP IN PATIENTS WITH ACUTE EXACERBATION OF COPD

Polazište.Srčanoţilne bolesti spadaju u najčešće istovremene bolesti u bolesnika s kroničnom opstruktivnom plućnom bolesti (KOPB). Pravovremena dijagnoza srčanog popuštanja kao uzroka pogoršanja ili kao prateće bolesti u bolesnika s KOPB-om, osobito je vaţna za optimalnu obradu i liječenje bolesnika.Cilj.U bolesnika s akutnim pogoršanjem KOPB-a (apKOPB) ţeljeli smo ustanoviti učestalost disfunkcije lijeve klijetke i odrediti ulogu kardijalnih laboratorijskih biomarkera u diferencijalnoj dijagnostici apKOPB-a, te ocijeniti rizik ponovne hospitalizacije.Metode.U prospektivno istraţivanje uključili smo 127 bolesnika (70±10 godina, 70% muški), koji su imali većinom teţak ili vrlo teţak KOPB (110 bolesnika –87%). Bolesnicima smo pri prijemu napravili ehokardiografiju, te pri prijemu, otpustu i 7-10 dana po otpustu uzeli krv za odreĎivanje koncentracije biomarkera: N-terminalnog moţdanog natriuretičnog peptida (NT-proBNP), troponina i cistatina. Iz bolesnikove dokumentacije prikupili smo podatke o demografskim značajkama, istovremenim bolestima i farmakološkom liječenju. Ponovne smo hospitalizacije pratili 180 dana po otpustu. Numeričke varijablepredstavili smo s aritmetičkom sredinom i standardnom devijacijom. Atributivne varijablesmo predstavili kao broj i udjel u postotcima. Razlike meĎu varijablama analizirali smo pomoću Studentovog t-testa za neovisne uzorke, parnim t-testom i hi-kvadrattestom. Učestalost ponovnih hospitalizacija i moţebitne čimbenike analizirali smo pomoćumetode preţivljavanja po Kaplan Meieru i Coxovim modelom proporcionalnih rizika. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. IVRezultati.Normalnu ejekcijsku frakciju lijeve klijetke imalo je 110 (87%) bolesnika. Disfunkciju lijeve klijetke ustvrdili smo u 70 (55%) bolesnika, od kojih je većina imala smetnje punjenja lijeve klijetke. NT-proBNP je pri prijemu bio povišen u 76 (60%) bolesnika, a pri otpustu u 46 (36%) bolesnika. Troponin je pri prijemu bio povišen u 35 (28%) bolesnika, a pri otpustu u 24 (19%) bolesnika. Bolesnici s disfunkcijom lijeve klijetke su u svim uzorcima imali višu koncentraciju NT-proBNP (p=0,004, 0,007 i 0,019). U obje skupine bolesnika je došlo do značajnog sniţenja koncentracije NT-proBNP od prijema do otpusta, odnosno 7-10 dana po otpustu (p=0,006 i 0,019). Koncentracija troponina T nije bila značajno različita tijekom obrade bolesnika (p=0,518, 0,185 i 0,299), ali je do značajnog sniţenja tijekom hospitalizacije došlo u skupini s disfunkcijom lijeve klijetke (p=0,043). Bolesnike smo pratili 6 mjeseci po otpustu i u tom su vremenu ponovno hospitalizirana 53 (42%) bolesnika. Rizik za rehospitalizaciju nije bio povezan sa stupnjem bolesti po GOLD-u, disfunkcijom lijeve klijetke i s nalazima NT-proBNP. Koncentracija troponina pri otpustu je bila jedini prognostički čimbenik za rehospitalizaciju (omjer rizika 1,95, 95% granica pouzdanosti 1,04 –3,64). Od 31 bolesnika s prethodnom diagnozom srčanoga popuštanja, 19 (61%) bolesnika je primalo inhibitore konvertaze angiotenzina, a 14 (45%) bolesnika beta blokatore. Ciljnu dozu od ≥50% inhibitora konvertaze angiotenzina primalo je 12 (63%) bolesnika, a ciljnu dozu od ≥50% beta blokatora 7 (50%) bolesnika.Zakljuĉci.U bolesnika s apKOPB-a česta je disfunkcija lijeve klijetke. OdreĎivanje koncentracije kardijalnih laboratorijskih biomakera je vaţno zbog procjene uzroka kliničkoga pogoršanja bolesnika s KOPB-om. Koncentracija troponina pri otpustu je bila jedini neovisni prognostički čimbenik za ponovnu hospitalizaciju. Liječenje srčane disfunkcije u bolesnika s KOPB-om nije bilo u skladu sa smjernicama.Baseline. Cardiovascular diseases are among the most important diseases that cause common co-morbidities in patients with chronic obstructive pulmonary disease (COPD). Diagnosis of heart failure as a cause of deterioration or as an associated disease in patients with COPD is very important for the proper and optimal patient management.Objectives.We aimed to determine the frequency of left ventricular dysfunction in patients with acute exacerbation of COPD. We wanted to evaluate the role of cardiac biomarkers in differential diagnosis of acute exacerbation and risk assessment for re-hospitalization. Method.Our prospective study included 127 consecutive patients (70 10 years, 70% male) with severe or very severe COPD (110 patients –87%). Upon admission of patients echocardiography was performed. On admission, discharge and 7-10 days after discharge blood was drawn to determineN-terminal brain natriuretic peptide (NT-proBNP), troponin and cystatin. Information about demographic characteristics, concomitant disease, and pharmacological management was retrieved from medical records. Re-hospitalisations were observed 180 days after discharge. Numeric variables were presented with mean and standard deviation. Attribute variables were presented as number and percentage shares. Differences between variables were analyzed using Student’s t-test for independent samples, paired t-test and χ2 test. Frequency and possible factors of re-hospitalization were analyzed with Kaplan Meier method and Cox proportional risk model. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. VIResults.Normal left ventricular ejection fraction had 110 (87%) patients. Left ventricular dysfunction was observed in 70 (55%) patients, where most of them had abnormal left ventricular filling. NT-proBNP was elevated at admission in 76 (60%) patients and in remission in 46 (36%) patients. Troponin was elevated at admission in 35 (28%) patients and at discharge in 24 (19%) patients. Higher concentration of NT-proBNP (p=0.004, 0.007 and 0.019) was observed in patients with left ventricular dysfunction. There was a significant reduction in concentration of NT-proBNP in both groups of patients; from admission until discharge, or 7-10 days after discharge (p=0.006 and 0.019). Concentration of troponin T was not significantly different during the treatment of patients (p=0.518, 0.185 and 0.299), however significant reduction occurred in the group with left ventricular dysfunction (p=0.043). Patients were assessed 6 months after discharge and 53 (42%) patients were re-hospitalized. The risk of hospitalization was not associated with the level of disease by Gold, left ventricular dysfunction or concentration of NT-proBNP. Concentration of troponin at discharge was the only factor to predict adverse prognosis (hazard ratio 1.95, 95% confidence interval 1.04 –3.64). Of 31 patients with a prior diagnosis of heart failure 19 (61%) patients were receiving ACE inhibitors and 14 (45%) patients beta–blocker. Target dose of ≥50% of the ACE inhibitor received 12 (63%) patients, target dose of ≥50% of beta-blocker received 7 (50%) patients.Conclusions.In patients with acute exacerbation of COPD, left ventricular dysfunction is frequent. Determination of cardiac biomarkers is important to identify the cause of clinical deterioration in patients with COPD. Concentration of troponin at discharge was the only independent prognostic factor for re-hospitalization. Treatment of cardiac dysfunction in patients with COPD is at the moment not in accordance with guidelines

THE ROLE OF ECHOCARDIOGRAPHY AND NT-proBNP IN PATIENTS WITH ACUTE EXACERBATION OF COPD

Polazište.Srčanoţilne bolesti spadaju u najčešće istovremene bolesti u bolesnika s kroničnom opstruktivnom plućnom bolesti (KOPB). Pravovremena dijagnoza srčanog popuštanja kao uzroka pogoršanja ili kao prateće bolesti u bolesnika s KOPB-om, osobito je vaţna za optimalnu obradu i liječenje bolesnika.Cilj.U bolesnika s akutnim pogoršanjem KOPB-a (apKOPB) ţeljeli smo ustanoviti učestalost disfunkcije lijeve klijetke i odrediti ulogu kardijalnih laboratorijskih biomarkera u diferencijalnoj dijagnostici apKOPB-a, te ocijeniti rizik ponovne hospitalizacije.Metode.U prospektivno istraţivanje uključili smo 127 bolesnika (70±10 godina, 70% muški), koji su imali većinom teţak ili vrlo teţak KOPB (110 bolesnika –87%). Bolesnicima smo pri prijemu napravili ehokardiografiju, te pri prijemu, otpustu i 7-10 dana po otpustu uzeli krv za odreĎivanje koncentracije biomarkera: N-terminalnog moţdanog natriuretičnog peptida (NT-proBNP), troponina i cistatina. Iz bolesnikove dokumentacije prikupili smo podatke o demografskim značajkama, istovremenim bolestima i farmakološkom liječenju. Ponovne smo hospitalizacije pratili 180 dana po otpustu. Numeričke varijablepredstavili smo s aritmetičkom sredinom i standardnom devijacijom. Atributivne varijablesmo predstavili kao broj i udjel u postotcima. Razlike meĎu varijablama analizirali smo pomoću Studentovog t-testa za neovisne uzorke, parnim t-testom i hi-kvadrattestom. Učestalost ponovnih hospitalizacija i moţebitne čimbenike analizirali smo pomoćumetode preţivljavanja po Kaplan Meieru i Coxovim modelom proporcionalnih rizika. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. IVRezultati.Normalnu ejekcijsku frakciju lijeve klijetke imalo je 110 (87%) bolesnika. Disfunkciju lijeve klijetke ustvrdili smo u 70 (55%) bolesnika, od kojih je većina imala smetnje punjenja lijeve klijetke. NT-proBNP je pri prijemu bio povišen u 76 (60%) bolesnika, a pri otpustu u 46 (36%) bolesnika. Troponin je pri prijemu bio povišen u 35 (28%) bolesnika, a pri otpustu u 24 (19%) bolesnika. Bolesnici s disfunkcijom lijeve klijetke su u svim uzorcima imali višu koncentraciju NT-proBNP (p=0,004, 0,007 i 0,019). U obje skupine bolesnika je došlo do značajnog sniţenja koncentracije NT-proBNP od prijema do otpusta, odnosno 7-10 dana po otpustu (p=0,006 i 0,019). Koncentracija troponina T nije bila značajno različita tijekom obrade bolesnika (p=0,518, 0,185 i 0,299), ali je do značajnog sniţenja tijekom hospitalizacije došlo u skupini s disfunkcijom lijeve klijetke (p=0,043). Bolesnike smo pratili 6 mjeseci po otpustu i u tom su vremenu ponovno hospitalizirana 53 (42%) bolesnika. Rizik za rehospitalizaciju nije bio povezan sa stupnjem bolesti po GOLD-u, disfunkcijom lijeve klijetke i s nalazima NT-proBNP. Koncentracija troponina pri otpustu je bila jedini prognostički čimbenik za rehospitalizaciju (omjer rizika 1,95, 95% granica pouzdanosti 1,04 –3,64). Od 31 bolesnika s prethodnom diagnozom srčanoga popuštanja, 19 (61%) bolesnika je primalo inhibitore konvertaze angiotenzina, a 14 (45%) bolesnika beta blokatore. Ciljnu dozu od ≥50% inhibitora konvertaze angiotenzina primalo je 12 (63%) bolesnika, a ciljnu dozu od ≥50% beta blokatora 7 (50%) bolesnika.Zakljuĉci.U bolesnika s apKOPB-a česta je disfunkcija lijeve klijetke. OdreĎivanje koncentracije kardijalnih laboratorijskih biomakera je vaţno zbog procjene uzroka kliničkoga pogoršanja bolesnika s KOPB-om. Koncentracija troponina pri otpustu je bila jedini neovisni prognostički čimbenik za ponovnu hospitalizaciju. Liječenje srčane disfunkcije u bolesnika s KOPB-om nije bilo u skladu sa smjernicama.Baseline. Cardiovascular diseases are among the most important diseases that cause common co-morbidities in patients with chronic obstructive pulmonary disease (COPD). Diagnosis of heart failure as a cause of deterioration or as an associated disease in patients with COPD is very important for the proper and optimal patient management.Objectives.We aimed to determine the frequency of left ventricular dysfunction in patients with acute exacerbation of COPD. We wanted to evaluate the role of cardiac biomarkers in differential diagnosis of acute exacerbation and risk assessment for re-hospitalization. Method.Our prospective study included 127 consecutive patients (70 10 years, 70% male) with severe or very severe COPD (110 patients –87%). Upon admission of patients echocardiography was performed. On admission, discharge and 7-10 days after discharge blood was drawn to determineN-terminal brain natriuretic peptide (NT-proBNP), troponin and cystatin. Information about demographic characteristics, concomitant disease, and pharmacological management was retrieved from medical records. Re-hospitalisations were observed 180 days after discharge. Numeric variables were presented with mean and standard deviation. Attribute variables were presented as number and percentage shares. Differences between variables were analyzed using Student’s t-test for independent samples, paired t-test and χ2 test. Frequency and possible factors of re-hospitalization were analyzed with Kaplan Meier method and Cox proportional risk model. Značaj ehokardiografije i NT-proBNP-a u bolesnika s akutnim pogoršanjem kronične opstruktivne plućne bolesti. VIResults.Normal left ventricular ejection fraction had 110 (87%) patients. Left ventricular dysfunction was observed in 70 (55%) patients, where most of them had abnormal left ventricular filling. NT-proBNP was elevated at admission in 76 (60%) patients and in remission in 46 (36%) patients. Troponin was elevated at admission in 35 (28%) patients and at discharge in 24 (19%) patients. Higher concentration of NT-proBNP (p=0.004, 0.007 and 0.019) was observed in patients with left ventricular dysfunction. There was a significant reduction in concentration of NT-proBNP in both groups of patients; from admission until discharge, or 7-10 days after discharge (p=0.006 and 0.019). Concentration of troponin T was not significantly different during the treatment of patients (p=0.518, 0.185 and 0.299), however significant reduction occurred in the group with left ventricular dysfunction (p=0.043). Patients were assessed 6 months after discharge and 53 (42%) patients were re-hospitalized. The risk of hospitalization was not associated with the level of disease by Gold, left ventricular dysfunction or concentration of NT-proBNP. Concentration of troponin at discharge was the only factor to predict adverse prognosis (hazard ratio 1.95, 95% confidence interval 1.04 –3.64). Of 31 patients with a prior diagnosis of heart failure 19 (61%) patients were receiving ACE inhibitors and 14 (45%) patients beta–blocker. Target dose of ≥50% of the ACE inhibitor received 12 (63%) patients, target dose of ≥50% of beta-blocker received 7 (50%) patients.Conclusions.In patients with acute exacerbation of COPD, left ventricular dysfunction is frequent. Determination of cardiac biomarkers is important to identify the cause of clinical deterioration in patients with COPD. Concentration of troponin at discharge was the only independent prognostic factor for re-hospitalization. Treatment of cardiac dysfunction in patients with COPD is at the moment not in accordance with guidelines

Sonographic evaluation of unexplained pleural exudate: a prospective case series

BACKGROUND: Thoracic ultrasound may be helpful in differentiating between malignant and tuberculosis-associated pleural exudate. This study aimed to evaluate its utility in patients with unexplained pleural exudate. METHODS: Consecutive patients were screened and pleural effusion was found in 278 patients. Pleural exudate was present in 106 patients and remained undiagnosed after biochemical and cytological evaluation in 40 patients (median age 58 years, 67% men) who then underwent detailed thoracic ultrasound for the presence of complex (septated or fibrous) or anechoic patterns. Pleural needle biopsy or thoracoscopy with histological evaluation were used for definitive diagnosis. RESULTS: History, clinical characteristics and routine procedures including cytology were not helpful in differential diagnosis. Pleural specimens for histological evaluation were obtained from all 40 patients and confirmed tuberculosis in 12 patients, cancer in nine and nonspecific pleuritis in 19. Sonographic finding of a complex septal pattern was present only in patients with tuberculosis (positive predictive value 100%); anechoic appearance was suggestive of nonspecific pleuritis (positive predictive value 65%). CONCLUSIONS: Thoracic ultrasound is a useful bedside method for differentiation of the etiology of pleural exudate. When a complex septal pattern is found, pleural needle biopsy should be the next diagnostic procedure, whereas with less complex pleural sonography findings other methods should be pursue

Heat shock protein 27 as a predictor of prognosis in patients admitted to hospital with acute COPD exacerbation

Episodes of acute exacerbations are major drivers of hospitalisation and death from COPD. To date, there are no objective biomarkers of disease activity or biomarkers to predict patient outcome. In this study, 211 patients hospitalised for an acute exacerbation of COPD have been included. At the time of admission,routine blood tests have been performed including complete blood count, C-reactive protein, cardiac troponin T and NT-proBNP. Heat shock protein 27 (HSP27) serum concentrations were determined at time of admission, discharge and 180 days after discharge by ELISA. We were able to demonstrate significantly increased HSP27 serum concentrations in COPD patients at time of admission to hospital as compared to HSP27 concentrations obtained 180 days after discharge. In univariable Cox regression analyses, a HSP27 serum concentration >/= 3098 pg/mL determined at admission was a predictor of all-cause mortality at 90 days, 180 days, 1 year and 3 years. In multivariable analyses, an increased HSP27 serum concentration at admission retained its prognostic ability with respect to all-cause mortality for up to 1year follow-up. However, an increased HSP27 serum concentration at admission was not an independent predictor of long-term all-cause mortality at 3 years. Elevated serum HSP27 concentrations significantly predicted short-term mortality in patients admitted to hospital with acute exacerbation of COPD and could help to improve outcomes by identifying high-risk patients

Systemic and airway oxidative stress in competitive swimmers

Background: The environment in swimming pools, which contain chlorine, might interact with the airway epithelium, resulting in oxidative stress and/or inflammation during high intensity training periods. Methods: We evaluated pulmonary functional (metacholine challenge test, FEV1 and VC), cellular (eosinophils and neutrophils), inflammatory (FeNo, IL-5, IL-6, IL-8 and TNF-[alpha]), oxidative (8-isoprostanes) and angiogenesis factors (VEGF) in induced sputum and peripheral blood of 41 healthy non-asthmatic elite swimmers (median 16 years) during the period of high intensity training before a national championship. The second paired sampling was performed seven months later after training had been stopped for one month. Results: There was a ten-fold increase (median 82-924 pg/mlP < 0.001) in 8-isoprostanes in induced sputum and five-fold increase (median 82-924 pg/mlP < 0.001) in sera during training in comparison to the period of rest. However, there was no difference in FEV1 (113 vs 116%), VC (119 vs 118%), FeNo (median 34 vs 38 ppb), eosinophils (2.7 vs 2.9% in sputum180 vs 165 cells/[micro]l in blood), neutrophils, different cytokines or VEGF in induced sputum or sera. The only exception was TNF-[alpha], which was moderately increased in sera (median 23 vs 40 pg/mlP=0.02) during the peak training period. Almost half (18 of 41) of swimmers showed bronchial hyperresponsiveness during the peak training period (PC20 cutoff was 4 mg/ml). There was no correlation between hyperresponsiveness and the markers of oxidative stress or inflammation. Conclusions: High intensity training in healthy, non-asthmatic competitive swimmers results in marked oxidative stress at the airway and systemic levels, but does not lead to airway inflammation. However, we could not confirm that oxidative stress is associated with bronchial hyperresponsiveness (AHR), which is often observed during the peak exercise training period