Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Liu, Mei; Hu, Ronggui; Jiang, Xuqin; Mei, Xiaodong

doi:10.1002/jcla.23733

“…Many studies [12][13][14][15] suggest that the body is in a long-term hypoxic state, which is easy to activate the coagulation system and promote the simultaneous occurrence of secondary fbrinolytic hyperfunction and hypercoagulability. Patients with AECOPD have long-term airfow restriction and hypoxia, resulting in an increase in the number of secondary red blood cells and a decrease in deformability, resulting in an increase in blood viscosity, promoting platelet adhesion and aggregation, and the formation of microthrombosis [16,17]. Tere is no consensus on the indications for anticoagulation and the duration of anticoagulation in COPD patients.…”

Section: Discussionmentioning

confidence: 99%

Changes in Thrombelastography in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and the Relationship with Lung Function

Zhou

¹

,

Yu

²

,

Zhou

³

2022

Emergency Medicine International

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Purpose. To analyze the changes in thrombelastography (TEG) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the relationship with indicators related to lung function. Methods. 100 patients with AECOPD admitted to our hospital from May 2021 to May 2022 were selected as the AE group, and another 80 patients with a stable phase of COPD in the same period were selected as the SP group. Fresh blood specimens were collected from both groups, and TEG-related indicators (R value, K value, α-angle, MA value) were measured using the TEG technique, and lung function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) were measured using a lung function meter, and the correlation between TEG-related indicators and lung function-related indicators was analyzed. Results. Patients in the AE group had lower R and K values and higher α-angle and MA values than those in the SP group, all with statistically significant differences ( P < 0.05 ). Patients in the AE group had lower FEV1, FVC, FEV1/FVC, and FEV1% levels than those in the SP group, all with statistically significant differences ( P < 0.05 ). Correlation analysis showed that the R value in TEG of AECOPD patients was positively correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = 0.565, 0.529, 0.447, 0.527, all P < 0.001 ); K value was positively correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = 0.512, 0.567, 0.459, 0.439, all P < 0.001 ); α-angle was inversely correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = −0.498, −0.372, −0.408, −0.424, all P < 0.001 ); MA value was inversely correlated with lung function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = −0.459, −0.429, −0.394, −0.403, all P < 0.001 ). Conclusion. There is a correlation between TEG-related indicators and lung function-related indicators in AECOPD patients, both of which can guide the diagnosis and treatment process of the disease and are worthy of clinical promotion. The clinical registration number is EA2021086.

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“…Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease of the respiratory system [ 1 ]. The acute exacerbation of COPD (AECOPD) is characterized by incomplete reversible airflow, progressive development, and even respiratory failure due to airway constriction, increased mucus secretion, airflow restriction aggravation, and further ventilation dysfunction [ 2 , 3 ]. The incidence has been on a rise and has become one of the leading causes of death worldwide.…”

Section: Introductionmentioning

confidence: 99%

Compound Ipratropium Bromide plus Budesonide Inhalation in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Its Effect on Heparin-Binding Protein

Dong

¹

,

Li

²

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To analyze the clinical effect of compound ipratropium bromide combined with budesonide atomization inhalation on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effect on the heparin-binding protein. Methods. A total of 110 patients with AECOPD who were admitted to our hospital between January 2020 and January 2021 were enrolled and assigned into control group (conventional treatment + compound ipratropium bromide) and combined group (conventional treatment + compound ipratropium bromide + budesonide) in a 1 : 1 ratio according to different treatment methods. The clinical effects, pulmonary function indexes, and heparin-binding protein levels before and after treatment were compared between the two groups. Results. The treatment with oxygen-driven nebulization of ipratropium bromide combined with budesonide led to a significantly higher total effective rate versus the treatment with ipratropium bromide alone ( P < 0.001 ). After treatment, remarkably higher arterial oxygen partial pressure (PaO2), arterial oxygen saturation (SaO2), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC in the combined group vs. the control group were observed ( P < 0.001 ). The carbon dioxide partial pressure (PaCO2) levels in the two groups were significantly lower than those before treatment, and the decrease in the combined group was greater ( P < 0.001 ). A significantl reduction was observed in heparin-binding protein in both groups after treatment, and the decrease in the combined group was greater versus the control group ( P < 0.001 ). Conclusion. Compound ipratropium bromide plus budesonide via aerosol inhalation therapy might be a preferable approach for AECOPD patients. It exhibits a synergistic effect on inhibiting inflammatory mediators and cytokine networks, significantly reduces airway hyperresponsiveness, and improves blood gas indicators and lung function.

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“…Moreover, HCT and blood viscosity have been found to be considerably higher in AECOPD patients with respiratory failure than in patients without respiratory failure. 38,39 A database study conducted by Chambellan et al showed a positive correlation between HCT and PaCO 2 and a negative correlation with mortality. 40 The study's findings stated that HCT was a risk factor for HRF, and as the per-single unit of HCT increased, the probability of HRF in AECOPD patients increased by 11.1%.…”

Section: Discussionmentioning

confidence: 99%

A Diagnostic Nomogram for Predicting Hypercapnic Respiratory Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Zhou,

Wang,

Wang

et al. 2024

COPD

0

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To develop and validate a nomogram for assessing the risk of developing hypercapnic respiratory failure (HRF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Patients and Methods: From January 2019 to August 2023, a total of 334 AECOPD patients were enrolled in this research. We employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to determine independent predictors and develop a nomogram. This nomogram was appraised by the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow goodness-of-fit test (HL test), decision curve analysis (DCA), and clinical impact curve (CIC). The enhanced bootstrap method was used for internal validation. Results: Sex, prognostic nutritional index (PNI), hematocrit (HCT), and activities of daily living (ADL) were independent predictors of HRF in AECOPD patients. The developed nomogram based on the above predictors showed good performance. The AUCs for the training, internal, and external validation cohorts were 0.841, 0.884, and 0.852, respectively. The calibration curves and HL test showed excellent concordance. The DCA and CIC showed excellent clinical usefulness. Finally, a dynamic nomogram was developed (https://a18895635453.shinyapps.io/dynnomapp/). Conclusion: This nomogram based on sex, PNI, HCT, and ADL demonstrated high accuracy and clinical value in predicting HRF. It is a less expensive and more accessible approach to assess the risk of developing HRF in AECOPD patients, which is more suitable for primary hospitals, especially in developing countries with high COPD-related morbidity and mortality.

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Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Cited by 14 publications

References 19 publications

Changes in Thrombelastography in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and the Relationship with Lung Function

Changes in Thrombelastography in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and the Relationship with Lung Function

Compound Ipratropium Bromide plus Budesonide Inhalation in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Its Effect on Heparin-Binding Protein

A Diagnostic Nomogram for Predicting Hypercapnic Respiratory Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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