Ashraf Rashid

Statins may reduce episodes of exacerbation and the requirement for intubation in patients with COPD : evidence from a retrospective cohort study

Introduction:  Statins have diverse anti‐inflammatory effects in addition to their lipid‐lowering ability. This study assesses the rate of chronic obstructive pulmonary disease (COPD) exacerbation and intubations in patients taking statins.

ALVEOLAR–ARTERIAL OXYGEN GRADIENT, PNEUMONIA SEVERITY INDEX AND OUTCOMES IN PATIENTS HOSPITALIZED WITH COMMUNITY ACQUIRED PNEUMONIA

1 The alveolar–arterial oxygen gradient (ΔA–a) provides a useful assessment of ventilation/perfusion (V/Q) abnormalities. The objectives of the present study were to: (i) examine the correlation between the ΔA–a and the pneumonia severity index (PSI); and (ii) determine whether these measures were comparable in predicting clinical outcomes. 2 The present study was conducted at a 750‐bed teaching hospital. It examined a retrospective cohort of 255 patients with community acquired pneumonia (CAP) over a 2 year period. Association between the CAP and ΔA–a was investigated by regression models and correlation, as well as two logistic models for subjects bifurcated by low‐risk/moderate‐to‐high risk. The decision levels (DL) for both PSI and ΔA–a were then compared as predictors of both length of stay (LOS) and survival. 3 The correlation between PSI and ΔA–a was strong (ρ = 0.76; P < 0.0001) and was best modelled by a curvilinear relationship. Both logistic models indicated a strong association (P < 0.001) between ΔA–a and PSI and yielded an optimal DL for the ΔA–a of < 89 mmHg. Inter‐test agreement of ΔA–a with PSI was 76.9% (κ = 0.60; 95% confidence interval 0.47–0.72; P < 0.0001). At < 89 mmHg, the odds ratios for LOS were similar to those at PSI = 90 in predicting LOS in the range 3–7 days, inclusive. There was no significant difference in the ability of ΔA–a and PSI to predict survival for either the low‐ or high‐risk group (P = 0.363 and P = 0.951, respectively). 4 The ΔA–a correlates well with PSI and performs comparably in predicting two major outcomes in subjects hospitalized with CAP.