Chin-Chou Wang

Correlation between serum biomarkers and BODE index in patients with stable COPD

Background and objective:u2003 The BODE index, based on BMI, obstructive ventilatory impairment, dyspnoea scale and exercise capacity, has been used to evaluate the severity of patients with COPD. However, the correlations between serum biomarkers and the BODE index in patients with stable COPD are not widely studied. This study evaluated potential serum biomarkers for their ability to identify smokers with COPD and reflect disease severity.

Alto valor de la combinación de la concentración sérica de proteína C reactiva y la puntuación BODE para la predicción de la mortalidad en pacientes con EPOC estable

INTRODUCTIONnBoth BODE score (body mass index, degree of airflow obstruction, functional dyspnea, and exercise capacity) and serum C-reactive protein (CRP) are validated predictors of mortality in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to investigate the predictive value of combined serum CRP and BODE score for mortality in COPD patients.nnnPATIENTS AND METHODSnA cohort of 114 clinically stable COPD patients was assessed for predictors of longitudinal mortality. Variables included age, gender, current smoking status, pack-years, maximal inspiratory/expiratory pressure, BODE score (body mass index, degree of airflow obstruction, functional dyspnea, and exercise capacity), serum CRP, and fibrinogen. Predictors were assessed by Cox proportional hazards regression model. Survival was estimated by Kaplan-Meier method and log-rank test.nnnRESULTSnSerum CRP (P=0.005; HR=1.042; 95% CI=1.019-1.066) and BODE score (P=0.032; HR=1.333; 95% CI=1.025-1.734) were independent predictors of survival in the multivariate analysis. The cumulative survival rates of COPD patients were sorted from the worst to the best as following: serum CRP >3mg/L & quartile 3-4; serum CRP >3mg/L & quartile 1-2; serum CRP ≤3mg/L & quartile 3-4; serum CRP ≤3mg/L & quartile 1-2 (P<0.001).nnnCONCLUSIONSnSerum CRP and BODE score are independent predictors of survival in stable COPD patients. Combination of serum CRP and BODE score has higher predictive value in clinical practice.

Experience of Cancer Care for Metastasis-Induced Acute Pancreatitis Patients with Lung Cancer

Introduction: Little information is available concerning the prognosis and treatment of metastasis-induced acute pancreatitis (MIAP) with lung cancer. The aim of this study was to investigate the prognostic factors of MIAP patients with lung cancer. Methods: A retrospective study of 20 MIAP patients with lung cancer was performed. Survival was estimated using Kaplan-Meier method. Prognostic factors were assessed with Cox proportional hazards regression model. Results: There were 14 men and six women; 15 cases were non-small cell lung cancer and five cases were small cell lung cancer. The median age was 68 (range, 41–83). The mean duration from lung cancer to MIAP diagnosis of having MIAP was 139.8 days (range, 3–892). However, two small cell lung cancer cases had preceded presentation with acute pancreatitis. Chemotherapy (p = 0.008; hazards ratio = 4.99; 95% confidence interval = 1.51–16.54) and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p = 0.007; hazards ratio = 6.13; 95% confidence interval = 0.04–0.61) were significant prognostic factors for survival. ECOG PS 3 to 4 at diagnosis of MIAP was 11/20. Survival of MIAP with lung cancer was 108.7 days. Patients with ECOG PS 3 to 4 had shorter mean survival than those with PS 0 to 2 (33.7 versus 226.4 days; p = 0.003). Chemotherapy group had longer mean survival than those without chemotherapy (161.9 versus 25.0 days; p = 0.01). Conclusion: Chemotherapy can improve survival of MIAP from bronchogenic carcinoma in the selected patients.

Wheezing, a significant clinical phenotype of COPD: experience from the Taiwan Obstructive Lung Disease Study.

Background COPD is an important public health challenge with significant heterogeneity of clinical presentation and disease progression. Clinicians have been trying to find phenotypes that may be linked to distinct prognoses and different therapeutic choices. Not all patients with COPD present with wheezing, a possible clinical phenotype that can help differentiate patient subgroups. Methods The Taiwan Obstructive Lung Disease study was a retrospective, multicenter research study to investigate the treatment patterns of COPD after the implementation of the Global Initiative for Chronic Obstructive Lung Disease 2011 guidelines. Between November 2012 and August 2013, medical records were retrieved from patients with COPD aged ≥40 years; patients diagnosed with asthma were excluded. Demographic data, lung function, symptom scores, and acute exacerbation were recorded and analyzed, and the differences between patients with and without wheezing were evaluated. Results Of the 1,096 patients with COPD, 424 (38.7%) had the wheezing phenotype. The wheezing group had significantly higher COPD Assessment Test scores (12.4±7.8 versus 10.5±6.7, P<0.001), higher modified Medical Research Council grade (2.0±1.0 versus 1.7±0.9, P<0.001), and more acute exacerbations within the past year (0.9±1.3 versus 0.4±0.9, P<0.001) than the nonwheezing group. The postbronchodilator forced expiratory volume in 1 second was lower in wheezing patients (1.2±0.5 L versus 1.5±0.6 L, P<0.001). Even in patients with maintenance treatment fitting the Global Initiative for Chronic Obstructive Lung Disease 2011 guidelines, the wheezing group still had worse symptom scores and more exacerbations. Conclusion Wheezing is an important phenotype in patients with COPD. Patients with COPD having the wheezing phenotype are associated with worse symptoms, more exacerbations, and worse lung function.

Factors associated with the prescription of inhaled corticosteroids in GOLD group A and B patients with COPD – subgroup analysis of the Taiwan obstructive lung disease cohort

Background and objective The overprescription of inhaled corticosteroids (ICS) in the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A and B patients with chronic obstructive pulmonary disease (COPD) is not uncommon in clinical practice. The aim of this study was to explore the factors associated with the use of ICS in these patients. Methods The Taiwan obstructive lung disease (TOLD) study was a retrospective, observational nationwide survey of COPD patients conducted at 12 hospitals (n=1,096) in Taiwan. Multivariate logistic regression models were used to explore the predictors of ICS prescription in GOLD group A and B patients. Results Among the group A (n=179) and group B (n=398) patients, 198 (34.3%) were prescribed ICS (30.2% in group A and 36.2% in group B, respectively). The wheezing phenotype was present in 28.5% of group A and 34.2% of group B patients. Wheezing was the most significant factor for an ICS prescription in group A (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.14–4.75; P=0.020), group B (OR, 1.93; 95% CI, 1.24–2.99; P=0.004), and overall (OR, 2.04; 95% CI, 1.40–2.96; P<0.001). The COPD assessment test score was also associated with an ICS prescription in group B (OR, 1.04; 95% CI, 1.00–1.07; P=0.038). Conclusion About one-third of the GOLD group A and B patients with COPD in Taiwan are prescribed ICS. Our findings suggest that wheezing and COPD assessment test score are related to the prescription of ICS in these patients.

RNA Interference Inhibits High Mobility Group Box 1 by Lipopolysaccharide-Activated Murine Macrophage RAW 264.7 Secretion

BACKGROUNDnThis study aims to evaluate the influence of RNA interference (RNAi) on the high mobility group box 1 (HMGB-1) in the lipopolysaccharide (LPS)-induced murine macrophage cell line RAW 264.7.nnnMATERIALS AND METHODSnIn order to observe the effect of RNAi on HMGB-1, tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and transforming growth factor β (TGF-β) levels, the RAW 264.7 cell line was divided into five treatment groups to measure separately as a function of time of negative control, LPS stimulation only, LPS + HMGB-1 short interfering RNAs (siRNAs), LPS + negative control siRNAs (siNC), and LPS + nafamostat mesilate (NM).nnnRESULTSnMeasurement does show HMGB-1 expression in the LPS-activated macrophages in an explicit time-dependent manner. The HMGB-1 cellular level is consistently knocked down 80%∼85% by the siRNA; TNF-α, IL-6, and TGF-β levels in turn significantly decrease following siRNA delivery to the inflammatory response. HMGB-1 expression is lower in the LPS + NM group than the LPS + HMGB-1 siRNA group at the initial stage, however, a significantly lower level of HMGB-1 in the siRNA group is observed 48 h later. The decrease of TNF-α, IL-6, and TGF-β levels in the LPS-induced inflammatory response is also observed in both groups.nnnCONCLUSIONSnOur results demonstrate that HMGB-1 RNAi treatment of LPS-stimulated macrophages inhibitxa0HMGB-1 and remarkably reduce the LPS-induced inflammatory responses. Hence, RNAi is highly recommended as a potential candidate for a new therapeutic strategy to minimize or, to a lesser extent, prevent the LPS-induced inflammatory injury.

Impact of overweight and obesity on acute exacerbations of COPD – subgroup analysis of the Taiwan Obstructive Lung Disease cohort

Purpose A low body mass index (BMI) is a poor prognostic marker of acute exacerbations and mortality in patients with COPD. However, the impact of overweight and obesity on COPD-related outcomes is uncertain. The aim of this study was to examine whether a high BMI is associated with the frequent exacerbator phenotype (≥2/year) in Taiwanese patients with COPD. Patients and methods Data were obtained from the Taiwan Obstructive Lung Disease study, a retrospective, observational nationwide survey of COPD patients conducted at 12 hospitals in Taiwan. Multivariate logistic regression models were used to explore the association between BMI and other factors with the frequency of COPD exacerbations in these patients. Results Among the whole study cohort (n=1,096), 735 (67.1%) had no exacerbations and 148 (13.5%) were frequent exacerbators in the previous year. The BMI values of the patients with 0, 1, and ≥2 exacerbations were 23.6, 23.5, and 22.6 kg/m2, respectively. In all, 256 (23.4%) and 196 (17.9%) patients were overweight (27 kg/m2 > BMI ≥24 kg/m2) and obese (BMI ≥27 kg/m2), respectively. Even after adjusting for multiple factors, overweight and obesity were associated with the frequency of exacerbations (odds ratio [95% confidence interval] 0.49 [0.28–0.87, P=0.015] and 0.49 [0.26–0.94, P=0.033], respectively). Conclusion Our results suggest that overweight and obesity are associated with a lower frequency of COPD exacerbations in Taiwan.