J Eklöf1, R Sørensen2, T S Ingebrigtsen3, P Sivapalan4, I Achir4, J B Boel5, J Bangsborg5, C Ostergaard6, R B Dessau7, U S Jensen7, A Browatzki8, T S Lapperre9, J Janner3, U M Weinreich10, K Armbruster4, T Wilcke4, N Seersholm4, J U S Jensen11. 1. Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark. Electronic address: josefin.viktoria.ekloef@regionh.dk. 2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 3. Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark. 4. Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark. 5. Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark. 6. Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark. 7. Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark. 8. Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Denmark. 9. Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. 10. Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark. 11. Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark; PERSIMUNE: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark.
Abstract
OBJECTIVES: The role of Pseudomonas aeruginosa in the long-term prognosis of chronic obstructive pulmonary disease (COPD) is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with COPD. METHODS: This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalization-demanding exacerbations and death after 2 years, separately and in combination. RESULTS: A total of 22 053 COPD outpatients were followed for a median of 1082 days (interquartile-range: 427-1862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalization for exacerbation or all-cause death (HR 2.8, 95%CI 2.2-3.6; p <0.0001) and all-cause death (HR 2.7, 95%CI 2.3-3.4; p <0.0001) in analyses adjusted for known and suspected confounders. The signal remained unchanged in unadjusted analyses as well as propensity-matched subgroup analyses. Among patients 'ever colonized' with P. aeruginosa, the incidence of hospital-demanding exacerbations doubled after the time of the first colonization. CONCLUSIONS: COPD patients in whom P. aeruginosa can be cultured from the airways had a markedly increased risk of exacerbations and death. It is still not clear whether this risk can be reduced by offering patients targeted antipseudomonal antibiotics. A randomized trial is currently recruiting patients to clarify this (ClinicalTrials.gov: NCT03262142).
OBJECTIVES: The role of Pseudomonas aeruginosa in the long-term prognosis of chronic obstructive pulmonary disease (COPD) is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with COPD. METHODS: This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalization-demanding exacerbations and death after 2 years, separately and in combination. RESULTS: A total of 22 053 COPD outpatients were followed for a median of 1082 days (interquartile-range: 427-1862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalization for exacerbation or all-cause death (HR 2.8, 95%CI 2.2-3.6; p <0.0001) and all-cause death (HR 2.7, 95%CI 2.3-3.4; p <0.0001) in analyses adjusted for known and suspected confounders. The signal remained unchanged in unadjusted analyses as well as propensity-matched subgroup analyses. Among patients 'ever colonized' with P. aeruginosa, the incidence of hospital-demanding exacerbations doubled after the time of the first colonization. CONCLUSIONS:COPDpatients in whom P. aeruginosa can be cultured from the airways had a markedly increased risk of exacerbations and death. It is still not clear whether this risk can be reduced by offering patients targeted antipseudomonal antibiotics. A randomized trial is currently recruiting patients to clarify this (ClinicalTrials.gov: NCT03262142).
Authors: J A Reales-Calderón; Z Sun; V Mascaraque; E Pérez-Navarro; V Vialás; E W Deutsch; R L Moritz; C Gil; J L Martínez; G Molero Journal: J Proteomics Date: 2021-03-20 Impact factor: 4.044
Authors: Marta Garcia-Clemente; David de la Rosa; Luis Máiz; Rosa Girón; Marina Blanco; Casilda Olveira; Rafael Canton; Miguel Angel Martinez-García Journal: J Clin Med Date: 2020-11-24 Impact factor: 4.241