Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the most devastating events in the course of the disease. Our aim was to investigate the value of early warning scoring systems: National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in AECOPD. This is a prospective observational study of patients with AECOPD who were admitted at hospital. The NEWS and MEWS scores were registered at admission (NEWS-d1, MEWS-d1) and on the second day (NEWS-d2, MEWS-d2). A nasopharyngeal and sputum sample was taken for culture. Follow-up was done at 3 and 6 months after hospitalization. Any possible correlations between NEWS and MEWS and other parameters of COPD were explored. A cohort of 64 patients were included. In-hospital mortality was 4.7% while total mortality at 6 months was 26%. We did not find any significant correlation between in-hospital mortality and any of the scores but we could show a higher mortality and more frequent AECOPD at 6 months of follow-up for those with higher NEWS-d2. NEWS-d2 was associated with higher pCO2 at presentation and a more frequent use of NIV. Higher NEWS-d1 and NEWS-d2 were predictive of a longer hospital stay. The presence of pathogens in the nasopharyngeal sample was related with a higher reduction of both scores on the second day. We therefore support the superiority of NEWS in the evaluation of hospitalized patients with AECOPD. A remaining high NEWS at the second day of hospital stay signals a high risk of hypercapnia and need of NIV but also higher mortality and more frequent exacerbations at 6 months after AECOPD.

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Background: Globally, thousands of patients suffer from postacute COVID-19 syndrome, a condition that already affects our health system. Although there is a growing literature upon the long-term effects of SARS-CoV-2 infection, there are up to date only a few reports on long-term follow-up of pulmonary function after severe COVID-19. Objective: To investigate risk factors for in-hospital COVID-19 fatalities and to assess the lung function and health status at one year after hospital discharge. Methods: Patients who were admitted to the hospital with confirmed COVID-19 and required supplementary oxygen delivery were included in this observational cohort study. Baseline and demographic data and information about hospital stay were obtained by medical charts. Patients were divided in 3 groups: group 1 (intensive care unit (ICU)-invasive mechanical ventilation (IMV), group 2 (high-flow nasal cannula (HFNC) and/or none-invasive ventilation (NIV) and group 3 (regular oxygen delivery treatment). All patients were required to answer health questionnaires at one year after acute infection, while patients in groups 1 and 2 performed dynamic spirometry. Results: The study population consisted of 130 patients. Forty five (35%) patients died at the hospital. Risk factors for in-hospital mortality were age, hypertension, ischemic heart disease, and renal disease. We did not find any significant difference in health scales between the 3 groups. Mean values of both FEV1% and FVC% in groups 1 and 2 were detected within the lower normal limits with no difference between the two groups. Conclusion: The main result of the study is lung function in the lower limit of normal evaluated at one-year follow-up. There were no significant differences related to initial disease severity in lung function and long-term health status, which suggests that more generous lung function testing even in less severely affected patients, could be indicated.

Background: Globally, thousands of patients suffer from long-term COVID-19 symptoms, often referred to as post-acute COVID-19 syndrome, a condition that already affects our health systems. Although there is a growing literature upon the long-term effects of SARS-CoV-2 infection, there are up to date only a few reports on long-term follow up of pulmonary function after severe COVID-19.Methods: The study is an observational cohort of patients who were admitted to hospital care with confirmed COVID-19 during the first pandemic wave and those who required some form of supplementary oxygen delivery. Baseline characteristics, demographic data and information about hospital stay including mortality were obtained by medical charts. Patients were divided in to 3 groups: group 1 (intensive care unit (ICU)-invasive mechanical ventilation (IMV), group 2 (high-flow nasal-cannula (HFNC) and/or none-invasive ventilation (NIV) and group 3 (regular oxygen delivery treatment). All patients were required to answer questionnaires (mMRC scale, Post-COVID-19 Functional Status Scale (PCFS), Hospital anxiety and depression scale (HAD) and 36-Item Short Form Health Survey (SF-36)) at one year after acute infection, while patients in groups 1 and 2 performed also dynamic spirometry. The R-language of statistics was used for all calculations and visualisations.Results: The study population consisted of 130 patients. Forty five (35%) patients died at the hospital. Risk factors for in-hospital mortality were age, hypertension, ischemic heart disease and renal disease. Patients who survived had, on average, a longer period from symptoms onset to hospital admission. No significant difference in all health scales between the 3 patient groups were found. Mean values of both FEV1% and FVC% in the groups 1 and 2 were detected within the lower normal limits while no difference was found between the two groups who were examined with spirometry. Conclusions: The main result of the study is lung function values in the lower limit of normal evaluated with dynamic spirometry at one-year follow-up. There were no significant differences related to initial disease severity in lung function and long-term health status at 12 months, which suggests that more generous lung function testing even in less severe individuals with lingering symptoms could be indicated.