&lt;p&gt;Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples&lt;/p&gt;

Alotaibi, Nawaf M.; Chen, Virginia; Hollander, Zsuzsanna; Leipsic, Jonathon; Hague, Cameron; Murphy, Darra; DeMarco, Mari L.; FitzGerald, J. Mark; McManus, Bruce M.; Ng, Raymond T.; Sin, Don D.

doi:10.2147/copd.s188186

Cited by 8 publications

(7 citation statements)

References 45 publications

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“…Which streptococcal species are being identified in the Streptococcus cluster is therefore not known; use of species-specific PCR could resolve identity to the species level in future studies. 34 It should also be noted that sputum, although widely used in studies of the airway microbiome, has limitations in that it is often intermediate between bronchoalveolar lavage and upper airway swabs and therefore contains contributions from the upper and lower airway. Because our study aims to test the prognostic and phenotypic utility of the sputum microbiome, we make no inferences about lung ecology.…”

Section: Discussionmentioning

confidence: 99%

The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease

Dicker

Huang

Lonergan

et al. 2021

Journal of Allergy and Clinical Immunology

139

104

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Microbiome, Airway Inflammation and Mortality in COPD n=253 n=96 n=135Background: The sputum microbiome has a potential role in disease phenotyping and risk stratification in chronic obstructive pulmonary disease (COPD), but few large longitudinal cohort studies exist. Objective: Our aim was to investigate the COPD sputum microbiome and its association with inflammatory phenotypes and mortality. Methods: 16S ribosomal RNA gene sequencing was performed on sputum from 253 clinically stable COPD patients (4-year median follow-up). Samples were classified as Proteobacteria or Firmicutes (phylum level) and Haemophilus or Streptococcus (genus level) dominant. Alpha diversity was measured by using Shannon-Wiener diversity and Berger-Parker dominance indices. Survival was modeled by using Cox proportional hazards regression. A subset of 78 patients had label-free liquid chromatography with tandem mass spectrometry performed, with partial least square discriminant analysis integrating clinical, microbiome, and proteomics data. Results: Proteobacteria dominance and lower diversity was associated with more severe COPD according to the Global Initiative for Chronic Obstructive Lung Disease classification system (P 5 .0015), more frequent exacerbations (P 5 .0042), blood eosinophil level less than or equal to 100 cells/mL (P < .0001), and lower FEV 1 (P 5 .026). Blood eosinophil counts showed a positive relationship with percent of Firmicutes and Streptococcus and a negative association with percent Proteobacteria and Haemophilus. Proteobacteria dominance was associated with increased mortality compared with Firmicutes-dominated or balanced microbiome profiles (hazard ratio 5 2.58; 95% CI 5 1.43-4.66; P 5 .0017 and hazard From a the

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Section: Discussionmentioning

confidence: 99%

The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease

Dicker

Huang

Lonergan

et al. 2021

Journal of Allergy and Clinical Immunology

139

104

View full text Add to dashboard Cite

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“…54 Among this population already in hospital with an acute exacerbation of COPD, the bacteriapositive subgroup had the best prognosis and the pathogen-negative group had the worst prognosis. 54 More recently, Prins et al reported the results of an RCT where CRP was used as a biomarker to direct antibiotic treatment in patients admitted to hospital with an acute exacerbation of COPD. Patients were randomized to receive biomarker directed antibiotic treatment if CRP was !50 mg/L (n ¼ 101) or guideline-based antibiotic treatment according to patient reported symptoms (n ¼ 119).…”

Section: Treatable Traits In Acute Exacerbationsmentioning

confidence: 95%

“…53 A further attempt to phenotype COPD patients using molecular microbiological techniques identified bacteria- and virus-positive groups or pathogen-negative patient groups. 54 Among this population already in hospital with an acute exacerbation of COPD, the bacteria-positive subgroup had the best prognosis and the pathogen-negative group had the worst prognosis. 54…”

Section: Treatable Traits: An Emerging Approach For Chronic Airway DImentioning

confidence: 95%

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Treatable traits in acute exacerbations of chronic airway diseases

2019

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Acute exacerbations of chronic airway disease are common occurrences that cause a major burden of illness. Acute exacerbations are associated with impaired health status, increased lung function decline, hospitalization and increased risk of death. Exacerbation avoidance is a major priority. Despite this goal, exacerbations continue to occur and the need for effective models of care that optimize patient outcomes are urgently needed. ‘Treatable Traits’ is an approach to personalized medicine that has been proposed for the management of airway diseases. The treatable traits approach allows for the recognition of clinically important, identifiable and treatable disease characteristics, followed by targeted and individualized treatment interventions to address each trait. We review the literature relating to treatable traits in airway diseases; in particular, those traits that can predict exacerbations and approaches to management that aim to prevent exacerbations by using a treatable traits model of care. We propose this approach as a potentially useful model of care to both prevent and manage acute exacerbations.

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“…Mortality was ascertained through medical records and validated by death certificates. The detailed information about this study was previously published [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

The impact of IgG subclass deficiency on the risk of mortality in hospitalized patients with COPD

et al. 2022

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Background Immunoglobulin G (IgG) deficiency increases the risk of acute exacerbations and mortality in chronic obstructive pulmonary disease (COPD). However, the impact of IgG subclass deficiency on mortality in COPD is unknown. Here, we determined which IgG subclass, if any, is associated with increased risk of mortality in COPD. Methods We measured serum IgG subclass concentrations of 489 hospitalized patients with COPD who were enrolled in the Rapid Transition Program (clinicaltrials.gov identifier NCT02050022). To evaluate the impact of IgG subclass deficiency on 1-year mortality, Cox proportional hazards regression analyses were performed with adjustments for potential confounders. Results Deficiencies in IgG1, IgG2, IgG3, and IgG4 were present in 1.8%, 12.1%, 4.3%, and 11.2% of patients, respectively. One-year mortality was 56% in patients with IgG1 deficiency, 27% in IgG2 deficiency, 24% in IgG3 deficiency, and 31% in IgG4 deficiency. Cox proportional modeling showed that IgG1 and IgG4 deficiencies increased the 1-year mortality risk with an adjusted hazard ratio of 3.92 (95% confidence interval [CI] = 1.55–9.87) and 1.74 (95% CI = 1.02–2.98), respectively. Neither IgG2 nor IgG3 deficiency significantly increased 1-year mortality. Two or more IgG subclass deficiencies were observed in 5.3%. Patients with 2 or more IgG subclass deficiencies had a higher 1-year mortality than those without any deficiencies (46.2% vs. 19.7%, p < 0.001), with an adjusted hazard ratio of 2.22 (95% CI = 1.18–4.17). Conclusions IgG1 and IgG4 deficiency was observed in 1.8% and 11.2% of hospitalized patients with COPD, respectively, and these deficiencies were associated with a significantly increased risk of 1-year mortality.

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<p>Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples</p>

Cited by 8 publications

References 45 publications

The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease

The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease

Treatable traits in acute exacerbations of chronic airway diseases

The impact of IgG subclass deficiency on the risk of mortality in hospitalized patients with COPD

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