Predictors of severe morbidity and death after elective abdominal aortic aneurysmectomy in patients with chronic obstructive pulmonary disease

Upchurch, Gilbert R.; Proctor, Mary C.; Henke, Peter K.; Zajkowski, Paul J.; Riles, Eric M.; Ascher, Michael S.; Eagleton, Matthew J.; Stanley, James C.

doi:10.1067/mva.2003.22

Cited by 53 publications

(38 citation statements)

References 15 publications

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“…A recent study found that a low preoperative hematocrit was also a predictor of a poor postoperative outcome. 46 These observations may suggest that COPD patients are more sensitive to the effects of anemia, acute or chronic, by the preexisting tissue hypoxia. Nevertheless, it may be argued that the higher mortality was the result of greater blood loss during surgery, especially as both studies had patients who underwent surgery for upper-gastrointestinal bleeding 45 or abdominal aortic aneurysm.…”

Section: Morbidity and Mortalitymentioning

confidence: 86%

“…Older cells are most likely to become stiffer and to be unable to penetrate the tissue microcirculation, so these transfusions may provide useful volume expansion but may not increase oxygen delivery. Further research is warranted Two studies 45,46 in which anemic COPD patients had undergone surgery found that mortality was higher than in the non-COPD subgroups. A recent study found that a low preoperative hematocrit was also a predictor of a poor postoperative outcome.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

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Anemia in COPD: A Systematic Review of the Prevalence, Quality of Life, and Mortality

Yohannes

Ershler

2011

Respir Care

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Anemia is common in patients with chronic diseases. However, little is known regarding the prevalence of comorbid anemia and its impact on quality of life, healthcare utilization, and mortality in patients with COPD. We conducted a systematic review and synthesis of the literature (1966 to March 2010). The prevalence of comorbid anemia in patients with COPD ranges from 7.5% to 34%, depending upon the populations selected and diagnostic tools employed to determine the level of hemoglobin. Comorbid anemia in patients with COPD was associated with greater healthcare resource utilization, impaired quality of life, older age, and male gender. Moreover, anemia in patients with COPD is an independent prognostic predictor of premature mortality and a greater likelihood of hospitalization. The true prevalence of anemia in patients with COPD is unknown. There is a lack of consensus agreement regarding this hematological abnormality's true frequency. Based on the findings from the existing literature, more work is necessary to establish the true prevalence of anemia in COPD. Robust and prospective clinical studies are needed to improve the management of COPD patients with comorbid anemia.

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Section: Morbidity and Mortalitymentioning

confidence: 86%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Anemia in COPD: A Systematic Review of the Prevalence, Quality of Life, and Mortality

Yohannes

Ershler

2011

Respir Care

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“…In one of these studies, mortality from gastrointestinal bleeding appeared to be higher in a cohort of 53 COPD patients, compared with bleeding controls without COPD (32% versus 10%, respectively; OR 4.3; 95% CI 1.22-1.48; p,0.01) and to COPD controls without bleeding (32% versus 11%, respectively; OR 3.7; p,0.02) [43]. In the other study, suboptimal management (fewer prescribed inhalers), preoperative renal insufficiency, coronary artery disease and reduced haematocrit (average 34% versus 39%), were significantly associated (p50.002) with an unfavourable outcome in COPD patients undergoing elective open abdominal aortic aneurysmectomy [44].…”

Section: Clinical Relevance Of Anaemia Of Copd Mortalitymentioning

confidence: 94%

The potential impact of anaemia of chronic disease in COPD

Similowski

Agustí²,

MacNee³

et al. 2006

Eur Respir J

153

107

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Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is ''traditionally'' associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If present in COPD, anaemia could worsen dyspnoea and limit exercise tolerance.Preliminary evidence suggests that anaemia in COPD patients may be more prevalent than expected, concerning 10-15% of patients suffering from severe forms of the disease. A database study conducted in 2,524 COPD patients being prescribed long-term oxygen therapy has shown that a low haematocrit is a strong predictor of survival in this population, before body mass index, and is associated with more hospitalisations and a longer cumulative duration of hospitalisation. COPD patients with low haemoglobin levels have a poorer prognosis than COPD patients with normal haemoglobin levels in the event of acute gastrointestinal bleeding or after elective aneurysm repair. Raising haemoglobinaemia through transfusion decreases minute ventilation and work of breathing in COPD patients.These preliminary evidences point to the need to study the prevalence of anaemia, and its physiological and clinical impact in chronic obstructive pulmonary disease. When this body of knowledge is available, the question of the putative benefits of raising haemoglobinaemia in chronic obstructive pulmonary disease will have to be addressed.

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“…In a small set of anaemic ventilator-dependent COPD patients, raising haemoglobin levels to >12 g·dL -1 seemed to improve patients enough to make ventilator weaning possible. A reduced haematocrit was found to be an independent predictor of poor outcomes in COPD patients following elective open abdominal aortic aneurysm resection [65].…”

Section: Anaemiamentioning

confidence: 99%

Chronic disease in the elderly: back to the future of internal medicine

Fabbri

Ferrari

2006

Breathe

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Key pointsThe ageing of the population has increased the prevalence of chronic diseases, which represent a huge proportion of human illness.The two most important risk factors underlying the most frequent chronic diseases of the elderly are tobacco use and obesity.The most important comorbidities are cardiovascular diseases and chronic respiratory diseases, particularly COPD.Comorbidities may not only contribute to the severity of a patient's clinical manifestations, but they may also complicate its treatment, and they are therefore important to recognise and treat effectively.Educational aimsTo increase the interest of chest physicians in multiple chronic comorbidities in the elderly.To define the most important and frequent comorbidities in elderly patients, particularly those with COPD.To provide updated information on the most common chronic diseases present in the elderly.To emphasise the limitations of single disease-oriented clinical practice guidelines, and the need for a more comprehensive “internistic” approach to patients with multiple chronic comorbidities.To suggest that chronic inflammation might represent the common pathogenetic link between the different chronic diseases present in the elderly.SummaryElderly people are often affected by two or more chronic diseases, more frequently cardiovascular diseases, chronic respiratory diseases, metabolic syndrome and cancer. These most frequent chronic diseases share largely preventable risk factors, the most important being smoking and obesity, and may be linked to chronic systemic inflammation. Coexisting chronic diseases affect the course of the primary disease and alter the efficacy and safety of its management. Current clinical practice is dominated by the "singledisease" approach, which has major limitations, and there is increasing evidence that a patient-oriented approach that takes into account the several co-existing components of chronic disease is required. This "change of concept" implies the need for medical specialists to extend their expertise to broader diagnostic and treatment approaches that are traditionally the purview of internal medicine. This new approach also requires a different approach to clinical research and teaching, followed by extensive rewriting of medical textbooks and remodelling of teaching curricula to reflect the complexity of the patient affected by chronic diseases.

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Predictors of severe morbidity and death after elective abdominal aortic aneurysmectomy in patients with chronic obstructive pulmonary disease

Cited by 53 publications

References 15 publications

Anemia in COPD: A Systematic Review of the Prevalence, Quality of Life, and Mortality

Anemia in COPD: A Systematic Review of the Prevalence, Quality of Life, and Mortality

The potential impact of anaemia of chronic disease in COPD

Chronic disease in the elderly: back to the future of internal medicine

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