Comportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE

IntroductionTo evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD.MethodsA cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire.ResultsPatients had a BODE index of 3.1 ± 2.0; FEV₁ (%) of 49 ± 19.2; BMI (kg/m²) of 24.7 ± 5.1; 6MWT distance (meters) of 444 ± 96. Significant correlations were found between the BODE index and SGRQ total scores (r = 0.5; < 0.001), impact (r = 0.45; < 0.001) and activity (r = 0.5; < 0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (< 0.05), BMI (< 0.002) and 6MWT (< 0.05), and with the increase in the Modified Medical Research Council (MMRC) score (< 0.05).ConclusionThere is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.     

A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD

STUDY OBJECTIVES: To compare categorizations of the level of dyspnea with the staging of disease severity as defined by the FEV(1) in representing how the health-related quality of life (HRQOL) is distributed in patients with COPD. DESIGN: Cross-sectional study. SETTING: Outpatient clinic at the respiratory department of a university hospital. PATIENTS: A total of 194 consecutive male patients with stable, mild-to-severe COPD. MEASUREMENTS: The score distributions for the components of the St. George's respiratory questionnaire (SGRQ) were used as disease-specific HRQOL measures, and the scores from the Medical Outcomes Study Short Form 36-item questionnaire (SF-36) were used as generic HRQOL measures. These scores were stratified according to the level of dyspnea, as defined by the Medical Research Council (MRC) dyspnea scale, and the stage of disease severity, as defined by the American Thoracic Society (ATS). Differences in the HRQOL scores among the subgroups were compared by an analysis of variance (ANOVA). Multiple pairwise comparisons were made with Fisher's least significant difference (LSD) method, with the overall alpha-level set at 0.05. RESULTS: In those groups classified according to the level of dyspnea, significant differences were observed for the scores on the SGRQ and SF-36 (ANOVA, p < 0.05). The scores for activity and impact, and the total scores of the SGRQ and all scales, except for bodily pain and general health on the SF-36, were significantly worse for patients with severe dyspnea (MRC scale grades, 3, 4, and 5, respectively) than for those with moderate dyspnea (MRC grade level, 2; Fisher's LSD method, p < 0.05). Significant differences were recognized among the different stages of disease severity with respect to the scores from all scales of the SF-36, except for bodily pain, and all scores from the SGRQ (ANOVA, p < 0.05). However, differences in the scores on the SGRQ and SF-36 between patients with ATS stage II disease (FEV(1), 35 to 49% predicted) and stage III disease (FEV(1), < 35% predicted) were not statistically significant. CONCLUSIONS: Using the SGRQ and SF-36, the HRQOL of patients with COPD was more clearly separated by the level of dyspnea than by the ATS disease staging. In addition to the ATS disease staging, categorizations based on the level of dyspnea may be useful to clinicians in terms of the HRQOL of COPD patients.     

Does the multidimensional grading system (BODE) correspond to differences in health status of patients with COPD?

Study objectives

To verify whether and to what extent the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index correlates with a disease-specific index of health status in patients with COPD.

Design

Cross-sectional study.

Setting

University-affiliated hospital.

Patients

One hundred patients with stable COPD recruited from the outpatient clinic of a single institution.

Measurements

The BODE index was calculated for each patient using variables obtained within 2 weeks of enrollment. At enrollment, all patients completed the St George’s Respiratory Questionnaire (SGRQ). The Kruskal-Wallis test was used to compare health status scores with clinical and functional categories of COPD. The Spearman correlation coefficient (r) was calculated to assess the association between health status scores and clinical or functional variables.

Results

Categorizing the BODE scores into 4 quartiles, we found that higher BODE quartiles were associated with higher (worse) SGRQ scores. The differences among the BODE quartiles in health status indexes were significant for total SGRQ as well as all 3 of the SGRQ sub-scales. In all sections of the SGRQ, scores were moderately to strongly associated with the BODE quartiles (r = 0.27–0.46). In contrast, the association between the SGRQ total, impacts, activity and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages were weaker (r = 0.27–0.28). There was no significant association between SGRQ symptoms and GOLD stages.

Conclusions

The BODE scoring system corresponds to important differences in health status of patients with COPD. This grading system is better correlated to the health status indexes of the SGRQ than the GOLD staging criteria.     

Liver transplantation and quality of life: relevance of a specific liver disease questionnaire

Aim: A positive effect of liver transplantation on health‐related quality of life (HRQOL) has been well documented in previous studies using generic instruments. Our aim was to re‐evaluate different aspects of HRQOL before and after liver transplantation with a relatively new questionnaire the ‘liver disease quality of life’ (LDQOL). Methods: The LDQOL and the Short Form 36 (SF‐36) questionnaires were applied to ambulatory patients, either in the transplant list (n=65) or after 6 months to 5 years of liver transplant (n=61). The aetiology of cirrhosis, comorbidities, model for end‐stage liver disease (MELD) Child–Pugh scores and recurrence of liver disease after liver transplantation were analysed using the Mann–Whitney and Kruskall–Wallis tests. Results: In patients awaiting liver transplantation, MELD scores ≥15 and Child–Pugh class C showed statistically significant worse HRQOL, using both the SF‐36 and the LDQOL questionnaires. HRQOL in pretransplant patients was found to be significantly worse in those with cirrhosis owing to hepatitis C (n=30) when compared with other aetiologies (n=35) in 2/7 domains of the SF‐36 and in 7/12 domains of the LDQOL. Significant deterioration of HRQOL after recurrence of hepatitis C post‐transplant was detected with the LDQOL questionnaire although not demonstrated with the SF‐36. The statistically significant differences were in the LDQOL domains: symptoms of liver disease, concentration, memory and health distress. Conclusions: The LDQOL, a specific instrument for measuring HRQOL, has shown a greater accuracy in relation to liver symptoms and could demonstrate, with better reliability, impairments before and after liver transplantation.     

Clinical Significance of Radiologic Characterizations in COPD

ABSTRACT

COPD is a heterogeneous disorder with clinical assessment becoming increasingly multidimensional. We hypothesized HRCT phenotype would strongly influence clinical outcomes including health status, exacerbation frequency, and BODE. COPD subjects were characterized via the SF-12, SGRQ, MMRC, physiologic testing, and standardized volumetric chest HRCT. Visual semi-quantitative estimation of bronchial wall thickness (VBT) and automated quantification of emphysema percent and bronchial wall thickness were generated. Multivariate modeling compared emphysema severity and airway abnormality with clinical outcome measures. Poisson models were used to analyze exacerbation frequency. SGRQ and SF-12 physical component scores were influenced by FEV₁% predicted, emphysema percent, and VBT. VBT scores > 2 (scale 0–48) were associated with increased exacerbation frequency (p = 0.009) in the preceding year adjusting for age, gender, emphysema percent, smoking history and FEV₁% predicted, although this effect was attenuated by age. Emphysema percent correlated with total BODE score in unadjusted (r = 0.73; p < 0.0001) and adjusted (p < 0.0001) analyses and with BODE individual components. HRCT provides unique COPD phenotyping information. Radiographic quantification of emphysema and bronchial thickness are independently associated with SGRQ and physical component score of the SF-12. Bronchial thickness but not emphysema is associated with exacerbation frequency, whereas emphysema is a stronger predictor of BODE and its systemic components MMRC, 6MWT, and BMI. Future research should clarify whether CT parameters complement BODE score in influencing survival.     

Impact of fibromyalgia pain on health‐related quality of life before and after treatment with tramadol/acetaminophen

Objective

To assess health‐related quality of life (HRQOL) in patients with moderate‐to‐severe fibromyalgia pain compared with the general population, and to assess the relationship between pain severity and HRQOL before and after treatment with an analgesic.

Methods

Data were obtained from a randomized, double‐blind study of patients with moderate‐to‐severe fibromyalgia pain. Patients received either tramadol/acetaminophen or placebo 4 times/day as needed for 91 days. HRQOL was measured with the Short Form 36 Health Survey (SF‐36) and the Fibromyalgia Impact Questionnaire (FIQ). Baseline HRQOL scores were compared with a national sample of noninstitutionalized adults and a sample of patients with impaired HRQOL due to congestive heart failure. Patients with fibromyalgia were divided into tertiles by change in pain severity, and SF‐36 scores were compared across the tertiles. Mean changes in SF‐36 and FIQ scores were compared between treatment groups.

Results

Patients with fibromyalgia scored lower than the US norm on all SF‐36 scales (P < 0.0001) and lower than patients with congestive heart failure on most scales. More severe pain was associated with greater impairment of HRQOL compared with less severe pain (P < 0.0001). Patients in the highest tertile for improved pain severity had greater improvement in HRQOL scores than patients in the lower tertiles. Compared with patients who received placebo (n = 157), patients treated with tramadol/acetaminophen (n = 156) showed greater improvement on SF‐36 physical functioning, role physical, bodily pain, and physical summary scales, as well as FIQ scales for ability to do job, pain, and stiffness (P < 0.01).

Conclusion

Moderate‐to‐severe fibromyalgia pain significantly impairs HRQOL, and effective pain relief in these patients significantly increases HRQOL.

     

合并抑郁症状的 COPD 患者与其 BODE指数及生活质量的相关性分析

目的：通过应用流行病学研究中心抑郁自评量表（center for epidemiologic studies depression ,CES‐D）量表调查COPD患者合并抑郁症状的情况,探讨合并抑郁症状的COPD患者与其BODE （body mass index ,degree of air‐flow obstruction ,dyspnea ,exercise capacity）指数及生活质量的相关性。方法74例稳定期COPD患者分别完成CES‐D评估、肺功能检测、BMI检测、改良版M RC呼吸困难指数评估、6分钟步行试验和圣乔治呼吸问卷调查等。结果 C O PD患者中合并抑郁症状的占48.6％（n＝36）。CES‐D评分与FEV1％ pred呈低度负相关（r＝－0.21,P＝0.01）。COPD患者中抑郁症状的患病率与BODE指数分级呈正相关（r＝0.61,P＝0.02）。圣乔治呼吸问卷评分与COPD患者的抑郁症状有相关性（r＝0.58,P＝0.004）。结论 COPD患者中抑郁症状的患病率及抑郁程度与BODE指数、呼吸功能受损程度等均相关。COPD患者的抑郁程度与圣乔治呼吸问卷评分相关。BODE指数对减少COPD患者合并抑郁症状的患病率和改善其生活质量有指导作用。     

Evaluation of the chronic obstructive pulmonary disease assessment test for measurement of health-related quality of life in patients with interstitial lung disease

Background and objective: A well‐validated instrument that is simple to use is needed to assess health‐related quality of life in patients with interstitial lung disease (ILD). The COPD assessment test (CAT) is a recently introduced, short and simple questionnaire for COPD patients, which shows good and valid measurement properties. This study was conducted to evaluate the validity of the CAT in patients with ILD. Methods: Patients with ILD (n = 55) completed the CAT and the St. George's Respiratory Questionnaire (SGRQ). These patients also completed the Medical Research Council (MRC) dyspnoea scale, the Leicester Cough Questionnaire (LCQ), and the hospital anxiety and depression scale; performed 6‐min walk tests and pulmonary function tests; and provided samples for arterial blood gas analysis. Results: There was a very strong correlation between the CAT score and the SGRQ total score (r = 0.93, P < 0.0001). The CAT score was also significantly correlated with the SGRQ symptoms score (r = 0.74, P < 0.0001), the SGRQ activity score (r = 0.87, P < 0.0001) and the SGRQ impact score (r = 0.89, P < 0.0001). Stepwise multiple regression analysis demonstrated that the MRC and LCQ scores contributed most to both the CAT score and the SGRQ total score. Conclusions: The CAT is a short and simple questionnaire that shows good and valid measurement properties for assessing the health status of patients with ILD.     

Quality of life in adults with juvenile‐onset dermatomyositis: A case–control study

Objective

To compare quality of life in adults diagnosed with juvenile dermatomyositis (DM) with that of matched controls, and to analyze the association with other disease parameters in patients.

Methods

Thirty‐nine patients with juvenile DM (ages ≥18 years) were clinically examined and compared with 39 age‐ and sex‐matched controls. Global and health‐related quality of life (HRQOL) were assessed by the Norwegian version of the Quality of Life Scale (QOLS‐N) and the Short Form 36 (SF‐36), respectively. For patients, disease parameters were assessed by the Disease Activity Score (DAS), Health Assessment Questionnaire (HAQ), and Myositis Damage Index (MDI).

Results

Compared to the controls, patients with juvenile DM assessed a median of 22.2 years (range 1.8–36.1 years) after disease onset had reduced HRQOL in general health (P = 0.009) measured by the SF‐36. In patients, a moderate correlation was found between the physical component summary (PCS) score and the DAS (r_s = ?0.422) and MDI (r_s = ?0.381), and a strong correlation was found between the PCS score and the HAQ (r_s = ?0.516). There were no differences between patients and controls in the SF‐36 mental component summary scores. Patients and controls had similar total scores of the QOLS‐N, but differences existed within certain items.

Conclusion

Adult patients with juvenile DM had, compared to controls, reduced HRQOL in general health measured by the SF‐36, but not in the other subscales of the SF‐36 or in global quality of life measured by the QOLS‐N. An association was found between disease parameters and reduced HRQOL in the physical domains.

     

慢性阻塞性肺疾病患者3年健康相关生活质量的变化及危险因素的分析

目的 探讨生活中COPD患者3年健康相关生活质量(health-related quality of life,HRQoL)的变化规律及影响生活质量变化的可能危险因素.方法 基于慢性呼吸病管理中心数据库3年的COPD患者临床资料,采用回顾性研究,利用圣乔治呼吸问卷(Saint George's Respiratory Questionnaire,SGRQ)评估HRQoL,分析SGRQ随时间变化规律;根据SGRQ 3年变化值进行分组,利用Logistic回归探寻影响HRQoL变化的危险因素.结果 60例COPD患者中63.3％～83.3％的患者经吸入激素联合长效支气管舒剂治疗后,SGRQ总分及各部分评分与基线值比较无明显上升(t值分别为:0.147、-0.014、0.335、0.227,P值均＞0.05),FEV1、FEV1％pred、6分钟步行距离较基线值下降(t值分别为:3.943、6.974、3.977,P值均＜0.05),BODE指数较基线值上升(t=-9.916,P＜0.05);其中生活质量相对稳定者36例(60％),多因素Logistic回归提示BODE指数升高是HRQoL下降的独立危险因素(OR =1.686,P=0.017),重度急性加重次数对其下降亦有影响(OR=3.316,P=0.052).结论 生活中大部分COPD患者经吸入激素联合长效支气管舒张剂治疗后生活质量相对稳定,除药物影响外,BODE指数升高是生活质量下降的独立危险因素,重度急性加重次数可能也对健康相关生活质量的变化具有预测价值.     

The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has introduced a four-stage classification of chronic obstructive pulmonary disease (COPD) severity. The present study investigated the discriminatory capacity of the GOLD classification for health status outcomes in patients with COPD. An additional analysis was performed to investigate the discriminatory capacity of a multidimensional staging system, i.e. the Body-Mass Index, Degree of Airflow Obstruction and Dyspnea, and Exercise Capacity Index (BODE index) for the outcome of quality of life. Retrospective analysis was performed on 253 COPD patients (30% stage II, 48% stage III, 22% stage IV), referred for outpatient pulmonary rehabilitation. Pulmonary function, exercise capacity, dyspnoea and quality of life were evaluated. Analyses of variance were used to detect differences between GOLD stages and BODE index quartiles, and scatterplots of individual responses were produced as well. The GOLD classification discriminated between stages for pulmonary function (p<0.001), exercise capacity (p<0.001), dyspnoea (p<0.001) and the activities section (p=0.001) of the St. George Respiratory Questionnaire (SGRQ). The BODE index discriminated between quartiles for the activities section (p<0.001), impacts section (p=0.04) and the total score (p=0.01) of the SGRQ. Scatterplots revealed marked inter-individual variation within each GOLD stage or BODE index quartile, and considerable overlap between stages for all health status outcomes. These findings show that the GOLD classification indeed can be used to discern groups of COPD patients, but due to large inter-individual variability it does not seem adequate as a basis for individual management plans in rehabilitation. The BODE index appeared to discriminate slightly better for quality of life, however, it still leaves a significant part of the variance unexplained.     

慢性阻塞性肺疾病评估测试评分对预后的评估意义

目的探讨慢性阻塞性肺疾病评估测试(CAT)评分与慢性阻塞性肺疾病(COPD)患者预后因素之间的相关性,明确CAT评分对COPD患者预后评估的应用价值。方法选取2013年1月至2015年1月我院呼吸内科住院及门诊就诊的106例COPD患者为研究对象。对106例患者治疗前后进行CAT评分、6 min步行实验(6MWD)、改良英国MRC呼吸困难指数(m MRC)、BODE(B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力)指数、圣乔治呼吸问卷(SGRQ)评分及肺功能的测定。采用单因素线性相关分析CAT评分与患者各临床特征之间的相关性。结果随着CAT评分的升高,患者6MWD、用力呼气容积(FVC)实测值、FVC实测/预测值、一秒用力呼气容积(FEV1)实测值、FEV1实测/预测值、FEV1/FVC、呼气峰流速(PEF)实测值、PEF实测/预测值均明显降低(P0.05),而m MRC评分、BODE指数及SGRQ总评分明显升高(P0.05);患者经短期治疗后,CAT评分、BODE指数及SGRQ总评分均显著低于治疗前(P0.05),而6MWD、FEV1实测值、FEV1实测/预测值、FEV1/FVC则均显著高于治疗前(P0.05);单因素相关分析发现,治疗前CAT评分与m MRC评分(r=0.254,P=0.018)、BODE指数(r=0.426,P=0.009)及SGRQ总评分(r=0.563,P=0.007)呈显著正相关,与6MWD(r=-0.387,P=0.008)、FVC实测值(r=-0.181,P=0.023)、FVC实测/预测值(r=-0.192,P=0.021)、FEV1实测值(r=-0.201,P=0.016)、FEV1实测/预测值(r=-0.214,P=0.013)及FEV1/FVC(r=-0.223,P=0.012)呈显著负相关;治疗后CAT评分与m MRC评分(r=0.304,P=0.011)、BODE指数(r=0.382,P=0.010)及SGRQ总评分(r=0.621,P=0.004)呈显著正相关,与6MWD(r=-0.407,P=0.007)、FEV1实测值(r=-0.211,P=0.014)、FEV1实测/预测值(r=-0.228,P=0.012)及FEV1/FVC(r=-0.231,P=0.011)呈显著负相关。结论 CAT评分与COPD患者m MRC评分、BODE指数、SGRQ总评分、6MWD及肺功能指标均有较好的相关性,具有较好的预测COPD患者预后的应用价值。     

Associations between BODE Index and Systemic Inflammatory Biomarkers in COPD

Background: COPD is a multicomponent disease and systemic inflammation represents one of the possible mechanisms responsible for its systemic manifestations, including skeletal muscle weakness and cachexia. Fat-free mass index (FFMI) that reflects the skeletal muscle mass, has been shown to be associated with both dyspnoea and exercise capacity. We hypothesized that the multidimensional BODE index, that reflects the multicomponent nature of COPD, might be related to biomarkers of systemic inflammation. We further evaluated associations between FFMI and systemic inflammation. Methods: BODE index and FFMI were calculated in 222 stable COPD patients and 132 smokers or ex-smokers with normal lung function. Systemic inflammation was evaluated with the measurement of leptin, adiponectin, CRP, IL-6, and TNF-α in serum samples of COPD patients. Results: In patients with COPD, both BODE index and FFMI presented significant positive and negative associations respectively with leptin levels (R² 0.61 and 0.65, respectively), whereas FFMI presented an additional negative association with the levels of TNF-α (R² 0.38). No significant associations were observed in smokers or ex-smokers with normal lung function. Conclusions: Both BODE index and FFMI, are related to the circulating levels of leptin in patients with COPD, suggesting a possible role for leptin in the systemic component of COPD. The additional association of FFMI with TNF-α may further support a role of systemic inflammation in muscle wasting in COPD.     

Assessment of health-related quality of life as an outcome measure in granulomatosis with polyangiitis (Wegener's)

Objective

To assess a generic measure of health‐related quality of life (HRQOL) as an outcome measure in granulomatosis with polyangiitis (Wegener's) (GPA).

Methods

Subjects were participants in the Wegener's Granulomatosis Etanercept Trial (WGET) or the Vasculitis Clinical Research Consortium Longitudinal Study (VCRC‐LS). HRQOL was assessed with the Short Form 36 (SF‐36) health survey that includes physical and mental component summary scores (PCS and MCS, respectively). Disease activity was assessed with the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG).

Results

The data from 180 subjects in the WGET (median followup 2.3 years, mean number of visits 10) and 237 subjects in the VCRC‐LS (median followup 2.0 years, mean number of visits 8) were analyzed. A 1 unit increase in the BVAS/WG corresponded to a 1.15 unit (95% confidence interval [95% CI] 1.02, 1.29) decrease for the PCS and a 0.93 (95% CI 0.78, 1.07) decrease for the MCS in the WGET, and to a 1.16 unit decrease for the PCS (95% CI 0.94, 1.39) and a 0.79 unit decrease for the MCS (95% CI 0.51, 1.39) in the VCRC‐LS. In both arms of the WGET study, SF‐36 measures improved rapidly during the first 6 weeks of treatment followed by gradual improvement among patients achieving sustained remission (0.5 improvement in PCS per 3 months), but worsened slightly (0.03 decrease in PCS every 3 months) among patients not achieving sustained remission (P = 0.005).

Conclusion

HRQOL, as measured by the SF‐36, is reduced among patients with GPA. SF‐36 measures are modestly associated with other disease outcomes and discriminate between disease states of importance in GPA.     

Inflammatory bowel disease versus irritable bowel syndrome: a hospital‐based,case‐control study of disease impact on quality of life

Background: Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are intestinal diseases perceived differently by patients and doctors: the former is considered essentially as an ‘organic’ disease (i.e. an illness in which the role of stress or psychological factors is at best secondary to the disease itself), whereas the latter is acknowledged as a ‘functional’ disorder (i.e. illness thought to be more in the ‘mind’ than in the body of the patient). Accordingly, the respective impact of the two diseases on patients' health‐related quality of life (HRQOL) is perceived to be very different. We aimed to compare the relative impact of the disease on HRQOL, psychological profile and perceived burden of stressful life events in two groups of outpatients suffering from IBS and IBD and attending our outpatient department at an Italian university hospital. Eighty patients with IBD (26 with ulcerative colitis and 54 with Crohn disease) and 85 controls with IBS formed the patient samples of the study. Methods: Three questionnaires were given to the patients while they were attending the outpatient department because of their previously diagnosed disease, namely the SF‐36 (a generic well‐validated tool for measuring HRQOL), the SCL‐90 (for assessing the psychological profile of patients), and the Holmes &; Rahe schedule (for the assessment of stressful life experiences). The results were then compared by means of analysis of variance (ANOVA) and Bonferroni‐adjusted t test, when appropriate. Results: HRQOL appeared to be similarly reduced in both disease groups (SF‐36 overall mean value: 58.2?±?16.1 in IBS patients versus 56.4?±?22.3 in IBD patients; P?>?0.05) in comparison with normative Italian data. Furthermore, the overall severity of psychological symptoms was not statistically different between patients suffering from IBD versus IBS, as shown by SCL‐90 mean scores of 0.89?±?0.45 versus 0.83?±?0.48, respectively (P?>?0.05). On the contrary, the severity of recent stressful life experiences was perceived to be higher by IBS than by IBD patients (mean SRE score: 110.8?±?110.2 versus 61.6?±?78.8; P?Conclusion: Our study supports the notion that, at least in referral centres, patients with IBS show health‐related quality of life, psychological distress and recent occurrence of stressful life events of severity at least comparable with age‐matched IBD patients.     

Microalbuminuria in Chronic Obstructive Pulmonary Disease

Abstract

Background: Microalbuminuria is an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). Objectives: In this study, we investigated prevalence and relationship of microalbuminuria with clinical and physiological parameters in patients with COPD. Method: During the research, 66 consecutive patients with COPD and 40 cases smokers with normal spirometry were included. The urinary albumin creatinin ratio (UACR) was calculated according to previously described formula. The presence of microalbuminuria was defined as UACR being ≥20 in men and ≥30 in women. The severity index of chronic diseases was evaluated by using MCIRS. Results: The rate of presence of microalbuminuria and UACR were higher in patients with COPD than smokers with normal spirometry. Pearson correlation analysis showed a significant inverse relationship between UACR and PaO₂, FEV₁%, FVC%. On the other hand, there was a positive relationship between UACR and BODE index. There was a significant relationship between the presence of microalbuminuria with PaO2 and BODE index. In the linear regression model, there was a negative relationship between UARC and PaO₂ yet there was a significantly positive relationship between UARC and MCIRS score, BODE index. In the logistic regression model, the presence of microalbuminuria showed significant associations with PaO₂, BODE index. Conclusion: Microalbuminuria may be seen in patients with COPD, depending on the severity of disease and hypoxemia. Microalbuminuria in patients with severe COPD should be examined in regular periods for risk of cardiovascular morbidity or mortality.     

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

Background and objective: 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. Methods: A comparative study was conducted of 100 clinically stable COPD patients and 50 matched healthy smokers and the difference in levels of biomarkers between the COPD patients and healthy smokers was measured. Serum inflammatory mediators measured were growth‐related oncogene‐α (GRO‐α), IL‐8, tumour necrosis factor‐α (TNF‐α), matrix metalloproteinase‐9 (MMP‐9) and monocyte chemoattractant protein‐1 (MCP‐1). Variables included age, pack‐years, current or ex‐smoker status, inhaler or oral steroid use and BODE index components, including airflow obstruction, the distance walked in 6MWD, modified Medical Research Council (MMRC) dyspnoea scale and BMI. The association between serum biomarkers and the components of the BODE index was assessed in the COPD patients. Results: The level of serum MCP‐1 was significantly different between the COPD group and the healthy smoker group (P = 0.003). Significant results in univariate and multivariate analysis of the association between biomarkers and BODE components were: serum MCP‐1 correlated with FEV₁% and 6MWD; serum IL‐8 and GRO‐α correlated with steroid use; serum TNF‐α correlated with steroid use and FEV₁%; and serum MMP‐9 correlated with MMRC dyspnoea scale. Conclusions: No single specific serum inflammatory mediator was completely correlated with BODE variable parameters in patients with stable COPD. Serum MCP‐1 may be an important biomarker for identifying COPD subjects from healthy smokers and classifying COPD severity.     

Evaluation of Left Ventricular Function and its Relationship With Multidimensional Grading System (BODE Index) in Patients With COPD

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (> –18.6 and ≤ –18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.     

The Glittre-ADL Test Cut-Off Point to Discriminate Abnormal Functional Capacity in Patients with COPD

The study objective was to determine a cut-off point for the Glittre activities of daily living (ADL)test (TGlittre) to discriminate patients with normal and abnormal functional capacity. Fifty-nine patients with moderate to very severe COPD (45 males; 65 ± 8.84 years; BMI: 26 ± 4.78 kg/m²; FEV₁: 35.3 ± 13.4% pred) were evaluated for spirometry, TGlittre, 6-minute walk test (6 MWT), physical ADL, modified Medical Research Council scale (mMRC), BODE index, Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). The receiver operating characteristic (ROC) curve was used to determine the cut-off point for TGlittre in order to discriminate patients with 6 MWT < 82% pred. The ROC curve indicated a cut-off point of 3.5 minutes for the TGlittre (sensitivity = 92%, specificity = 83%, and area under the ROC curve = 0.95 [95% CI: 0.89–0.99]). Patients with abnormal functional capacity had higher mMRC (median difference 1 point), CAT (mean difference: 4.5 points), SGRQ (mean difference: 12.1 points), and BODE (1.37 points) scores, longer time of physical activity <1.5 metabolic equivalent of task (mean difference: 47.9 minutes) and in sitting position (mean difference: 59.4 minutes) and smaller number of steps (mean difference: 1,549 minutes); p < 0.05 for all. In conclusion, the cut-off point of 3.5 minutes in the TGlittre is sensitive and specific to distinguish COPD patients with abnormal and normal functional capacity.