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. 2015 Oct 20:10:2257-63.
doi: 10.2147/COPD.S92160. eCollection 2015.

Respiratory infectious phenotypes in acute exacerbation of COPD: an aid to length of stay and COPD Assessment Test

Meng-Yuan Dai  1 , Jin-Ping Qiao  2 , Yuan-Hong Xu  2 , Guang-He Fei  1
Affiliations

Respiratory infectious phenotypes in acute exacerbation of COPD: an aid to length of stay and COPD Assessment Test

Meng-Yuan Dai et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: To investigate the respiratory infectious phenotypes and their impact on length of stay (LOS) and the COPD Assessment Test (CAT) Scale in acute exacerbation of COPD (AECOPD).

Patients and methods: We categorized 81 eligible patients into bacterial infection, viral infection, coinfection, and non-infectious groups. The respiratory virus examination was determined by a liquid bead array xTAG Respiratory Virus Panel in pharyngeal swabs, while bacterial infection was studied by conventional sputum culture. LOS and CAT as well as demographic information were recorded.

Results: Viruses were detected in 38 subjects, bacteria in 17, and of these, seven had both. Influenza virus was the most frequently isolated virus, followed by enterovirus/rhinovirus, coronavirus, bocavirus, metapneumovirus, parainfluenza virus types 1, 2, 3, and 4, and respiratory syncytial virus. Bacteriologic analyses of sputum showed that Pseudomonas aeruginosa was the most common bacteria, followed by Acinetobacter baumannii, Klebsiella, Escherichia coli, and Streptococcus pneumoniae. The longest LOS and the highest CAT score were detected in coinfection group. CAT score was positively correlated with LOS.

Conclusion: Respiratory infection is a common causative agent of exacerbations in COPD. Respiratory coinfection is likely to be a determinant of more severe acute exacerbations with longer LOS. CAT score may be a predictor of longer LOS in AECOPD.

Keywords: CAT; COPD; LOS; acute exacerbation; phenotypes; respiratory infectious.

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Figures

Figure 1
Figure 1
Strategies for screening patients with AECOPD. Abbreviations: AECOPD, acute exacerbation of COPD; CAT, COPD Assessment Test.
Figure 2
Figure 2
Viruses detected by RVP kit from the nasopharyngeal samples of 81 patients admitted for AECOPD were influenza virus (n=21), enterovirus/rhinovirus (n=11), coronavirus (n=9), bocavirus (n=6), metapneumovirus (n=5), parainfluenza virus types 1, 2, 3, and 4 (n=3), and RSV (n=3). Abbreviations: RVP, respiratory virus panel; AECOPD, acute exacerbation of COPD; RSV, respiratory syncytial virus.
Figure 3
Figure 3
Statistical distribution (box plot) of LOS according to the four respiratory infectious phenotypes: 0 – non-infectious group, 1 – viral infection, 2 – bacterial infection, 3 – coinfection. Notes: The longitudinal axis of the picture above represents the days of stay in hospital. The central box represents the value from the lower to the upper quartile (25%–75%). The middle line inside the box represents the median value. The lines extend from the minimum to the maximum values, excluding outliers that are displayed as separate points. An outlier is defined as a value that is smaller than the lower quartile minus 1.5 times the interquartile range, or larger than the upper quartile plus 1.5 times the interquartile range. These values are plotted with a • marker. Abbreviation: LOS, length of stay.
Figure 4
Figure 4
Statistical distribution (box plot) of CAT scores according to the four respiratory infectious phenotypes: 0 – non-infectious group, 1 – viral infection, 2 – bacterial infection, 3 – coinfection. Abbreviation: CAT, COPD Assessment Test.
Figure 5
Figure 5
Pearson’s correlations between CAT and LOS. Note: Solid line, CAT vs LOS: r=0.372, P<0.05. Abbreviations: LOS, length of stay; CAT, COPD Assessment Test.
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