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Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples.
Int J Chron Obstruct Pulmon Dis. 2019; 14:311-319.IJ

Abstract

Background

Etiologies of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are heterogeneous. We phenotyped severe AECOPD based on molecular pathogen detection of sputum samples collected at hospitalization of COPD patients and determined their outcomes.

Methods

We phenotyped 72 sputum samples of COPD patients who were hospitalized with a primary diagnosis of AECOPD using a molecular array that detected common bacterial and viral respiratory pathogens. Based on these results, the patients were classified into positive or negative pathogen groups. The pathogen-positive group was further divided into virus or bacteria subgroups. Admission day 1 blood samples were assayed for N-terminal prohormone brain natriuretic peptide, CRP, and complete blood counts.

Results

A total of 52 patients had a positive result on the array, while 20 patients had no pathogens detected. The most common bacterial pathogen detected was Haemophilus influenzae and the most common virus was rhinovirus. The pathogen-negative group had the worse outcomes with longer hospital stays (median 6.5 vs 5 days for bacteria-positive group, P=0.02) and a trend toward increased 1-year mortality (P=0.052). The bacteria-positive group had the best prognosis, whereas the virus-positive group had outcomes somewhere in between the bacteria-positive and pathogen-negative groups.

Conclusion

Molecular diagnostics on sputum can rapidly phenotype serious AECOPD into bacteria-, virus-, or pathogen-negative groups. The bacteria-positive group appears to have the best prognosis, while pathogen-negative group has the worst. These data suggest that AECOPD is a heterogeneous event and that accurate phenotyping of AECOPD may lead to novel management strategies that are personalized and more precise.

Authors+Show Affiliations

Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Department of Medicine, Division of Pulmonary Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Institute for Heart and Lung Health, Vancouver, BC, Canada, don.sin@hli.ubc.ca. PROOF Centre of Excellence, Vancouver, BC, Canada.Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Institute for Heart and Lung Health, Vancouver, BC, Canada, don.sin@hli.ubc.ca. PROOF Centre of Excellence, Vancouver, BC, Canada.Department of Radiology, St Paul's Hospital, Vancouver, BC, Canada.Department of Radiology, St Paul's Hospital, Vancouver, BC, Canada.Department of Radiology, St Paul's Hospital, Vancouver, BC, Canada.Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.Institute for Heart and Lung Health, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada, don.sin@hli.ubc.ca. The Lung Centre, Vancouver General Hospital, Vancouver, BC, Canada.Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Institute for Heart and Lung Health, Vancouver, BC, Canada, don.sin@hli.ubc.ca. PROOF Centre of Excellence, Vancouver, BC, Canada. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.PROOF Centre of Excellence, Vancouver, BC, Canada. Department of Computer Sciences, University of British Columbia, Vancouver, BC, Canada.Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Institute for Heart and Lung Health, Vancouver, BC, Canada, don.sin@hli.ubc.ca. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada, don.sin@hli.ubc.ca.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30774328

Citation

Alotaibi, Nawaf M., et al. "Phenotyping and Outcomes of Hospitalized COPD Patients Using Rapid Molecular Diagnostics On Sputum Samples." International Journal of Chronic Obstructive Pulmonary Disease, vol. 14, 2019, pp. 311-319.
Alotaibi NM, Chen V, Hollander Z, et al. Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples. Int J Chron Obstruct Pulmon Dis. 2019;14:311-319.
Alotaibi, N. M., Chen, V., Hollander, Z., Leipsic, J. A., Hague, C. J., Murphy, D. T., DeMarco, M. L., FitzGerald, J. M., McManus, B. M., Ng, R. T., & Sin, D. D. (2019). Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples. International Journal of Chronic Obstructive Pulmonary Disease, 14, 311-319. https://doi.org/10.2147/COPD.S188186
Alotaibi NM, et al. Phenotyping and Outcomes of Hospitalized COPD Patients Using Rapid Molecular Diagnostics On Sputum Samples. Int J Chron Obstruct Pulmon Dis. 2019;14:311-319. PubMed PMID: 30774328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phenotyping and outcomes of hospitalized COPD patients using rapid molecular diagnostics on sputum samples. AU - Alotaibi,Nawaf M, AU - Chen,Virginia, AU - Hollander,Zsuzsanna, AU - Leipsic,Jonathon A, AU - Hague,Cameron J, AU - Murphy,Darra T, AU - DeMarco,Mari L, AU - FitzGerald,J M, AU - McManus,Bruce M, AU - Ng,Raymond T, AU - Sin,Don D, Y1 - 2019/01/23/ PY - 2019/2/19/entrez PY - 2019/2/19/pubmed PY - 2019/7/30/medline KW - COPD KW - exacerbation phenotypes KW - molecular pathogen detection SP - 311 EP - 319 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 14 N2 - Background: Etiologies of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are heterogeneous. We phenotyped severe AECOPD based on molecular pathogen detection of sputum samples collected at hospitalization of COPD patients and determined their outcomes. Methods: We phenotyped 72 sputum samples of COPD patients who were hospitalized with a primary diagnosis of AECOPD using a molecular array that detected common bacterial and viral respiratory pathogens. Based on these results, the patients were classified into positive or negative pathogen groups. The pathogen-positive group was further divided into virus or bacteria subgroups. Admission day 1 blood samples were assayed for N-terminal prohormone brain natriuretic peptide, CRP, and complete blood counts. Results: A total of 52 patients had a positive result on the array, while 20 patients had no pathogens detected. The most common bacterial pathogen detected was Haemophilus influenzae and the most common virus was rhinovirus. The pathogen-negative group had the worse outcomes with longer hospital stays (median 6.5 vs 5 days for bacteria-positive group, P=0.02) and a trend toward increased 1-year mortality (P=0.052). The bacteria-positive group had the best prognosis, whereas the virus-positive group had outcomes somewhere in between the bacteria-positive and pathogen-negative groups. Conclusion: Molecular diagnostics on sputum can rapidly phenotype serious AECOPD into bacteria-, virus-, or pathogen-negative groups. The bacteria-positive group appears to have the best prognosis, while pathogen-negative group has the worst. These data suggest that AECOPD is a heterogeneous event and that accurate phenotyping of AECOPD may lead to novel management strategies that are personalized and more precise. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/30774328/Phenotyping_and_outcomes_of_hospitalized_COPD_patients_using_rapid_molecular_diagnostics_on_sputum_samples_ L2 - https://dx.doi.org/10.2147/COPD.S188186 DB - PRIME DP - Unbound Medicine ER -