Pulmonary Medicine

Souza, R.F. and Spechler, S.J. (2021). “Advances in Biomarkers for Risk Stratification in Barrett’s Esophagus.” Gastrointest Endosc Clin N Am 31(1): 105-115.

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Dysplasia currently is the primary biomarker used to risk stratify patients with Barrett’s esophagus, but dysplasia has a number of considerable limitations in this regard. Thus, investigators over the years have explored innumerable alternative molecular biomarkers for risk stratification in Barrett’s esophagus. This report focuses only on those biomarkers that appear most promising based on the availability of multiple published studies corroborating good results, and on the commercial availability of the test. These promising biomarkers include p53 immunostaining, TissueCypher, BarreGEN, and wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS(3D)).

Naik, C.A., Mathai, S.K., Sandkovsky, U.S., Ausloos, K.A., Guileyardo, J.M., Schwartz, G., Mason, D.P., Gottlieb, R. and Grazia, T.J. (2021). “Acute myocardial infarction secondary to mucormycosis after lung transplantation.” IDCases 23: e01019.

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We present a case of a 57-year-old man who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. His immediately post-operative course was complicated by fever and cardiac arrest. Despite supportive care and broad-spectrum antibiotics, he experienced continued clinical decline. Autopsy results indicated angioinvasive mucormycosis and coronary arteritis resulting in acute myocardial infarction as the cause of death.

Mathai, S.K., Cardwell, J., Metzger, F., Powers, J., Walts, A.D., Kropski, J.A., Eickelberg, O., Hauck, S.M., Yang, I.V. and Schwartz, D.A. (2020). “Preclinical Pulmonary Fibrosis Circulating Protein Biomarkers.” Am J Respir Crit Care Med 202(12): 1720-1724.

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Idiopathic pulmonary fibrosis (IPF) is characterized by progressive, irreversible scarring of the lung parenchyma that can require invasive diagnostic testing (1). Interstitial lung abnormalities (ILAs) have been described in the general population (2). Among asymptomatic first-degree relatives of patients with familial interstitial pneumonia (FIP), 14% have radiologic ILAs and 35% have interstitial abnormalities on biopsy (3). In the Framingham population, fibrotic ILAs were present in 1.8% of subjects ≥50 years of age (4) and associated with increased risk of death (5, 6), suggesting ILAs may be a harbinger of IPF. [No abstract; excerpt from article].

McGraw, M., White, H.D., Boethel, C., Zolfaghari, K., Hochhalter, A. and Arroliga, A. (2020). “Corticosteroid Dosing and Glucose Levels in COPD Patients Are Not Associated with Increased Readmissions.” Chronic Obstr Pulm Dis Nov 25. [Epub ahead of print.].

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INTRODUCTION: Hospital admissions and readmissions for chronic obstructive pulmonary disease (COPD) exacerbations are associated with increased mortality and higher cost. The management of exacerbations with a shortened course of systemic corticosteroids has similar efficacy as compared to longer steroid courses, but actual overall steroid dose given is still variable. The outcomes associated with steroid side effects, such as hyperglycemia, need further evaluation. We hypothesize that the use of higher doses of corticosteroids, and the subsequent hyperglycemia, contributes to readmission. METHODS: This is an retrospective study at a tertiary care referral center in Central Texas between February 2014 and July 2016. Daily corticosteroid dose, blood glucose levels, and readmission rates at 30 and 31-90 days were recorded. Sample characteristics are described using descriptive statistics. A chi-square test or student’s t-test were used to test for associations in bivariate comparisons. Multivariable logistic regression assessed the association between readmission rate and demographic and clinical characteristics. RESULTS: There were 1,120 patients admitted for COPD exacerbation between February 2014 and July 2016. Fifty seven percent were female, mean age was 69 (SD 12), and average BMI was 29.4 (SD 9.8). Of the total, 349 (31%) had diabetes prior to admission. The 30 days readmission rate was 16%, and the readmission rate from 31-90 days was 14%. The average prednisone equivalent dose per day during hospitalization was 86 mg (SD 52). A multivariable logistic regression model did not show any significant association between readmission and average daily glucose, high maximum glucose (>180 mg/dL on any reading), or prednisone equivalent administered per day. CONCLUSION: Corticosteroid dose and hyperglycemia were not associated with an increased 30 or 31-90 days readmission rate after COPD exacerbation discharge. In addition, using higher doses of corticosteroids instead of standard-of-care (Prednisone 40 mg per day for a 5-day period) did not appear to affect the readmission rate in this cohort.

Palazzuoli, A., Ruberto, F., De Ferrari, G.M., Forleo, G., Secco, G.G., Ruocco, G.M., D’Ascenzo, F., Mojoli, F., Monticone, S., Paggi, A., Vicenzi, M., Corcione, S., Palazzo, A.G., Landolina, M., Taravelli, E., Tavazzi, G., Blasi, F., Mancone, M., Birtolo, L.I., Alessandri, F., Infusino, F., Pugliese, F., Fedele, F., De Rosa, F.G., Emmett, M., Schussler, J.M., McCullough, P.A. and Tecson, K.M. (2020). “Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study.” Crit Care Explor 2(9): e0220.

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OBJECTIVES: To describe patients according to the maximum degree of respiratory support received and report their inpatient mortality due to coronavirus disease 2019. DESIGN: Analysis of patients in the Coracle registry from February 22, 2020, to April 1, 2020. SETTING: Hospitals in the Piedmont, Lombardy, Tuscany, and Lazio regions of Italy. PATIENTS: Nine-hundred forty-eight patients hospitalized for coronavirus disease 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 948 patients, 122 (12.87%) received invasive ventilation, 637 (67.19%) received supplemental oxygen only, and 189 (19.94%) received no respiratory support. The median (quartile 1-quartile 3) age was 65 years (54-76.59 yr), and there was evidence of differential respiratory treatment by decade of life (p = 0.0046); patients greater than 80 years old were generally not intubated. There were 606 men (63.9%) in this study, and they were more likely to receive respiratory support than women (p < 0.0001). The rate of in-hospital death for invasive ventilation recipients was 22.95%, 12.87% for supplemental oxygen recipients, and 7.41% for those who received neither (p = 0.0004). A sensitivity analysis of the 770 patients less than 80 years old revealed a lower, but similar mortality trend (18.02%, 8.10%, 5.23%; p = 0.0008) among the 14.42%, 65.71%, and 19.87% of patients treated with mechanical ventilation, supplemental oxygen only, or neither. Overall, invasive ventilation recipients who died were significantly older than those who survived (median age: 68.5 yr [60-81.36 yr] vs 62.5 yr [55.52-71 yr]; p = 0.0145). CONCLUSIONS: Among patients hospitalized for coronavirus disease 2019, 13% received mechanical ventilation, which was associated with a mortality rate of 23%.