Objective To analyze the difference of sputum flora between acute exacerbation and stable chronic obstructive pulmonary disease (COPD) patients basing on metagenomic next generation sequencing (mNGS), and its relationship with clinical indicators. The role of sputum flora of COPD patients in unexplained deterioration was explored, so as to find a targeted treatment plan. Methods From December 2021 to June 2022, 54 COPD patients who had a history of smoking were recruited, including 25 patients in stable COPD (SCOPD group) and 29 patients in acute exacerbation (AECOPD group). The sputum was collected and sequenced by mNGS, and the difference of sputum flora between the two groups was compared. Results Compared with SCOPD group, the evenness of sputum flora (Shannon index) in AECOPD group decreased significantly (P=0.019, Mann-Whitney U test). At the phylum level, the relative abundance of Fusobacteria in AECOPD group was significantly lower than that in SCOPD group (Z=–2.669, P=0.008). At genus level, compared with SCOPD group, the relative abundance of Fusobacterium and Haemophilus in AECOPD group decreased significantly (Z=–3.062, P=0.002; Z=–2.143, P=0.032), and the relative abundance of Granulicatella increased significantly (Z=–2.186, P=0.029). At species level, the relative abundance of sputum Haemophilus parainfluenzae, Moraxella catarrhalis and Haemophilus influenzae in AECOPD group was significantly lower than that in SCOPD group (Z=–2.230, P=0.026; Z=–2.125, P=0.034; Z=–2.099, P=0.036). At the time of acute exacerbation of COPD, the relative abundance of Gemella in sputum was positively correlated with forced expiratory volume in first second/forced vital capacity (FEV1/FVC) and body mass index (r=0.476, P=0.009; r=0.427, P=0.021), which was negatively correlated with nutrition risk screening 2002 (r=–0.570, P=0.001). The relative abundance of Neisseria and Neisseria subflava was negatively correlated with GOLD grade (r=–0.428, P=0.020; r=–0.455, P=0.013). The relative abundance of Rothia aeria was posotively correlated with C-reactive peotein (r=0.388, P=0.038). Conclusions There are significant differences of sputum flora in phylum, genus and species level between stable and acute exacerbation COPD patients. The evenness of sputum flora in COPD patients in acute exacerbation is significantly lower than that in patients in stable stage. Fusobacteria, Fusobacterium, Gemella and Nesseria (Neisseria subflava) may play a beneficial role in COPD, while Rothia aeria may be associated with COPD exacerbation.
Objective To explore the correlation between risk factors in respiratory department patients and the occurrence of venous thromboembolism (VTE), and to evaluate the optimization of the Padua score for predicting VTE occurrence in hospitalized respiratory patients based on these correlations. The effectiveness of the modified assessment model for VTE prediction was also validated. Methods A retrospective study was conducted, involving 51 VTE patients who were hospitalized in the Respiratory Department of Huaian First People’s Hospital from March 2019 to July 2023. These patients were compared with 1,600 non-VTE patients who were discharged during the same period. Clinical data, including medical history and laboratory test results, were retrospectively collected from both groups. The correlation between clinical data and VTE occurrence was analyzed, and highly relevant risk factors were incorporated into the Padua score. The modified Padua risk assessment model was applied to all patients and validated in a validation group. The scores from both the original and modified risk assessment models were compared to evaluate the effectiveness of the modified Padua score. Results Rank sum tests showed significant differences in basic information, such as age, BMI, and length of hospital stay, as well as laboratory tests including mean corpuscular volume, procalcitonin, albumin, alanine aminotransferase, aspartate aminotransferase, urea, and D-dimer (P<0.05). Univariate and multivariate logistic regression analyses revealed that newly identified high-risk factors for VTE included hypoalbuminemia (OR=2.972), blood transfusion (OR=47.035), and mechanical ventilation (OR=6.782) (P<0.05). Receiver operating characteristic curve analysis showed that the sensitivity and specificity of the modified Padua score were higher than those of the original version. The area under the curve (AUC) difference was 0.058, with a Z-test value of 2.442, showing statistical significance (P<0.05). Conclusions The modified Padua score demonstrated superior predictive ability for VTE in hospitalized respiratory patients compared to the original Padua score.