Objective
To discuss the correlation between immune status and clinical characteristics in pulmonary cryptococcosis.
Methods
The clinical data of 32 non-AIDS patients with pulmonary cryptococcosis, diagnosed from August 2001 to October 2017 in Tianjin Medical University General Hospital, were retrospectively analyzed. The enrolled patients were divided into an immune-competent group with 13 cases and an immune-suppressed group with 19 cases. The clinical characteristics were compared between the two groups with different immune status.
Results
All 32 patients were treated for clinical symptoms. The main symptoms were cough, expectoration, fever, chest tightness, chest pain, and hemoptysis. There were no statistical differences between the two groups. The computed tomography of chest showed that there were 2 patients (6.3%) involving upper lung in the immune-competent group, and 5 patients (15.6%) in the immune-suppressed group. There were 9 patients (28.1%) involving lower lung in the immune-competent group, and 12 patients (37.5%) in the immune-suppressed group. There were 10 patients (31.3%) with nodular masses of lesions in the immune-competent group and none in the immune-suppressed group. There was 1 patient with infiltrating in the immune-competent group and 8 patients in the immune-suppressed group. There were 2 patients with mixed types of lesions in the immune-competent group and 11 patients in the immune-suppressed group. Five patients were complicated with cryptococcal meningitis, and 2 patients with eosinophilia.
Conclusions
The clinical characteristics of the patients with pulmonary cryptococcosis are not specific in difference immune status. The chest CT shows that the lesions of immune-competent patients are mainly nodular masses type, while lesions of immune-suppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.
Objective Exploring the risk factors for sarcopenia in elderly patients with chronic obstructive pulmonary disease (COPD) and constructing a risk prediction nomogram model. Methods A retrospective study was conducted on elderly COPD patients admitted to the General Internal Medicine Department of Tianjin Hospital in Tianjin from January 2024 to December 2024. They were divided into a sarcopenia group and a non-sarcopenia group based on the presence of sarcopenia. General data of the two groups were compared, and logistic regression analysis was used to identify risk factors for sarcopenia in elderly COPD patients. The diagnostic value of blood urea nitrogen/creatinine (BUN/Cr) in predicting COPD with sarcopenia was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a risk prediction nomogram model was constructed and validated. Results The study included a total of 128 patients, with 30 cases in the sarcopenia group and 98 cases in the non-sarcopenia group. The sarcopenia group had higher age, age-adjusted Charlson comorbidity index (ACCI), and BUN/Cr ratio than the non-sarcopenia group (P<0.05); body mass index (BMI), low-density lipoprotein cholesterol, albumin, prealbumin, Cr, 6-minute walk distance and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) were lower in the sarcopenia group than those in the non-sarcopenia group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, albumin, BUN/Cr and theFEV1/FVC were independent risk factors for sarcopenia in elderly COPD patients. ROC curve analysis was used to assess the predictive value of BUN/Cr for sarcopenia in the COPD patients, with an area under the ROC curve (AUC) of 0.725, an optimal cutoff point of 80.45, sensitivity of 60%, and specificity of 82.7%. A prediction model was constructed based on the above risk factors, with an AUC of 0.912 (95%CI 0.853-0.971), sensitivity of 80.0%, and specificity of 89.8%. The calibration curve of the prediction model fitted well. The decision curve analysis indicated that the nomogram had good clinical predictive performance within the threshold range of 0.2-0.8. Conclusion The BUN/Cr is associated with the development of sarcopenia in elderly COPD patients, and the predictive nomogram based on risk factors exhibits good performance for elderly COPD patients with concurrent sarcopenia.
