Clinical features and prognostic risk factors of different gender with acute exacerbations of chronic obstructive pulmonary disease

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Methods: We aim to collect the first hospitalization patients who were diagnosed as AECOPD between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital, Shanghai the Fifith Peoples Hospital, Fudan University. Demographic data, initial clinical symptoms, on admission vital signs, comorbidities, laboratory tests and imaging examination, treatment and the follow-up were compared between the two groups. Results: The patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital, all these difference were not statistically significant in hospital readmissions and mortality(P＞0.05). The multivariate analysis incorporated seven factors according to the results of the univariate regression analysis, The results showed that readmission was independently associated with increased course of disease(P=0.032), combined with chronic pulmonary heart disease(P=0.011) , and combined with peptic ulcer(P=0.044). Conversely, gender were not retained(P=0.304). Conclusion: The short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex. Health sciences/Diseases Health sciences/Risk factors Acute exacerbation Chronic obstuctive pulmonary disease gender Clinical features prognosis. Figures Figure 1 Figure 2 Introduction Chronic obstructive pulmonary disease (COPD) is a common disease that lower the quality of life of sufferers and their families, and impose a heavy economic burden on society. According to data derived from the World Health Organization(WHO) in 2019, COPD is currently the third leading cause of death worldwide 1 . On average, each COPD patients suffers from 0.5 to 3.5 episodes of acute excerbations per year, and AECOPD is a major cause of death and causes huge medical expenditures 2 . An acute pulmonary exacerbation includes flaring up or worsening of the signs and symptoms such as cough, excessive mucus, and dyspnea. However, some studies have suggested that the clinical presentation is manifested differently in woman compared with men. A study has found that young female COPD patients tend to exhibit severe symptoms of breathlessness and airflow blockage, a higher risk of acute exacerbation, and the GOLD group was more divided into group B and group D 3 . Among comorbidities, cardiometabolic diseases such as osteoporosis is more prevalent in women, male patients are subjected to a greater rate of cardiovascular disease, such as hypertension, ischaemic heart disease, chronic heart failure, etc 3 . With respect to the treatment, female gender were associated with the risk of COPD hospitalization, and have higher daily medications 4 . However, the prognosis research of COPD varies widely. A real-world study showed that the mortality of COPD is around 11.2% and 10.8% in men and women over a period of 3 years, the results did not display significant differences 5 .Tamara et al found that COPD-attributed mortality was worse in males (76.3%) than in females (86.9%) over a period of 5 years(P<0.001) 6 . While these statistics provide some evidence of the differently in woman compared with men, these data are incomplete and related research on COPD is relatively scarce in China. Therefore, the study was aimed at describing the clinical characteristics of, and the outcomes of AECOPD patients between different gender, to help provide a better understanding of the population and identify certain features that may drive individualised therapy. Methods Study Population We retrospectively enrolled 352 inpatients with a diagnosis of AECOPD in our hospital between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital. Pulmonary function tests that meet the Global Initiative for Chronic Obstructive Lung Disease(GOLD) 2019 COPD diagnostic criteria 7 , all methods were performed in accordance with the relevant guidelines and regulations; diagnosis of COPD was defined by the presence of a postbronchodilator FEV1/FVC < 0.70 in patients with appropriate symptoms and significant exposure to noxious stimuli, according to the GOLD 2019 report; AECOPD were defined as an acute worsening of respiratory symptoms that results in additional therapy and requires hospitalisation or visiting the emergency department. Criteria for admission were the first hospitalization in this periods. Patients who were less than 18 years old, hospital stay less than 48 hours, pregnant or lactating women, the diagnosis of bronchiectasia, bronchogenic carcinoma and other chronic respiratory disease, and cases with incomplete clinical data (>10%) were excluded from the study. Data Collection Database were build up to collect clinical information: 1) Demographic data, ie, age, sex, body-mass index, smoking status, inpatients stay, hospitalization expenditure. 2)Initial clinical symptoms, ie, comorbidities,on admission vital signs, clinical complications. 3) Laboratory examination and imaging examination, ie, routine analysis of blood, blood biochemistry, inflammatory index, blood coagulation function, examination of sputum etiology, arterial blood gases analysis, lung function, pulmonary CT imaging, B-ultrasound examination. 4) Treatment, ie, antibiotic use, glucocorticoid use, mechanical ventilation condition, treatment outcome. 5) The follow-up, inhaling preparations at a stable stage, readmission at 30 days, 90 days and 180 days after discharge, death at 180 days. Statistical Analysis All statistical analyses were performed using IBM SPSS 25.0 and GraphPad Prism 9.4.1. Patients were divided into two groups (male group and female group) according to sex. Continuous variables conforming to the normal distribution were presented as means ± SD, those that did not conform were expressed as the median (interquartile range), Categorical data are presented as frequencies and percentages.The data that met the assumption of normality and homogeneity of variance were compared using two-tailed Students t -tests ( t ), the welch correction was applied if the data did not conform to the normality assumption by the homogeneity of variance test, while those that did not meet the normality assumption were subjected to Mann-Whitney U test. Categorical variables were analyzed by Pearson chi-square or Fisher exact tests. Study outcomes the composite end point was readmission or death, Kaplan-Meier curves and Cox proportional hazards analyses also were performed to examine the composite endpoint. In addition, to identify which risk factors play a critical role as determinants of readmission to the hospital within 180 days in the study population, we performed a univariate and multivariate stepwise logistic regression analysis. A value of p < 0.05 was considered statistically significant. Results Demographic Characteristics We reviewed medical case records from 1 January 2019 to 31 December 2021. Finally, 352 patients with AECOPD met our inclusion criteria and were included.The patients were divided into a female group (72 cases) and male group (280 cases). The mean age of female group was significantly higher than male group(78.07 ± 8.27 vs 74.13 ± 9.02, P = 0.001), and the same with BMI (24.18 ± 4.74 vs 22.42 ± 4.26, P = 0.01), but few women were current- or ex- smokers(2.78% vs 71.79%, P <0.001)(Table 1 ). Table 1 Demographics and clinical Characteristics of the Overall Population male group(n = 280) female group(n = 72) p value Age(years),mean(SD) 74.13 ± 9.02 78.07 ± 8.27 0.001 Course of disease(years) 10( 5 , 20 ) 10( 3 , 20 ) 0.645 Length of stay(days) 9( 7 , 12 ) 9( 7 , 12 ) 0.735 Smoking history 201(71.79%) 2(2.78%) <0.001 BMI(kg/m 2 ) 22.42 ± 4.26 24.18 ± 4.74 0.010 Place of hospitalization Respiratory ward 230(82.1%) 57(79.2%) 0.562 ICU 42(15%) 10(13.9%) 0.813 Other wards 8(2.9%) 5(6.9%) 0.101 Clinical symptoms Aggravated cough 242(86.4%) 55(76.4%) 0.036 Increased sputum 217(77.5%) 54(75%) 0.653 Dyspnea 237(84.6%) 59(81.9%) 0.577 Paroxysmal nocturnal dyspnea 6(2.1%) 6(8.3%) 0.027 Fever 44(15.7%) 18(25%) 0.065 Clinical complications Asthma 5(1.8%) 2(2.8%) 0.949 Chronic pulmonary heart disease 26(9.3%) 4(5.6%) 0.312 Respiratory failure 55(19.6%) 16(22.2%) 0.627 Pneumoconiosis 4(1.4%) 0(0.0%) 0.586 Pulmonary tuberculosis 11(3.9%) 1(1.4%) 0.484 Bronchiectasia 11(3.9%) 10(13.9%) 0.004 OSA 4(1.4%) 0(0.0%) 0.586 Lung cancer 11(3.9%) 0(0.0%) 0.184 CCI index 1( 1 , 2 ) 1.5(1, 2.75) 0.005 Abbreviations : BMI: body mass index;ICU:intensive care unit; OSA:obstructive sleep apnea; CCI: Charlson Comorbidity Index. Clinical Characteristics Some clinical symptoms varied significantly among members of the two groups, such as increased coughing(76.4% vs 86.4%, P = 0.036) and paroxysmal nocturnal dyspnea(8.3% vs 2.1%, P = 0.027), there were no difference in sputum, dyspnea and pyrexia. In clinical complications, the female group significantly higher proportion of bronchiectasis(13.9% vs 13.9%, P = 0.004) and higher CCI [1.5(1,2.75) vs 1( 1 , 2 ), P = 0.005], but differences in other complications between the two groups were not significant(Table 1 ). Laboratory Examinations Compared to the male group, the female group had lower eosinophils(0.05 ± 0.08 vs 0.09 ± 0.21, P = 0.02), monocytes(0.45 ± 0.29 vs 0.54 ± 0.31, P = 0.033), hemoglobin (121.10 ± 17.29 vs 131.90 ± 22.17, P <0.001), total bilirubin[7.65(5.45,10.9) vs 8.9(6.2,12.38), P = 0.046], serum creatinine[72(57.25,96) vs 77(68,96), P = 0.029] and IgE[44.1(18.9,128.5) vs 75.4(28.1,210), P = 0.012]. The female group had significantly higher HbA1c%>6%(58.33% vs 36.43%, P = 0.001), low density lipoprotein [2.69(2.13,3.39) vs 2.69(2.13,3.39), P = 0.034], BNP[454(199.25,1742.5) vs 244.5(116.25,822.25), P = 0.001], D-dimer[0.78(0.47,1.83) vs 0.54(0.29,1.01), P = 0.001]. Differences in WBCs, neutrophils, platelets, CRP, PCT, ESR, albumin, pH, PaO 2 and PaCO 2 were not significant(Supplemental Table 1 ). Pulmonary Function Test, B-Ultrasound and Radiographic Imaging The female group had significantly higher FEV 1 /FVC(66.58 ± 11.73 vs 56.26 ± 12.56, P <0.001) over the male group and the GOLD group 4 were markedly lower (7.69% vs 21.68%, P = 0.047).There was no statistically significant difference between the two groups in terms of pulmonary artery systolic pressure and pleural effusion. Emphysema(43.1% vs 82.9%, P <0.001), bullae(1.4% vs 15.0%, P = 0.002) and interstitil chnges (22.2% vs 35.4%, P = 0.034)was significantly less common among the female group, compared to the male group(Supplemental Table 1 ). Treatment and Outcome Intravenous antibiotic and glucocorticoid use, mechanical ventilation and outcome in both groups had no statistical significance(Supplemental Table 2). Follow-up After Hospital Discharge Medications used after discharge were compared. The female group showed significantly lower in use LABA/LAMA/ICS(15.5% vs 34.5%, P = 0.002), but higher use of LABA/ICS(40.8% vs 27.7%, P = 0.035). Differences in use LAMA and LAMA/LABA were not significant(Table 2 ). Table 2 Followed up data after discharge of the two groups male group(n = 280) female group(n = 72) p value Inhalation use 54(19.4%) 18(25.4%) 0.284 Unused 18(6.5%) 7(9.9%) 0.332 LAMA 77(27.7%) 29(40.8%) 0.035 LABA/ICS 33(11.9%) 6(8.5%) 0.405 LAMA/LABA 96(34.5%) 11(15.5%) 0.002 LABA/LAMA/ICS 54(19.4%) 18(25.4%) 0.284 Followed up after discharge 30d readmission rate 22(8.3%) 6(8.96%) 0.863 90d readmission rate 43(16.23%) 14(20.9%) 0.365 180d readmission rate 66(24.91%) 16(23.88%) 0.862 180d death rate 17(6.42%) 2(2.99%) 0.406 Compound results of readmission and mortality 77(29.06%) 15(22.39%) 0.276 Abbreviations : LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; ICS:Inhaled corticosteroids. The patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital. In female group, the rates of time to readmission for 30 days, 90 days, and 180 days from the time of admission were 9.96%, 20.9%, and 23.88%, while the male group were 8.3%, 16.23%, 24.91%, respectively. However, all these difference were not statistically significant in hospital readmissions(Table 2 ). Study outcomes the composite end point was readmission or death, survival analysis using the Kaplan-Meier survival curve did not show any difference between the two groups for the composite endpoint(Fig. 1 ). Cox proportional hazards analyses also did not show any difference between the two groups(HR = 1.325, 95%CI: 0.762ཞ2.303, P >0.05)(Table 3 ). Table 3 COX regression analysis of two groups B SE Wald p value HR 95%CI Male and female group 0.281 0.282 0.992 0.319 1.325 0.762ཞ2.303 Factors associated with readmission to the hospital within 180 days Univariate and multivariate logistic regression analysis were compared in the study population. The multivariate analysis incorporated seven factors according to the results of the univariate regression analysis, The results showed that readmission was independently associated with increased course of disease( P = 0.032), combined with chronic pulmonary heart disease( P = 0.011), and combined with peptic ulcer( P = 0.044). Conversely, gender were not retained( P = 0.304)(Fig. 2 ). Discussion COPD causes death for approximately 3 million people each year and is the third leading cause of death worldwide in 2019 1 . It seriously affects the patients’ physical and mental health, and brings heavy mental and economic burden to the society, patients and families. Our study was aimed at describing the clinical characteristics of, and the outcomes of AECOPD patients between different gender, to help provide a better understanding of the population and identify certain features that may drive individualised therapy. In this study, we found that woman in the first AECOPD hospitalizations tended to be older, less somker, higher mean BMI, more often had bronchiectasis, lower eosinophils and IgE, better FEV 1 /FVC ratios, more emphysema, bullae and interstitil chnges, and less likely to use LABA/LAMA/ICS, but there was no clear difference between the two groups in the short-term prognoses. The multivariate logistic regression analysis showed that readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex. Cigarette smoking is a major cause of COPD. The results of this study show that smoking was performed more commonly on male patients (71.79%) compared to the female patients (2.78%), and similar study findings from abroad also supported this finding 8,9 . This may explain why COPD prevalence was significantly higher among men than women. Besides this, some research show that COPD is characterized by different phenotypes and clinical presentations. Study shows that biomass fuel is highly prevalent in China and women are still the main bearers of housework so that they have relatively more access to biomass fuel 10 . It has been reported that smokers are more likely to develop emphysema than those exposed to biomass fuel. Camp et al found that female COPD patients exposed to biomass smoke had less emphysema but more air retention than those exposed to e-tobacco smoke, suggesting that biofuels-induced COPD may be a respiratory tract dominated phenotype 11 . In this study, we found that men had more emphysema, bullae and interstitil chnges, but lower FEV 1 /FVC ratios than women, demonstrated these same findings in our study. Therefore, this study shows that different approaches to preventive measures should be taken according to gender. A crucial pathologic feature of COPD is airway inflammation and remodeling. Eosinophils are pro-inflammatory effector cells which release pleiotropic chemokines, cytokines and cytotoxic granules such as eosinophil peroxidase and eosinophil-derived neurotoxin, play a role in the immune response to inflammation and infection. Couillard et al found the eosinophil count elevated were associated with increased risk of readmission 12 . The main finding of this study was that the eosinophil count and EOS%≥2% increased in the male patients compared with the female patients, which is consistent with the relevant results from both domestic and foreign studies 13,14 . This may explain why male patients had a higher hospitalization rate than females. It has been suggested that airway eosinophilia facilitated responsiveness to bronchodilator and steroidal therapies 15 . In the course of clinical diagnosis and treatment, our study discovered that male patients were more likely to use LABA/LAMA/ICS, it also proves the rationality of clinical treatment. IgE is the major mediator in allergic responses, plays a pivotal role in airway inflammation and remodeling 16 . Many study suggest that patients with COPD also have higher total IgE levels, and there are gender differences. Study found that elevated serum IgE is associated with the occurrence of exacerbations in men with COPD and with the risk of lung function decline, and they speculate that IgE-mediated pathways might be involved in the pathogenesis of exacerbations in men with COPD and in the pathogenesis of progressive airfow limitation in patients with elevated IgE levels 17 . This was also found in the studies of Marek et al 18 , and they also found that there were higher total IgE levels in currently smoking than in not currently smoking men. In this study, the IgE levels of males were significantly higher than in females. Therefore, using antibodies targeting the IgE pathway for COPD may help in the prevention and control of disease, especially among men. But mechanism of gender-related and smoke-related differences in IgE level, further research is still needed. Complications will also have an impact on the quality of life of COPD patients. Juan et al found that cardiovascular comorbidities such as hypertension and ischemic heart disease, are the most common comorbid combinations in the male patients, and the female patients were the most likely to have metabolic diseases such as osteoporosis 19 . Maeva et al found that the proportion of subjects with ischemic heart disease and OSA was higher in males, but women tend to experience a greater prevalence of rhinitis and anxiety disorders 20 . In this study, the prevalence of bronchiectasis in female patients with COPD is higher compared to male patients, were inconsistent with the findings of other study, but we found some abnormalities in metabolism-related indicators between different genders, such as glycosylated hemoglobin and low density lipoprotein, which can also serve as fields for continued in-depth research in the future. On average, each COPD patients suffers from 0.5 to 3.5 episodes of acute excerbations per year, and AECOPD is a major cause of death and causes huge medical expenditures 2 . Marshall et al followed up for 3 years, the mortality was 10.8% in females and 11.2% in males, but the difference was not statistically significant 5 . In a 5-year follow-up study, Tamara et al found women have higher 5-year survival rates than men ( 86.9% vs 76.3%, P<0.001) 6 . However, we found that the mortality rate was lower but had a higer rate of readmission within 180 days, although the difference in our study did not reach statistical significance. In female group, the rates of time to readmission for 30 days, 90 days, and 180 days from the time of admission were 9.96%, 20.9%, and 23.88%, while the male group were 8.3%, 16.23%, 24.91%, respectively. Therefore, we further investigated the risk factors associated with short-term readmission. Our study found that readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex. As a result, it is necessary to take the necessary measures to reduce readmissions. Despite these strengths, our study has some limitations. First, as a retrospective study, some information, such as risk factor exposure and objective questionnaires, was incomplete during clinical data collection. Second, the number of cases in this study was relatively small, and the number of patients in the 2 groups was not balanced. This might have influenced the results. Conclusion Woman in the first AECOPD hospitalizations tended to be older and less likely to use LABA/LAMA/ICS, possibly related to less smoker, better nutrition status, low-level of eosinophils and IgE level, and better lung function. The short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex. Declarations Author Contributions Yun-Xia Yuwrote the study protocol and analysis plan, oversaw the data analysis and drafted the manuscript. Jing-Jing Feng, Tian-yun Shi and Yong Du contributed to the analysis and the interpretation of the data. Jin-dong Shi and Jun-qing Li contributed to the data collection. Zhi-Jun Jie contributed to the conception and design of the study and the interpretation of the data. Funding This study is funded by the Cooperation Programme of Fudan University-Minghang District Joint Health Center(NO.2021FM23) and Key discipline construction plan of public health in Minhang district: improvement program for surveillance capacity of respiratory infectious diseases(NO.MGWXK2023-01). Competing interests The authors declare no competing interests. Data availability The data supporting the results of this study are available from the corresponding author on reasonable request (secondary analysis data). Consultation of the raw source data is subject to the agreement of the Shanghai the Fifith Peoples Hospital. Ethics declarations Due to the retrospective nature of the study, the Ethics Committee of Shanghai the Fifith Peoples Hospital waived the need of obtaining informed consent. References World Health Organization. The top 10 causes of death..https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.htm.(2020). Expert group on Acute Exacerbation of Chronic obstructive pulmonary Disease (AECOPD).[ Expert Consensus on the Diagnosis and Treatment of Acute Exacerbation of Chronic obstructive Pulmonary Disease (AECOPD) in China (2017 Update)].Int J Respir.37(14):1041-1057.(2017). DeMeo D. L. et al. [COPDGene Investigators. Women manifest more severe COPD symptoms across the life course]. Int J Chron Obstruct Pulmon Dis. 13:3021-3029. (2018). Lisspers, K. et al. [Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study]. NPJ Prim Care Respir Med. 29(1):45. (2019). Zysman, M. et al. [Initiatives BPCO scientific committee and investigators. Relationship between gender and survival in a real-life cohort of patients with COPD]. Respir Res. 20(1):191.(2019) . Perez, T.A. et al. [Sex differences between women and men with COPD: A new analysis of the 3CIA study]. Respir Med. 171:106105. (2020). López-Campos JL, Soler-Cataluña JJ, Miravitlles M. [Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2019 Report: Future Challenges]. Arch Bronconeumol (Engl Ed). 56(2):65-67. (2020). JIA, G.et al. [Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China]. International journal of chronic obstructive pulmonary disease. 13:3269-3280.(2018). BAJPAI, J. et al. [Clinical, demographic and radiological profile of smoker COPD versus nonsmoker COPD patients at a tertiary care center in North India]. Journal of family medicine and primary care. 8(7): 2364-2368.(2019). Feng Y. J. et al. [Analysis on consumption of polluting fuels in households aged 40 and above in China in 2014] . Chinese Journal of Epidemiology.39 (5): 569-573.(2018). Camp P.G. et al. [COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women]. Eur Respir J. 43(3):725-734. (2014). Couillard, S. et al. [Eosinophils in chronic obstructive pulmonary disease exacerbations are associated with increased readmissions]. Chest.151(2):366-373.(2016). Singh, D. et al. [Eosinophilic inflammation in COPD: prevalence and clinical characteristics]. Eur Respir J. 44(6):1697-700.(2014). Zheng D. L. et al. [Distribution and clinical characteristics of eosinophils in patients with chronic obstructive pulmonary disease]. Chinese Journal of Tuberculosis and Respiratory.44(3) : 218-224. (2021). Pascoe, S. et al. [Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials]. Lancet Respir Med. 3(6):435-442. (2015) . Roth, M. et al. [The role of IgE-receptors in IgE-dependent airway smooth muscle cell remodelling]. PLoS One. 8(2):e56015. (2013). Fan Mingxin, Zhang Yongxiang. [Serum IgE levels and their clinical significance in patients with chronic obstructive pulmonary disease]. International Respiratory Journal.39 (20): 1532-1536. (2019). Lommatzsch, M. et al. [IgE is associated with exacerbations and lung function decline in COPD]. Respir Res. 23(1):1. (2022). Trigueros, J.A. et al. [Clinical Features Of Women With COPD: Sex Differences In A Cross-Sectional Study In Spain ("The ESPIRAL-ES Study")]. Int J Chron Obstruct Pulmon Dis. 14:2469-2478.(2019). Zysman, M. et al. [Initiatives BPCO scientific committee and investigators. Relationship between gender and survival in a real-life cohort of patients with COPD]. Respir Res. 20(1):191.(2019). Additional Declarations No competing interests reported. Supplementary Files SupplementalTable.docx Cite Share Download PDF Status: Published Journal Publication published 28 Dec, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Reviews received at journal 05 Sep, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviews received at journal 24 Jul, 2024 Reviewers agreed at journal 09 Jul, 2024 Reviewers invited by journal 02 Jun, 2024 Editor assigned by journal 02 Jun, 2024 Editor invited by journal 11 May, 2024 Submission checks completed at journal 08 May, 2024 First submitted to journal 04 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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ofFudan","correspondingAuthor":true,"prefix":"","firstName":"Zhi-jun","middleName":"","lastName":"Jie","suffix":""}],"badges":[],"createdAt":"2024-05-04 19:54:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4369615/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4369615/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-82275-0","type":"published","date":"2024-12-28T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56809397,"identity":"a5cb8ecc-18f4-45b8-8391-1df08ee48f57","added_by":"auto","created_at":"2024-05-20 18:48:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31186,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve of the two groups\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4369615/v1/a1b16468ff20a2e353c0359c.png"},{"id":56809399,"identity":"fe424eba-ac20-4690-b630-254c7cb98b1d","added_by":"auto","created_at":"2024-05-20 18:48:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":60042,"visible":true,"origin":"","legend":"\u003cp\u003eFactors associated with readmission to the hospital within 180 days\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4369615/v1/f161b33f14d414289c5e3edc.png"},{"id":72640377,"identity":"04545663-065d-4070-9acb-dfe7423c75d1","added_by":"auto","created_at":"2024-12-30 16:05:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":683710,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4369615/v1/28c411ba-65a9-43f7-9fe9-330af1f2fd80.pdf"},{"id":56810368,"identity":"e611fc3e-11c3-4f2c-b98f-67b719a002a5","added_by":"auto","created_at":"2024-05-20 18:56:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18947,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-4369615/v1/45839e859d7857386668e654.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical features and prognostic risk factors of different gender with acute exacerbations of chronic obstructive pulmonary disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic obstructive pulmonary disease (COPD) is a common disease that lower the quality of life of sufferers and their families, and impose a heavy economic burden on society. According to data derived from the World Health Organization(WHO) in 2019, COPD is currently the third leading cause of death worldwide\u003csup\u003e1\u003c/sup\u003e. On average, each COPD patients suffers from 0.5 to 3.5 episodes of acute excerbations per year, and AECOPD is a major cause of death and causes huge medical expenditures\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAn acute pulmonary exacerbation includes flaring up or worsening of the signs and symptoms such as cough, excessive mucus, and dyspnea. However, some studies have suggested that the clinical presentation is manifested differently in woman compared with men. A study has found that young female COPD patients tend to exhibit severe symptoms of breathlessness and airflow blockage, a higher risk of acute exacerbation, and the GOLD group was more divided into group B and group D\u003csup\u003e3\u003c/sup\u003e. Among comorbidities, cardiometabolic diseases such as osteoporosis is more prevalent in women, male patients are subjected to a greater rate of cardiovascular disease, such as hypertension, ischaemic heart disease, chronic heart failure, etc\u003csup\u003e3\u003c/sup\u003e. With respect to the treatment, female gender were associated with the risk of COPD hospitalization, and have higher daily medications\u003csup\u003e4\u003c/sup\u003e. However, the prognosis research of COPD varies widely. A real-world study showed that the mortality of COPD is around 11.2% and 10.8% in men and women over a period of 3 years, the results did not display significant differences\u003csup\u003e5\u003c/sup\u003e.Tamara et al found that COPD-attributed mortality was worse in males (76.3%) than in females (86.9%) over a period of 5 years(P\u0026lt;0.001)\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhile these statistics provide some evidence of the differently in woman compared with men, these data are incomplete and related research on COPD is relatively scarce in China. Therefore, the study was aimed at describing the clinical characteristics of, and the outcomes of AECOPD patients between different gender, to help provide a better understanding of the population and identify certain features that may drive individualised therapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eWe retrospectively enrolled 352 inpatients with a diagnosis of AECOPD in our hospital between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital. Pulmonary function tests that meet the Global Initiative for Chronic Obstructive Lung Disease(GOLD) 2019 COPD diagnostic criteria\u003csup\u003e7\u003c/sup\u003e, all methods were performed in accordance with the relevant guidelines and regulations; diagnosis of COPD was defined by the presence of a postbronchodilator FEV1/FVC\u0026thinsp;\u0026lt;\u0026thinsp;0.70 in patients with appropriate symptoms and significant exposure to noxious stimuli, according to the GOLD 2019 report; AECOPD were defined as an acute worsening of respiratory symptoms that results in additional therapy and requires hospitalisation or visiting the emergency department. Criteria for admission were the first hospitalization in this periods. Patients who were less than 18 years old, hospital stay less than 48 hours, pregnant or lactating women, the diagnosis of bronchiectasia, bronchogenic carcinoma and other chronic respiratory disease, and cases with incomplete clinical data (\u0026gt;10%) were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eDatabase were build up to collect clinical information: 1) Demographic data, ie, age, sex, body-mass index, smoking status, inpatients stay, hospitalization expenditure. 2)Initial clinical symptoms, ie, comorbidities,on admission vital signs, clinical complications. 3) Laboratory examination and imaging examination, ie, routine analysis of blood, blood biochemistry, inflammatory index, blood coagulation function, examination of sputum etiology, arterial blood gases analysis, lung function, pulmonary CT imaging, B-ultrasound examination. 4) Treatment, ie, antibiotic use, glucocorticoid use, mechanical ventilation condition, treatment outcome. 5) The follow-up, inhaling preparations at a stable stage, readmission at 30 days, 90 days and 180 days after discharge, death at 180 days.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS 25.0 and GraphPad Prism 9.4.1. Patients were divided into two groups (male group and female group) according to sex. Continuous variables conforming to the normal distribution were presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, those that did not conform were expressed as the median (interquartile range), Categorical data are presented as frequencies and percentages.The data that met the assumption of normality and homogeneity of variance were compared using two-tailed Students t -tests ( t ), the welch correction was applied if the data did not conform to the normality assumption by the homogeneity of variance test, while those that did not meet the normality assumption were subjected to Mann-Whitney U test. Categorical variables were analyzed by Pearson chi-square or Fisher exact tests. Study outcomes the composite end point was readmission or death, Kaplan-Meier curves and Cox proportional hazards analyses also were performed to examine the composite endpoint. In addition, to identify which risk factors play a critical role as determinants of readmission to the hospital within 180 days in the study population, we performed a univariate and multivariate stepwise logistic regression analysis. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics\u003c/h2\u003e \u003cp\u003eWe reviewed medical case records from 1 January 2019 to 31 December 2021. Finally, 352 patients with AECOPD met our inclusion criteria and were included.The patients were divided into a female group (72 cases) and male group (280 cases). The mean age of female group was significantly higher than male group(78.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27 vs 74.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and the same with BMI (24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74 vs 22.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), but few women were current- or ex- smokers(2.78% vs 71.79%, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and clinical Characteristics of the Overall Population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale group(n\u0026thinsp;=\u0026thinsp;280)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale group(n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years),mean(SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of disease(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201(71.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of hospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230(82.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(79.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther wards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggravated cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242(86.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(76.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased sputum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e217(77.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e237(84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(81.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParoxysmal nocturnal dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic pulmonary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumoconiosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchiectasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5(1, 2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: BMI: body mass index;ICU:intensive care unit; OSA:obstructive sleep apnea; CCI: Charlson Comorbidity Index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristics\u003c/h2\u003e \u003cp\u003eSome clinical symptoms varied significantly among members of the two groups, such as increased coughing(76.4% vs 86.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036) and paroxysmal nocturnal dyspnea(8.3% vs 2.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027), there were no difference in sputum, dyspnea and pyrexia. In clinical complications, the female group significantly higher proportion of bronchiectasis(13.9% vs 13.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and higher CCI [1.5(1,2.75) vs 1(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005], but differences in other complications between the two groups were not significant(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e ).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory Examinations\u003c/h2\u003e \u003cp\u003eCompared to the male group, the female group had lower eosinophils(0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08 vs 0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), monocytes(0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 vs 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033), hemoglobin (121.10\u0026thinsp;\u0026plusmn;\u0026thinsp;17.29 vs 131.90\u0026thinsp;\u0026plusmn;\u0026thinsp;22.17, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), total bilirubin[7.65(5.45,10.9) vs 8.9(6.2,12.38), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046], serum creatinine[72(57.25,96) vs 77(68,96), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029] and IgE[44.1(18.9,128.5) vs 75.4(28.1,210), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012]. The female group had significantly higher HbA1c%\u0026gt;6%(58.33% vs 36.43%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), low density lipoprotein [2.69(2.13,3.39) vs 2.69(2.13,3.39), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034], BNP[454(199.25,1742.5) vs 244.5(116.25,822.25), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001], D-dimer[0.78(0.47,1.83) vs 0.54(0.29,1.01), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001]. Differences in WBCs, neutrophils, platelets, CRP, PCT, ESR, albumin, pH, PaO\u003csub\u003e2\u003c/sub\u003e and PaCO\u003csub\u003e2\u003c/sub\u003e were not significant(Supplemental Table\u0026nbsp;1 ).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePulmonary Function Test, B-Ultrasound and Radiographic Imaging\u003c/h2\u003e \u003cp\u003eThe female group had significantly higher FEV\u003csub\u003e1\u003c/sub\u003e/FVC(66.58\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73 vs 56.26\u0026thinsp;\u0026plusmn;\u0026thinsp;12.56, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) over the male group and the GOLD group 4 were markedly lower (7.69% vs 21.68%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047).There was no statistically significant difference between the two groups in terms of pulmonary artery systolic pressure and pleural effusion. Emphysema(43.1% vs 82.9%, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), bullae(1.4% vs 15.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) and interstitil chnges (22.2% vs 35.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034)was significantly less common among the female group, compared to the male group(Supplemental Table\u0026nbsp;1 ).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTreatment and Outcome\u003c/h2\u003e \u003cp\u003eIntravenous antibiotic and glucocorticoid use, mechanical ventilation and outcome in both groups had no statistical significance(Supplemental Table\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up After Hospital Discharge\u003c/h2\u003e \u003cp\u003eMedications used after discharge were compared. The female group showed significantly lower in use LABA/LAMA/ICS(15.5% vs 34.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), but higher use of LABA/ICS(40.8% vs 27.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035). Differences in use LAMA and LAMA/LABA were not significant(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFollowed up data after discharge of the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale group(n\u0026thinsp;=\u0026thinsp;280)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale group(n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInhalation use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54(19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(25.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAMA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLABA/ICS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33(11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAMA/LABA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96(34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLABA/LAMA/ICS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54(19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(25.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollowed up after discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30d readmission rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(8.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90d readmission rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43(16.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e180d readmission rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66(24.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(23.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e180d death rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(6.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(2.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompound results of readmission and mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77(29.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(22.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; ICS:Inhaled corticosteroids.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital. In female group, the rates of time to readmission for 30 days, 90 days, and 180 days from the time of admission were 9.96%, 20.9%, and 23.88%, while the male group were 8.3%, 16.23%, 24.91%, respectively. However, all these difference were not statistically significant in hospital readmissions(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy outcomes the composite end point was readmission or death, survival analysis using the Kaplan-Meier survival curve did not show any difference between the two groups for the composite endpoint(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Cox proportional hazards analyses also did not show any difference between the two groups(HR\u0026thinsp;=\u0026thinsp;1.325, 95%CI: 0.762ཞ2.303, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCOX regression analysis of two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale and female group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.762ཞ2.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with readmission to the hospital within 180 days\u003c/h2\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis were compared in the study population. The multivariate analysis incorporated seven factors according to the results of the univariate regression analysis, The results showed that readmission was independently associated with increased course of disease(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), combined with chronic pulmonary heart disease(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011), and combined with peptic ulcer(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044). Conversely, gender were not retained(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.304)(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCOPD causes death for approximately 3\u0026nbsp;million people each year and is the third leading cause of death worldwide in 2019\u003csup\u003e1\u003c/sup\u003e. It seriously affects the patients\u0026rsquo; physical and mental health, and brings heavy mental and economic burden to the society, patients and families. Our study was aimed at describing the clinical characteristics of, and the outcomes of AECOPD patients between different gender, to help provide a better understanding of the population and identify certain features that may drive individualised therapy. In this study, we found that woman in the first AECOPD hospitalizations tended to be older, less somker, higher mean BMI, more often had bronchiectasis, lower eosinophils and IgE, better FEV\u003csub\u003e1\u003c/sub\u003e/FVC ratios, more emphysema, bullae and interstitil chnges, and less likely to use LABA/LAMA/ICS, but there was no clear difference between the two groups in the short-term prognoses. The multivariate logistic regression analysis showed that readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex.\u003c/p\u003e \u003cp\u003eCigarette smoking is a major cause of COPD. The results of this study show that smoking was performed more commonly on male patients (71.79%) compared to the female patients (2.78%), and similar study findings from abroad also supported this finding\u003csup\u003e8,9\u003c/sup\u003e. This may explain why COPD prevalence was significantly higher among men than women. Besides this, some research show that COPD is characterized by different phenotypes and clinical presentations. Study shows that biomass fuel is highly prevalent in China and women are still the main bearers of housework so that they have relatively more access to biomass fuel\u003csup\u003e10\u003c/sup\u003e. It has been reported that smokers are more likely to develop emphysema than those exposed to biomass fuel. Camp et al found that female COPD patients exposed to biomass smoke had less emphysema but more air retention than those exposed to e-tobacco smoke, suggesting that biofuels-induced COPD may be a respiratory tract dominated phenotype\u003csup\u003e11\u003c/sup\u003e. In this study, we found that men had more emphysema, bullae and interstitil chnges, but lower FEV\u003csub\u003e1\u003c/sub\u003e/FVC ratios than women, demonstrated these same findings in our study. Therefore, this study shows that different approaches to preventive measures should be taken according to gender.\u003c/p\u003e \u003cp\u003eA crucial pathologic feature of COPD is airway inflammation and remodeling. Eosinophils are pro-inflammatory effector cells which release pleiotropic chemokines, cytokines and cytotoxic granules such as eosinophil peroxidase and eosinophil-derived neurotoxin, play a role in the immune response to inflammation and infection. Couillard et al found the eosinophil count elevated were associated with increased risk of readmission\u003csup\u003e12\u003c/sup\u003e. The main finding of this study was that the eosinophil count and EOS%\u0026ge;2% increased in the male patients compared with the female patients, which is consistent with the relevant results from both domestic and foreign studies\u003csup\u003e13,14\u003c/sup\u003e. This may explain why male patients had a higher hospitalization rate than females. It has been suggested that airway eosinophilia facilitated responsiveness to bronchodilator and steroidal therapies\u003csup\u003e15\u003c/sup\u003e. In the course of clinical diagnosis and treatment, our study discovered that male patients were more likely to use LABA/LAMA/ICS, it also proves the rationality of clinical treatment. IgE is the major mediator in allergic responses, plays a pivotal role in airway inflammation and remodeling\u003csup\u003e16\u003c/sup\u003e. Many study suggest that patients with COPD also have higher total IgE levels, and there are gender differences. Study found that elevated serum IgE is associated with the occurrence of exacerbations in men with COPD and with the risk of lung function decline, and they speculate that IgE-mediated pathways might be involved in the pathogenesis of exacerbations in men with COPD and in the pathogenesis of progressive airfow limitation in patients with elevated IgE levels\u003csup\u003e17\u003c/sup\u003e. This was also found in the studies of Marek et al\u003csup\u003e18\u003c/sup\u003e, and they also found that there were higher total IgE levels in currently smoking than in not currently smoking men. In this study, the IgE levels of males were significantly higher than in females. Therefore, using antibodies targeting the IgE pathway for COPD may help in the prevention and control of disease, especially among men. But mechanism of gender-related and smoke-related differences in IgE level, further research is still needed.\u003c/p\u003e \u003cp\u003eComplications will also have an impact on the quality of life of COPD patients. Juan et al found that cardiovascular comorbidities such as hypertension and ischemic heart disease, are the most common comorbid combinations in the male patients, and the female patients were the most likely to have metabolic diseases such as osteoporosis\u003csup\u003e19\u003c/sup\u003e. Maeva et al found that the proportion of subjects with ischemic heart disease and OSA was higher in males, but women tend to experience a greater prevalence of rhinitis and anxiety disorders\u003csup\u003e20\u003c/sup\u003e. In this study, the prevalence of bronchiectasis in female patients with COPD is higher compared to male patients, were inconsistent with the findings of other study, but we found some abnormalities in metabolism-related indicators between different genders, such as glycosylated hemoglobin and low density lipoprotein, which can also serve as fields for continued in-depth research in the future.\u003c/p\u003e \u003cp\u003eOn average, each COPD patients suffers from 0.5 to 3.5 episodes of acute excerbations per year, and AECOPD is a major cause of death and causes huge medical expenditures\u003csup\u003e2\u003c/sup\u003e. Marshall et al followed up for 3 years, the mortality was 10.8% in females and 11.2% in males, but the difference was not statistically significant\u003csup\u003e5\u003c/sup\u003e. In a 5-year follow-up study, Tamara et al found women have higher 5-year survival rates than men ( 86.9% vs 76.3%, P\u0026lt;0.001)\u003csup\u003e6\u003c/sup\u003e. However, we found that the mortality rate was lower but had a higer rate of readmission within 180 days, although the difference in our study did not reach statistical significance. In female group, the rates of time to readmission for 30 days, 90 days, and 180 days from the time of admission were 9.96%, 20.9%, and 23.88%, while the male group were 8.3%, 16.23%, 24.91%, respectively. Therefore, we further investigated the risk factors associated with short-term readmission. Our study found that readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex. As a result, it is necessary to take the necessary measures to reduce readmissions.\u003c/p\u003e \u003cp\u003eDespite these strengths, our study has some limitations. First, as a retrospective study, some information, such as risk factor exposure and objective questionnaires, was incomplete during clinical data collection. Second, the number of cases in this study was relatively small, and the number of patients in the 2 groups was not balanced. This might have influenced the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWoman in the first AECOPD hospitalizations tended to be older and less likely to use LABA/LAMA/ICS, possibly related to less smoker, better nutrition status, low-level of eosinophils and IgE level, and better lung function. The short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYun-Xia Yuwrote the study protocol and analysis plan, oversaw the data analysis and drafted the manuscript. Jing-Jing Feng, Tian-yun Shi and Yong Du contributed to the analysis and the interpretation of the data. Jin-dong Shi and Jun-qing Li contributed to the data collection. Zhi-Jun Jie contributed to the conception and design of the study and the interpretation of the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is funded by the Cooperation Programme of Fudan University-Minghang District Joint Health Center(NO.2021FM23) and Key discipline construction plan of public health in Minhang district: improvement program for surveillance capacity of respiratory infectious diseases(NO.MGWXK2023-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the results of this study are available from the corresponding\u003c/p\u003e\n\u003cp\u003eauthor on reasonable request (secondary analysis data). Consultation of the raw\u003c/p\u003e\n\u003cp\u003esource data is subject to the agreement of the Shanghai the Fifith Peoples Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the retrospective nature of the study, the Ethics Committee of Shanghai the Fifith Peoples Hospital waived the need of obtaining informed consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. The top 10 causes of death..https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.htm.(2020).\u003c/li\u003e\n \u003cli\u003eExpert group on Acute Exacerbation of Chronic obstructive pulmonary Disease (AECOPD).[ Expert Consensus on the Diagnosis and Treatment of Acute Exacerbation of Chronic obstructive Pulmonary Disease (AECOPD) in China (2017 Update)].Int J Respir.37(14):1041-1057.(2017).\u003c/li\u003e\n \u003cli\u003eDeMeo D. L. et al. [COPDGene Investigators. Women manifest more severe COPD symptoms across the life course]. Int J Chron Obstruct Pulmon Dis. 13:3021-3029. (2018).\u003c/li\u003e\n \u003cli\u003eLisspers, K. et al. [Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study]. NPJ Prim Care Respir Med. 29(1):45. (2019).\u003c/li\u003e\n \u003cli\u003eZysman, M. et al. [Initiatives BPCO scientific committee and investigators. Relationship between gender and survival in a real-life cohort of patients with COPD]. Respir Res. 20(1):191.(2019) .\u003c/li\u003e\n \u003cli\u003ePerez, T.A. et al. [Sex differences between women and men with COPD: A new analysis of the 3CIA study]. Respir Med. 171:106105. (2020).\u003c/li\u003e\n \u003cli\u003eL\u0026oacute;pez-Campos JL, Soler-Catalu\u0026ntilde;a JJ, Miravitlles M. [Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2019 Report: Future Challenges]. Arch Bronconeumol (Engl Ed). 56(2):65-67. (2020).\u003c/li\u003e\n \u003cli\u003eJIA, G.et al. [Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China]. International journal of chronic obstructive pulmonary disease. 13:3269-3280.(2018).\u003c/li\u003e\n \u003cli\u003eBAJPAI, J. et al. [Clinical, demographic and radiological profile of smoker COPD versus nonsmoker COPD patients at a tertiary care center in North India]. Journal of family medicine and primary care. 8(7): 2364-2368.(2019).\u003c/li\u003e\n \u003cli\u003eFeng Y. J. et al. [Analysis on consumption of polluting fuels in households aged 40 and above in China in 2014] . Chinese Journal of Epidemiology.39 (5): 569-573.(2018).\u003c/li\u003e\n \u003cli\u003eCamp P.G. et al. [COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women]. Eur Respir J. 43(3):725-734. (2014).\u003c/li\u003e\n \u003cli\u003eCouillard, S. et al. [Eosinophils in chronic obstructive pulmonary disease exacerbations are associated with increased readmissions]. Chest.151(2):366-373.(2016).\u003c/li\u003e\n \u003cli\u003eSingh, D. et al. [Eosinophilic inflammation in COPD: prevalence and clinical characteristics]. Eur Respir J. 44(6):1697-700.(2014).\u003c/li\u003e\n \u003cli\u003eZheng D. L. et al. [Distribution and clinical characteristics of eosinophils in patients with chronic obstructive pulmonary disease]. Chinese Journal of Tuberculosis and Respiratory.44(3) : 218-224. (2021).\u003c/li\u003e\n \u003cli\u003ePascoe, S. et al. [Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials]. Lancet Respir Med. 3(6):435-442. (2015) .\u003c/li\u003e\n \u003cli\u003eRoth, M. et al. [The role of IgE-receptors in IgE-dependent airway smooth muscle cell remodelling]. PLoS One. 8(2):e56015. (2013).\u003c/li\u003e\n \u003cli\u003eFan Mingxin, Zhang Yongxiang. [Serum IgE levels and their clinical significance in patients with chronic obstructive pulmonary disease]. International Respiratory Journal.39 (20): 1532-1536. (2019).\u003c/li\u003e\n \u003cli\u003eLommatzsch, M. et al. [IgE is associated with exacerbations and lung function decline in COPD]. Respir Res. 23(1):1. (2022).\u003c/li\u003e\n \u003cli\u003eTrigueros, J.A. et al. [Clinical Features Of Women With COPD: Sex Differences In A Cross-Sectional Study In Spain (\u0026quot;The ESPIRAL-ES Study\u0026quot;)]. Int J Chron Obstruct Pulmon Dis. 14:2469-2478.(2019).\u003c/li\u003e\n \u003cli\u003eZysman, M. et al. [Initiatives BPCO scientific committee and investigators. Relationship between gender and survival in a real-life cohort of patients with COPD]. Respir Res. 20(1):191.(2019).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute exacerbation, Chronic obstuctive pulmonary disease, gender, Clinical features, prognosis.","lastPublishedDoi":"10.21203/rs.3.rs-4369615/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4369615/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aim of this retrospective case control study was to investigate the clinical characteristics and the outcomes of acute excerbations of chronic obstuctive pulmonary disease (AECOPD) patients between different gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe aim to collect the first hospitalization patients who were diagnosed as AECOPD between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital, Shanghai the Fifith Peoples Hospital, Fudan University. Demographic data, initial clinical symptoms, on admission vital signs, comorbidities, laboratory tests and imaging examination, treatment and the follow-up were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital, all these difference were not statistically significant in hospital readmissions and mortality(P＞0.05). The multivariate analysis incorporated seven factors according to the results of the univariate \u0026nbsp;regression analysis, The results showed that readmission was independently associated with increased course of disease(P=0.032), combined with chronic pulmonary heart disease(P=0.011) , and combined with peptic ulcer(P=0.044). Conversely, gender were not retained(P=0.304).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer but not with sex.\u003c/p\u003e","manuscriptTitle":"Clinical features and prognostic risk factors of different gender with acute exacerbations of chronic obstructive pulmonary disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-20 18:48:31","doi":"10.21203/rs.3.rs-4369615/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T05:10:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T06:41:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42229307804709683105129190058597401302","date":"2024-08-20T12:39:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-24T06:49:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237025597204945758288606513412391449028","date":"2024-07-09T05:21:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-03T02:43:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-03T02:07:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-11T10:43:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-09T03:51:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-04T19:42:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"986317f9-46ff-403b-b6aa-868307aa1fa7","owner":[],"postedDate":"May 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32110448,"name":"Health sciences/Diseases"},{"id":32110449,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2024-12-30T15:58:44+00:00","versionOfRecord":{"articleIdentity":"rs-4369615","link":"https://doi.org/10.1038/s41598-024-82275-0","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-12-28 15:56:59","publishedOnDateReadable":"December 28th, 2024"},"versionCreatedAt":"2024-05-20 18:48:31","video":"","vorDoi":"10.1038/s41598-024-82275-0","vorDoiUrl":"https://doi.org/10.1038/s41598-024-82275-0","workflowStages":[]},"version":"v1","identity":"rs-4369615","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4369615","identity":"rs-4369615","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}