Risk indexes for exacerbations and hospitalizations due to COPD
Risk indexes for exacerbations and hospitalizations due to COPD
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DOI：
10.1378/chest.06-1316
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发表时间：
2007-01-01
期刊：
影响因子：
9.6
通讯作者：
Kesten, Steven
中科院分区：
文献类型：
--
作者：
Niewoehner, Dennis E.;Lokhnygina, Yuliya;Kesten, Steven
目的：预测COPI患者急性加重的能力可能允许更合理地使用预防性干预措施。我们的目的是建立急性加重和因急性加重而住院的风险指数，这些风险指数可能适用于个体patient.Methods：在基线时获得了1，829例中度至极重度COPI患者的肺功能测定、人口统计学和病史，这些患者进入了吸入噻托溴铵试验。在6个月随访期间收集了关于急性加重和因急性加重而住院的信息。采用单变量和多变量考克斯比例风险regressions.Results：在随访期间，551例患者至少有一个恶化和151例患者至少有一个住院治疗，由于恶化的第一个结果进行建模分析。在急性加重的多变量模型中，年龄较大、预计FEV 1百分比、COPI持续时间、排痰性咳嗽、前一年因COPI使用抗生素或全身性皮质类固醇、前一年因COPI住院以及基线时使用茶碱预测风险较高。在住院多变量模型中，年龄较大、预计FEV 1百分比、前一年因COPD而计划外就诊/急诊、任何心血管合并症和基线时使用泼尼松与更大的风险相关。急性发作和住院模型均提供了中等程度的区分，验证的一致性指数分别为0.66和0.73。计算风险的方法在个别patients.Conclusions：肺功能测定沿着几个问题，直接向病人是强烈的预测急性加重和相关的住院治疗，在随后的6个月。
Objective: The ability to predict exacerbations in patients with COPI) might permit more rational use of preventive interventions. Our objective was to develop risk indexes for exacerbations and hospitalizations due to exacerbations that might be applied to the individual patient.Methods: Spirometry, demographics, and medical history were obtained at baseline in 1,829 patients with moderate-to-very severe COPI) who entered a trial of inhaled tiotropium. Information about exacerbations and hospitalizations due to exacerbation was collected during the 6-month follow-up period. Analyses of first outcomes were modeled using univariable and multivariable Cox proportional hazards regressions.Results: During follow-up, 551 patients had at least one exacerbation and 151 patients had at least one hospitalization due to exacerbation. In the multivariable model for exacerbation, older age, percentage of predicted FEV1, duration of COPI), a productive cough, antibiotic or systemic corticosteroid use for COPI) in the prior year, hospitalization for COPI) in the prior year, and theophylline use at baseline predicted a higher risk. In the multivariable model for hospitalization, older age, percentage of predicted FEV1, unscheduled clinic/emergency department visits for COPD in the prior year, any cardiovascular comorbidity, and prednisone use at baseline were associated with greater risk. Both the exacerbation and the hospitalization models provided moderately good discrimination, the validated concordance indexes being 0.66 and 0.73, respectively. Methods for calculating risk in individual patients are provided.Conclusions: Spirometry along with a few questions directed to the patient are strongly predictive of exacerbations and related hospitalizations over the ensuing 6 months.