Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire
Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire
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DOI：
10.2147/copd.s87469
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发表时间：
2015-01-01
影响因子：
2.8
通讯作者：
Benzo, Roberto P.
中科院分区：
文献类型：
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作者：
Abascal-Bolado, Beatriz;Novotny, Paul J.;Benzo, Roberto P.
目的：预测COPD患者的住院率在COPD护理领域引起了极大的兴趣。有必要找到简单的工具，可以帮助临床医生分层的风险，这些患者在住院治疗的时间。据报道，生活质量的感知与住院独立相关，但问卷调查对于日常临床使用是不切实际的。有效问卷中的单个问题可能具有强大的预测能力，如之前的报告所建议的，作为使用患者报告的结果来预测COPD住院等重要事件的一种方式。我们的主要目的是评估慢性呼吸问卷自我评估调查（CRQ-SAS）中各个问题对住院风险的预测价值，并开发一种临床相关的简单算法，临床医生可以在常规实践中使用该算法来识别住院风险增加的患者。从门诊肺科诊所前瞻性招募了总计493名COPD患者，完成了CRQ-SAS、人口统计学信息、肺功能测试和临床结局。研究对象平均年龄70岁，男性占54%，第1秒用力呼气容积预测值为42.8 ± 16.7，改良医学研究理事会呼吸困难量表评分为2 ± 1.13。重要的是，递归划分分析确定了三个CRQ-SAS项目，涉及呼吸困难的恐惧或恐慌，日常生活基本活动的呼吸困难和抑郁症状，这些症状高度预测住院。我们提出了一个强大的（曲线下面积=0.70），但用于日常临床护理以预测COPD患者的住院的简单算法。我们确定了三个主题-呼吸困难恐惧，日常生活基本活动的呼吸困难和抑郁症状-作为预测住院的重要患者报告结局，并提出了一个简单的算法来预测COPD患者的住院情况。
Purpose: Forecasting hospitalization in patients with COPD has gained significant interest in the field of COPD care. There is a need to find simple tools that can help clinicians to stratify the risk of hospitalization in these patients at the time of care. The perception of quality of life has been reported to be independently associated with hospitalizations, but questionnaires are impractical for daily clinical use. Individual questions from valid questionnaires can have robust predictive abilities, as has been suggested in previous reports, as a way to use patient-reported outcomes to forecast important events like hospitalizations in COPD. Our primary aim was to assess the predictive value of individual questions from the Chronic Respiratory Questionnaire Self-Assessment Survey (CRQ-SAS) on the risk of hospitalization and to develop a clinically relevant and simple algorithm that clinicians can use in routine practice to identify patients with an increased risk of hospitalization.Patients and methods: A total of 493 patients with COPD prospectively recruited from an outpatient pulmonary clinic completed the CRQ-SAS, demographic information, pulmonary function testing, and clinical outcomes. The cohort had a mean age of 70 years, was 54% male, with forced expiratory volume in 1 second percentage predicted 42.8 +/- 16.7, and modified Medical Research Council dyspnea scale score of 2 +/- 1.13.Results: Our analysis validated the original CRQ-SAS domains. Importantly, recursive partitioning analysis identified three CRQ-SAS items regarding fear or panic of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms that were highly predictive of hospitalization. We propose a robust (area under the curve =0.70) but short and easy algorithm for daily clinical care to forecast hospitalizations in patients with COPD.Conclusion: We identified three themes - fear of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms - as important patient-reported outcomes to predict hospitalizations, and propose a short and easy algorithm to forecast hospitalizations in patients with COPD.