Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease.
Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease.
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DOI：
10.1371/journal.pone.0158727
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
García-Rivero JL
中科院分区：
文献类型：
--
作者：
Santibáñez M;Garrastazu R;Ruiz-Nuñez M;Helguera JM;Arenal S;Bonnardeux C;León C;García-Rivero JL
慢性阻塞性肺疾病（COPD）的加重会给患者带来严重的后果，并造成相当大的医疗费用，特别是如果需要住院治疗。尽管住院急性发作的重要性，相对较少的是知道他们的决定因素。本研究旨在分析COPD患者住院急性加重和死亡率的预测因素。这是一项回顾性人群队列研究。我们于2011年12月31日在坎塔布里亚（西班牙北方）的所有COPD患者中通过简单随机抽样选择了900例年龄≥35岁的确诊COPD患者。我们将中度急性发作定义为导致医护人员开具抗生素或皮质类固醇的事件，将重度急性发作定义为需要住院的急性发作。我们观察了上一年（2011年）和下一年（2012年）的加重频率。我们根据COPD严重程度对患者进行了分类，基于1秒用力呼气量（慢性阻塞性肺疾病全球倡议[GOLD] 1-4级）。我们通过logistic回归，校正年龄、性别、吸烟状况、COPD严重程度和前一年频繁加重表型，估计比值比（OR）。在这些患者中，16.4%发生了≥1次重度急性加重，从轻度GOLD 1级的9.3%到极重度COPD患者的44%不等。既往至少有两次重度急性加重病史与新发重度急性加重（校正OR，6.73; 95%置信区间[CI]，3.53-12.83）和死亡率（校正OR，7.63; 95%CI，3.41-17.05）呈正相关。老年和几种合并症，如心力衰竭和糖尿病，也同样相关。所有级别的气流受限均发生住院加重。重度急性发作史与新发住院急性发作和死亡率相关。
Exacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs—particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients. This was a retrospective population-based cohort study. We selected 900 patients with confirmed COPD aged ≥35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission. We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1–4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year. Of the patients, 16.4% had ≥1 severe exacerbations, varying from 9.3% in mild GOLD grade 1 to 44% in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95% confidence interval [CI], 3.53–12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41–17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated. Hospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality.