Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients:: A multiple logistic regression analysis
Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients:: A multiple logistic regression analysis
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DOI：
10.1159/000067462
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发表时间：
2000-09-01
期刊：
影响因子：
3.7
通讯作者：
Segú, JL
中科院分区：
文献类型：
--
作者：
Miravitlles, M;Guerrero, T;Segú, JL
背景和目的：本研究的目的是开发和验证两个模型，以估计慢性阻塞性肺病（COPD）频繁加重（每年超过1次）和入院的概率，可用于初级保健环境。研究方法：信息是在一项对西班牙201家全科诊所的非卧床COPD患者进行的横断面观察性研究中获得的。入院模型包括713例病例，499例为发育样本，214例为验证样本;频繁急性发作模型包括896例患者，627例为发育样本，269例为验证模型。两个模型中包含的候选变量为：年龄、性别、体重指数（BMI）、FEV1预测值百分比[FEV1（% pred.）]，主动吸烟、慢性粘液高分泌（CMH）和显著的合并症。结果：入院模型包含2个容易获得的变量：合并症（OR = 1.97，CI 95%= 1.24-3.14）和FEV1（% pred.）。(OR= 0.72; 0.58 - 0.88，每10个单位），并在开发和确认样品中进行了良好校准（拟合优度检验：分别为p = 0.989和p = 0.720）。频繁急性加重模型包括3个变量：年龄（OR = 1.21; 1.01 - 1.44;年龄每增加10岁）、FEV1（% pred.）(OR= 0.82; 0.70 - 0.96，每10个单位）和CMH（OR = 1.54; 1.11 - 2.14），以及孔校准（开发和验证样品中分别为p = 0.411和p = 0.340）。结论：我们的研究结果表明，FEV1损害解释了频繁加重和住院的部分风险。此外，CMH和年龄增加与频繁加重的风险显著相关，但加重的严重程度引起住院与显著合并症的存在相关。这些重要且易于测量的变量包含了对COPD非卧床患者进行最佳管理的有价值信息。版权所有（C）2000 S. Karger AG，巴塞尔。
Background and Objective: The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. Methods: Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV1 as percent predicted [FEV1 (% pred.)], active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. Results:The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1.24-3.14) and FEV1(% pred.) (OR = 0.72; 0.58-0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1.21; 1.01-1.44; for every 10 years of increasing age), FEV1 (% pred.) (OR = 0.82; 0.70-0.96, for every 10 units) and CMH (OR = 1.54; 1.11-2.14) and also well call calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). Conclusions: Our results suggest that FEV1 impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD. Copyright (C) 2000 S. Karger AG, Basel.