A prediction model for bacterial etiology in acute exacerbations of COPD
A prediction model for bacterial etiology in acute exacerbations of COPD
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DOI：
10.1007/s15010-007-6078-z
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发表时间：
2007-06-01
期刊：
影响因子：
7.5
通讯作者：
Schmidt-Ioanas, M.
中科院分区：
文献类型：
--
作者：
Lode, H.;Allewelt, M.;Schmidt-Ioanas, M.
目的：细菌在慢性阻塞性肺疾病（COPD）急性加重中起主导作用，但我们缺乏细菌病因的预测因子。我们建立了革兰氏阴性肠道细菌（GNEB）和铜绿假单胞菌感染的预测模型。方法：前瞻性记录中重度COPD加重患者的临床表现、痰液特征、微生物痰型、肺功能、既往及伴随用药情况。计算了特定细菌病因的危险因素，并建立了预测模型。结果：共纳入193例急性加重患者。其中121例（62.6%）可确定微生物病因，最常见的是流感嗜血杆菌（32株）、肺炎链球菌（22株）和铜绿假单胞菌（12株）。多因素分析发现，严重气流阻塞和使用全身类固醇是革兰氏阴性肠杆菌和铜绿假单胞菌引起的病情恶化的预测因素。一个预测模型包括FEV1 <预测值的35%，前3个月内全身性使用类固醇和既往抗生素治疗，其阴性预测率为89%，在所有标准都不存在的情况下，这是排除革兰氏阴性肠杆菌和铜绿假单胞菌引起的恶化风险的有用工具。结论：基于三个因素的简单预测模型可以识别出革兰氏阴性肠杆菌和铜绿假单胞菌急性加重的低风险COPD患者。慢性阻塞性肺病加重的细菌病因学。
Objectives: Bacteria play a leading role in acute exacerbations of chronic obstructive pulmonary disease (COPD), but we lack predictors of bacterial etiology. We developed a prediction model for infection with gram-negative enteric bacteria (GNEB) and Pseudomonas aeruginosa.Methods: Clinical presentation, sputum characteristics, microbial sputum patterns, lung function and previous and concomitant medication were prospectively recorded in patients with moderate to severe exacerbation of COPD. Risk factors for a specific bacterial etiology were c alculated and a prediction model developed.Results: A total of 193 patients with acute exacerbation were included. In 121 (62.6%) of them a microbial etiology could be identified, most frequently Haemophilus influenzae (32 strains), Streptococcus pneumoniae (22 strains) and P. aeruginosa (12 strains). Multivariate analysis identified severe airflow obstruction and use of systemic steroids as predictors for exacerbation due to gram-negative enteric bacilli and P. aeruginosa. A prediction model including FEV1 < 35% of predicted value, systemic steroid use and prior antibiotic therapy within preceeding 3 months had a negative predictive of 89%, being a helpful tool in excluding patients at risk of exacerbation due to gram-negative enteric bacilli and P. aeruginosa when all criteria are absent.Conclusions: A simple prediction model based on three factors may identify COPD patients at low risk for exacerbations with gram-negative enteric bacilli and P. aeruginosa. Bacterial Etiology in COPD Exacerbations.