Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease
Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease
复制标题
DOI：
10.1164/ajrccm.159.1.9803117
复制
发表时间：
1999-01-01
影响因子：
24.7
通讯作者：
Weitzenblum, E
中科院分区：
文献类型：
--
作者：
Kessler, R;Faller, M;Weitzenblum, E
慢性阻塞性肺疾病（COPD）患者因急性加重而住院对医疗费用有很大影响。本研究的目的是观察一组中重度COPD患者急性加重住院的预测因素。在1994年，我们纳入了64例COPD患者在这项研究。在入选时，患者处于稳定状态，我们对其临床、肺功能、气量和肺血流动力学特征进行了全面评价。所有患者随访至少2.5年。我们记录了急性加重的无住院时间间隔，并使用Kaplan-Meier方法分析了不住院的比例风险。使用对数秩检验的单变量分析显示，低体重指数（BMI ≤ 20 kg/m2，p = 0.015）和6分钟步行距离有限（≤ 367 m，p = 0.045）的COPD患者住院风险显著增加。但最重要的是，气体交换障碍和肺血流动力学恶化显著增加了急性加重的住院风险：Pa-O2 ≤ 65 mm Hg vs Pa-O2 > 65 mm Hg，p = 0.005; Pa-CO2 > 44 mm Hg vs Pa-CO2 ≤ 44 mm Hg，p = 0.005;静息时平均肺动脉压（Ppa/bar）> 18 mm Hg与Ppa/bar小于或等于18 mm Hg，p = 0.0008。在我们的研究中，年龄、一种或多种合并症与COPD的相关性以及吸烟习惯对住院风险均无显著影响。多因素分析显示，仅Pa-CO2和（Ppa）over bar与COPD急性加重住院风险独立相关。结论：慢性高碳酸血症性呼吸功能不全和肺动脉高压是COPD患者急性加重期住院的预测因素。
Hospitalizations for acute exacerbation in patients with chronic obstructive pulmonary disease (COPD) have a great impact on health care expenditure. The aim of this study was to look at predictive factors of hospitalization for acute exacerbation in a group of patients with moderate to severe COPD. During the year 1994, we included 64 patients with COPD in this study. At inclusion, the patients being in a stable state, we performed a complete evaluation of their clinical, spirometric, gasometric, and pulmonary hemodynamic characteristics. All patients were followed during a period of at least 2.5 yr. We recorded the intervals free of hospitalization for exacerbation and realized an analysis of the proportional hazards not to be hospitalized using the Kaplan-Meier method. Univariate analysis using the log-rank test showed that the risk of being hospitalized was significantly increased in patients with COPD with a low body mass index (BMI less than or equal to 20 kg/m(2), p = 0.015) and in patients with a limited 6-min walk distance (less than or equal to 367 m, p = 0.045). But above all, the risk of hospitalization for acute exacerbation was significantly increased by gas exchange impairment and pulmonary hemodynamic worsening: Pa-O2 less than or equal to 65 mm Hg versus Pa-O2 > 65 mm Hg, p = 0.005; Pa-CO2 > 44 mm Hg versus Pa-CO2 less than or equal to 44 mm Hg, p = 0.005; and mean pulmonary artery pressure ((Ppa) over bar) at rest > 18 mm Hg versus (Ppa) over bar less than or equal to 18 mm Hg, p = 0.0008. Neither age, nor the association of one or more comorbidities with COPD, nor the smoking habits had a significant impact on the risk of hospitalization in our study. Multivariate analysis showed that only Pa-CO2 and (Ppa) over bar were independently related to the risk of hospitalization for acute exacerbation of COPD. We conclude that chronic hypercapnic respiratory insufficiency and pulmonary hypertension are predictive factors of hospitalization fdr acute exacerbation in COPD patients.