Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease.
Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease.
复制标题
慢性阻塞性肺疾病急性加重患者短期再恶化的预测。
DOI：
10.2147/copd.s83378
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发表时间：
2015
影响因子：
2.8
通讯作者：
Qu JM
中科院分区：
文献类型：
--
作者：
Liu D;Peng SH;Zhang J;Bai SH;Liu HX;Qu JM
本研究的目的是开发一种评分系统，用于预测慢性阻塞性肺疾病急性加重（AECOPD）住院患者的90天再加重。共纳入176例连续住院AECOPD患者。收集社会人口统计学特征、急性加重（AE）前的状态、当前AE的表现和治疗以及出院后90天内的再次加重。90天内再加重率为48.9%（86/176）。与肺功能损害程度有关（慢性阻塞性肺疾病全球倡议[GOLD]分级）、前一年AE的频率和当前AE的参数，包括胸腔积液、辅助呼吸肌的使用、吸入性长效β 2-受体激动剂、吸入性皮质类固醇、控制性氧疗、无创机械通气和住院时间，但与体重指数、改良医学研究理事会量表或慢性阻塞性肺疾病评估测试无关。选择10个变量的亚组，并将其发展为再加重指数评分系统（年龄分级、GOLD分级、前一年AE次数、胸腔积液、使用辅助呼吸肌、无创机械通气、控制性氧疗、吸入长效β 2受体激动剂和吸入皮质类固醇、住院时间）。再加重指数对再加重显示出良好的区分力，C-统计量为0.750（P<0.001）。一项综合稳定期慢性阻塞性肺疾病参数、急性加重时的临床表现和治疗的综合评估显示，对AECOPD患者的短期结局具有较强的预测能力。需要进一步的研究来验证这些发现。
The objective of the study is to develop a scoring system for predicting a 90-day re-exacerbation in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A total of 176 consecutive hospitalized patients with AECOPD were included. The sociodemographic characteristics, status before acute exacerbation (AE), presentations of and treatment for the current AE, and the re-exacerbation in 90 days after discharge from hospital were collected. The re-exacerbation rate in 90 days was 48.9% (86 out of 176). It was associated with the degree of lung function impairment (Global initiative for chronic Obstructive Lung Disease [GOLD] grades), frequency of AE in the previous year, and parameters of the current AE, including pleural effusion, use of accessory respiratory muscles, inhaled long-acting β-2-agonists, inhaled corticosteroids, controlled oxygen therapy, noninvasive mechanical ventilation, and length of hospital stay, but was not associated with body mass index, modified Medical Research Council scale, or chronic obstructive pulmonary disease assessment test. A subgroup of ten variables was selected and developed into the re-exacerbation index scoring system (age grades, GOLD grades, AE times in the previous year, pleural effusion, use of accessory respiratory muscles, noninvasive mechanical ventilation, controlled oxygen therapy, inhaled long-acting β-2-agonists and inhaled corticosteroids, and length of hospital stay). The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001). A comprehensive assessment integrating parameters of stable chronic obstructive pulmonary disease, clinical presentations at exacerbation, and treatment showed a strong predictive capacity for short-term outcome in patients with AECOPD. Further studies are required to verify these findings.