Outcomes following acute exacerbation of severe chronic obstructive lung disease
Outcomes following acute exacerbation of severe chronic obstructive lung disease
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DOI：
10.1164/ajrccm.154.4.8887592
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发表时间：
1996-10-01
影响因子：
24.7
通讯作者：
Knaus, WA
中科院分区：
文献类型：
--
作者：
Connors, AF;Dawson, NV;Knaus, WA
为了描述重度慢性阻塞性肺疾病（COPD）急性加重住院患者的结局，并确定患者特征与生存时间之间的关系，我们研究了来自5家医院的1，016例COPD急性加重和Pa-CO2 ≥ 50 mm Hg的成年患者的前瞻性队列。确定患者特征和急性生理学。在6个月的时间内评估了结果。虽然只有11%的患者在住院期间死亡，但60天、180天、1年和2年的死亡率很高（分别为20%、33%、43%和49%）。指数住院费用中位数为7，100美元（4，100美元至16，000美元;四分位数范围）。索引住院时间的中位数为9天（5至15天）。446例患者出院后6个月内再入院754次。在6个月时，只有26%的队列存活，并且能够报告良好、非常好或极好的生活质量。生存时间与疾病严重程度、体重指数（BMI）、年龄、既往功能状态、Pa-O2/FIO 2、充血性心力衰竭、血清白蛋白和肺心病的存在独立相关。患者和护理人员应了解因COPD加重伴高碳酸血症住院治疗后不良结局的可能性。
In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective cohort of 1,016 adult patients from five hospitals who were admitted with an exacerbation of COPD and a Pa-CO2 of 50 mm Hg or more. Patient characteristics and acute physiology were determined. Outcomes were evaluated over a 6 mo period. Although only 11% of the patients died during the index hospital stay, the 60-d, 180-d, 1-yr, and 2-yr mortality was high (20%, 33%, 43%, and 49%, respectively). The median cost of the index hospital stay was $7,100 ($4,100 to $16,000; interquartile range). The median length of the index hospital stay was 9 d (5 to 15 d). After discharge, 446 patients were readmitted 754 times in the next 6 mo. At 6 mo, only 26% of the cohort were both alive and able to report a good, very good, or excellent quality of life. Survival time was independently related to severity of illness, body mass index (BMI), age, prior functional status, Pa-O2/FIO2, congestive heart failure, serum albumin, and the presence of cor pulmonale. Patients and caregivers should be aware of the likelihood of poor outcomes following hospitalization for exacerbation of COPD associated with hypercarbia.