Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization.
Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization.
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DOI：
10.4103/0970-2113.164150
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Hattiholi J
中科院分区：
文献类型：
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作者：
Gaude GS;Rajesh BP;Chaudhury A;Hattiholi J
已知慢性阻塞性肺疾病急性加重（AECOPD）与发病率和死亡率增加相关，并具有显著的社会经济影响。对AECOPD患者频繁再入院的决定因素知之甚少。本研究旨在确定AECOPD后的失败率，并评估与频繁再入院相关的因素。我们在三级医院的186例COPD患者中进行了一项前瞻性研究，这些患者有一次或多次急性加重入院。在出院前和出院后6个月，在稳定状态下确定了过去一年中因AECOPD再次入院的频率和临床特征，包括肺量测定。在随访期间确定治疗后的失败率。所有患者在出院后随访2年，以评估AECOPD再次入院的情况。在186例因AECOPD入院的COPD患者中，54%有一次或多次再入院，另外45%在2年内有两次或两次以上再入院。在COPD患者中，当前或既往重度吸烟者、相关合并症、体重不足患者、疫苗接种率低和辅助氧疗使用率高。在本研究中观察到的死亡率总计为12%。首次急性加重后即刻失败率为34.8%。多变量分析显示，病程>20年（OR = 0.37; 95%CI：0.10-0.86）、使用噻托溴铵（OR = 2.29; 95%CI：1.12-4.69）和首次入院时使用co-amoxiclav（OR = 2.41; 95%CI：1.21-4.79）与较高的即刻失败率显著相关。多因素分析显示，病程>10年（OR = 0.50; 95% CI：0.27-0.93），吸入ICS + LABA使用率低（OR = 2.21; 95% CI：1.08-4.54）和MRC呼吸困难分级>3（OR = 2.51; 95% CI：1.08-5.82）与AECOPD频繁再次入院独立相关。因COPD急性加重而入院的患者结局较差。影响COPD反复加重频率的主要因素是病程、吸入ICS + LABA使用率低和MRC呼吸困难分级>3。
Acute exacerbations of chronic obstructive pulmonary disorder (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The present study was done to ascertain failures rates following AECOPD and to evaluate factors associated with frequent readmissions. We conducted a prospective study among 186 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous re-admissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post-discharge. Failure rates following treatment were ascertained during the follow-up period. All the patients were followed up for a period of 2 years after discharge to evaluate re-admissions for the AECOPD. Of 186 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.37; 95% CI: 0.10-0.86), use of Tiotropium (OR = 2.29; 95% CI: 1.12-4.69) and use of co-amoxiclav during first admission (OR = 2.41; 95% CI: 1.21-4.79) were significantly associated with higher immediate failure rates. The multivariate analysis for repeated admissions revealed that disease duration >10 years (OR = 0.50; 95% CI: 0.27-0.93), low usage of inhaled ICS + LABA (OR = 2.21; 95% CI: 1.08-4.54), and MRC dyspnea grade >3 (OR = 2.51; 95% CI: 1.08-5.82) were independently associated with frequent re-admissions for AECOPD. The outcomes of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing frequency of repeated COPD exacerbations were disease duration, low usage of inhaled ICS + LABA, and MRC dyspnea grade >3.