Prognostic Factors in Patients With Pulmonary Hypertension-A Nationwide Cohort Study.
Prognostic Factors in Patients With Pulmonary Hypertension-A Nationwide Cohort Study.
复制标题
肺高血压患者的预后因素 - 全国人群研究。
DOI：
10.1161/jaha.116.003579
复制
发表时间：
2016-08-29
影响因子：
5.4
通讯作者：
Chen ZC
中科院分区：
文献类型：
--
作者：
Chang WT;Weng SF;Hsu CH;Shih JY;Wang JJ;Wu CY;Chen ZC
肺动脉高压（PH）是一种罕见但致命的疾病。缺乏大规模的研究来检查预后因素。在本研究中，我们的目的是调查与PH患者总体死亡率相关的因素。根据台湾全民健康保险数据库，我们在1999年至2011年期间确定了1092名新发现的PH患者。根据年龄、性别和慢性心血管危险因素计算的倾向评分，将这些患者与8736名健康受试者进行匹配。计算总死亡率、死亡发生率比和风险比。PH患者的死亡率高于对照组（每1000人年56.45人与18.51人，P<0.0001），风险比为3.3（95%CI：2.92-3.73，P<0.001）。PH患者的1年、5年和10年长期生存率分别为87.9%、72.5%和62.6%，显著低于对照组的1年、5年和10年长期生存率分别为98.4%、90.8%和83.6%。在PH患者中，老年和男性患者的死亡率较高。然而，在按年龄和性别分层后，年轻（<50岁）和女性患者的风险较高。在不同病因的PH中，慢性阻塞性肺疾病和肺栓塞是导致死亡的主要原因（校正后的危险比分别为3.2，95% CI：2.76-3.71和4.64，95% CI：2.74-7.87，P<0.05）。 PH的死亡率高，尤其是女性、年轻患者和慢性病患者。慢性阻塞性肺疾病和肺栓塞导致PH患者死亡风险增加。
Pulmonary hypertension (PH) is a rare but fatal condition. Large‐scale studies to examine the prognostic factors are lacking. In the present study, we aimed to investigate the factors associated with overall mortality in PH patients. Based on Taiwan's National Health Insurance Database, we identified 1092 newly identified PH patients between 1999 and 2011. These patients were matched with 8736 healthy subjects based on propensity score calculated with age, sex, and chronic cardiovascular risk factors. Overall mortality, death incidence rate ratio, and hazard ratio were calculated. Patients with PH had a higher mortality than controls (56.45 versus 18.51 per 1000 person‐years, P<0.0001), with hazard ratio at 3.3 (95% CI: 2.92–3.73, P<0.001). The long‐term survival rates of the PH patients at 1, 5, and 10 years were 87.9%, 72.5%, and 62.6%, respectively, which were significantly lower than controls with 98.4%, 90.8%, and 83.6% at 1, 5, and 10 years, respectively. Among patients with PH, the mortality rate was higher in the older and male patients. However, after stratifying by age and sex, the younger (<50 years) and female patients had a higher risk. Regarding different etiologies of PH, chronic obstructive pulmonary disease and pulmonary embolism led to most cases of mortality (adjusted hazard ratio: 3.2, 95% CI: 2.76–3.71 and 4.64, 95% CI: 2.74–7.87, P<0.05). PH has high mortality, especially in females, and patients with younger age and with chronic diseases. Chronic obstructive pulmonary disease and pulmonary embolism contributed to an increased risk of mortality in PH patients.