Mortality after hospitalization for COPD
Mortality after hospitalization for COPD
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DOI：
10.1378/chest.121.5.1441
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发表时间：
2002-05-01
期刊：
影响因子：
9.6
通讯作者：
Garau, J
中科院分区：
文献类型：
--
作者：
Almagro, P;Calbo, E;Garau, J
目的：确定与慢性阻塞性肺疾病急性加重期住院患者死亡率相关的变量。设计：前瞻性队列研究。地点：西班牙巴塞罗那的急诊医院。患者：自1996年10月至1997年5月连续135名因慢性阻塞性肺病急性加重期住院的患者。测量和结果：在纳入研究时对临床、肺活量和气体计量变量进行评估。分析患者的社会经济特征、合并症、呼吸困难、功能状态、抑郁和生活质量。180d、1年和2年的死亡率分别为13.4%、22%和35.6%。64名患者(47.4%)在研究结束时死亡(平均随访时间为838天)。在双变量分析中观察到年龄最大的患者(P<；0.0001)、女性(P<；0.01)和未婚患者(P<；0.002)的死亡率更高。前一年入院(p<；0.001)、功能依赖(Katz指数)[p<；0.0004]、更严重的合并症(查尔森指数)[p<；0.0006]、抑郁(Yesavage量表)[p<；0.00001]、生活质量(圣乔治呼吸问卷)[p<；0.01]和出院时二氧化碳分压(p<；0.03)也是死亡率的重要预测因素。在多因素分析中，活动SGRQ子量表(P<；0.001；优势比[OR]，2.62；可信区间[CI]，1.43至4.78)、共病(P<；0.005；OR，2.2；CI，1.26至3.84)、抑郁(P<；0.004；OR，3.6；CI，1.5至8.65)、再住院(P<；0.03；OR，1.85；婚姻状况(P<；0.0002；OR，3.12；CI，1.73~5.63)是影响死亡的独立预测因素。结论：生活质量、婚姻状况、抑郁症状、合并症、既往住院情况为本组慢性阻塞性肺疾病患者预后提供了相关信息。
Objectives: To identify variables associated with mortality in patients admitted to the hospital for acute exacerbation of COPD.Design: Prospective cohort study.Setting: Acute-care hospital in Barcelona (Spain).Patients: One hundred thirty-five consecutive patients hospitalized for acute exacerbation of COPD, between October 1996 and May 1997.Measurements and results: Clinical; spirometric, and gasometric variables were evaluated at the time of inclusion in the study. Socioeconomic characteristics, comorbidity, dyspnea, functional status, depression, and quality of life were analyzed. Mortality at 180 days, 1 year, and 2 years was 13.4%, 22%, and 35.6%, respectively. Sixty-four patients (47.4%) were dead at the end of the study (median follow-up duration, 838 days). Greater mortality was observed in the bivariate analysis among the oldest patients (p < 0.0001), women (p < 0.01), and unmarried patients (p < 0.002). Hospital admission during the previous year (p < 0.001), functional dependence (Katz index) [p < 0.0004], greater comorbidity (Charlson index) [p < 0.0006], depression (Yesavage Scale) [p < 0.00001]), quality of life (St. George's Respiratory Questionnaire [SGRQ]) [p < 0.01], and P-CO2 at discharge (p < 0.03) were also among the significant predictors of mortality. In the multivariate analysis, the activity SGRQ subscale (p < 0.001; odds ratio [OR], 2.62; confidence interval [CI], 1.43 to 4.78), comorbidity (p < 0.005; OR, 2.2; CI, 1.26 to 3.84), depression (p < 0.004; OR, 3.6; CI, 1.5 to 8.65), hospital readmission (p < 0.03; OR, 1.85; CI, 1.26 to 3.84), and marital status (p < 0.0002; OR, 3.12; CI, 1.73 to 5.63) were independent predictors of mortality.Conclusions: Quality of life, marital status, depressive symptoms, comorbidity, and prior hospital admission provide relevant information of prognosis in this group of COPD patients.