Stability of Frequency of Severe Chronic Obstructive Pulmonary Disease Exacerbations and Health Care Utilization in Clinical Populations
Stability of Frequency of Severe Chronic Obstructive Pulmonary Disease Exacerbations and Health Care Utilization in Clinical Populations
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DOI：
10.15326/jcopdf.5.3.2017.0183
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发表时间：
2018-07-01
影响因子：
2.4
通讯作者：
Arjomandi, Mehrdad
中科院分区：
文献类型：
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作者：
Blagev, Denitza P.;Collingridge, Dave S.;Arjomandi, Mehrdad
基本原理：虽然慢性阻塞性肺疾病（COPD）加重的频率是稳定的研究队列，严重的COPD加重的频率是否可以用来确定患者在未来严重的COPD加重和/或死亡率的高风险是unknow.Methods：严重的COPD加重频率稳定性确定在3个不同的临床队列。根据每年重度COPD急性加重的数量，对Intermountain Healthcare的17，450例COPD患者进行了分类。我们确定急性发作频率是否稳定，以及是否可预测死亡率。这些发现在来自美国退伍军人事务部（VA）全国医疗保健系统的83，134名患者和来自芝加哥大学医学卫生系统的3326名患者中得到验证。在Intermountain Healthcare队列中，大多数（84%，14，706例患者）在2009年没有发生急性加重，并且可能仍然是非急性加重者，与频繁急性加重者相比，6年死亡率显著降低（每年2次或2次以上急性加重）（25% vs 57%，p< 0.001）。在弗吉尼亚州卫生系统和芝加哥大学医学卫生系统也有类似的发现。非恶化者可能仍然是非恶化者，总死亡率最低。在所有队列中，频繁加重因素在患者至少连续2年频繁加重之前不是稳定表型。COPD急性加重频率预测任何原因mortality.Conclusions：在不同组织的临床数据集中，重度COPD急性加重频率在至少连续2年频繁加重后保持稳定。因此，重度COPD急性加重频率在整个医疗保健系统中识别出未来COPD相关医疗保健利用和总体死亡率高风险的患者。
Rationale: Although chronic obstructive pulmonary disease (COPD) exacerbation frequency is stable in research cohorts, whether severe COPD exacerbation frequency can be used to identify patients at high risk for future severe COPD exacerbations and/or mortality is unknown.Methods: Severe COPD exacerbation frequency stability was determined in 3 distinct clinical cohorts. A total of 17,450 patients with COPD in Intermountain Healthcare were categorized based on the number of severe COPD exacerbations per year. We determined whether exacerbation frequency was stable and whether it predicted mortality. These findings were validated in 83,134 patients from the U.S. Veterans Affairs (VA) nationwide health care system and 3326 patients from the University of Chicago Medicine health system.Results: In the Intermountain Healthcare cohort, the majority (84%, 14,706 patients) had no exacerbations in 2009 and were likely to remain non-exacerbators with a significantly lower 6-year mortality compared with frequent exacerbators (2 or more exacerbations per year) (25% versus 57%, p< 0.001). Similar findings were noted in the VA health system and the University of Chicago Medicine health system. Non-exacerbators were likely to remain non-exacerbators with the lowest overall mortality. In all cohorts, frequent exacerbator was not a stable phenotype until patients had at least 2 consecutive years of frequent exacerbations. COPD exacerbation frequency predicted any cause mortality.Conclusions: In clinical datasets across different organizations, severe COPD exacerbation frequency was stable after at least 2 consecutive years of frequent exacerbations. Thus, severe COPD exacerbation frequency identifies patients across a health care system at high risk for future COPD-related health care utilization and overall mortality.