Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
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DOI：
10.1513/annalsats.201507-439oc
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发表时间：
2016-02-01
影响因子：
8.3
通讯作者：
Dransfield, Mark T.
中科院分区：
文献类型：
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作者：
Iyer, Anand S.;Bhatt, Surya P.;Dransfield, Mark T.
理由：慢性阻塞性肺病 (COPD) 急性加重住院与高发病率和医疗费用相关，美国的医院现在因过多的再入院率而受到医疗保险和医疗补助服务中心的处罚。识别有再入院风险的患者很重要，但可改变的危险因素尚未明确确定，并且心理疾病的潜在贡献作用尚未得到充分研究。我们假设抑郁和焦虑会增加 COPD 急性恶化的短期和长期再入院风险。目的：描述抑郁和焦虑与 COPD 再入院风险之间的关联。方法：我们检查了 2010 年 11 月至 10 月期间阿拉巴马大学伯明翰医院收治的所有根据国际疾病分类第九版修订代码初步诊断为 COPD 急性恶化的患者的病历。 2012年，不符合COPD急性加重标准化研究标准的患者和以其他呼吸道疾病为主要诊断的患者被排除。根据电子病历中的医生诊断文件和/或药物使用情况记录合并症。多变量回归分析确定了与 1 年内、30 和 90 天内 COPD 急性加重再次入院相关的因素。测量和主要结果：纳入了 422 名患者，其中 132 名患者在 1 年内再次入院。平均年龄为 64.8 +/- 11.7 岁，平均预测 FEV1 百分比为 48.1 +/- 18.7%。在单变量分析中，再入院患者的预测 FEV1 百分比较低（44.9 +/- 17.3% vs. 50.2 +/- 19.4%；P = 0.05），抑郁频率较高（47.7% vs. 23.4%；P < 0.001）。多变量分析显示，1 年再入院与抑郁症（调整后比值比 [OR]，2.67；95% 置信区间 [CI]，1.59-4.47）和院内戒烟咨询（调整后 OR，0.34；95% CI，0.18-0.66）独立相关。抑郁症还预测 30 天（调整后 OR，3.83；95% CI，1.84-7.96）和 90 天（调整后 OR，2.47；95% CI，1.34-4.55）时的再入院风险。 结论：抑郁症是 COPD 急性加重短期和长期再入院的独立危险因素，并且可能代表可改变的危险因素。院内戒烟咨询也与减少 1 年再入院率有关。
Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk.Methods: We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 +/- 11.7 years, and mean percent predicted FEV1 was 48.1 +/- 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV1 (44.9 +/- 17.3% vs. 50.2 +/- 19.4%; P = 0.05) and a higher frequency of depression(47.7% vs. 23.4%; P < 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.