Prospective study of hospitalization for asthma. A preliminary risk factor model.
Prospective study of hospitalization for asthma. A preliminary risk factor model.
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哮喘住院的前瞻性研究。
DOI：
10.1164/ajrccm.151.3.7881651
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Wilson,SR
中科院分区：
文献类型：
--
作者：
Li,D;German,D;Lulla,S;Thomas,RG;Wilson,SR
我们对310例年龄在18 - 50岁的中重度哮喘患者进行了一项探索性分析，对前瞻性获得的疾病活动性客观指标进行了分析，以得出哮喘住院的预测模型。与下一年住院风险增加相关的基线特征包括（1）前一年住院，（2）中度或重度呼吸损害，（3）与重度哮喘一致的药物治疗方案，（4）显著的全身性类固醇使用史，（5）最大夜间PEF变异性> 40%，（6）平均夜间PEF <预测值的60%（相对危险度分别为6.5、6.9、8.1、3.7、3.0和3.2）。递归划分分析，描述为一个“分类树”，提供了一个更敏感（94%）和具体（68%）的数据集的多变量描述比逻辑回归（87和48%，分别）或简单的加性风险模型（46和93%，分别）。根据既往住院史、呼吸损害程度和药物治疗方案的特定组合，确定具有非常高（> 50%）、中度升高（10 - 15%）和非常低（< 5%）住院风险的患者。在2周内在家中测量的夜间变异性和平均夜间PEF被证明比在基线时通过办公室肺量计测定一次的呼吸功能损害对风险分层的信息量更少。这些发现值得在其他人群中复制和推广，目标是制定风险分层的决策规则和降低风险的有效干预措施。
We conducted an exploratory analysis of several prospectively obtained objective measures of disease activity to derive a predictive model of hospitalization for asthma among 310 adults, ages 18 to 50 yr, with moderate to severe asthma. Baseline characteristics associated with increased risk of hospitalization in the succeeding year include (1) prior year hospitalization, (2) moderate or severe respiratory impairment, (3) a medication regimen consistent with severe asthma, (4) a history of significant systemic steroid use, (5) maximum overnight PEF variability > 40%, and (6) mean evening PEF < 60% of predicted (relative risk = 6.5, 6.9, 8.1, 3.7, 3.0, and 3.2, respectively). Recursive partitioning analysis, depicted as a “classification tree,” provided a more sensitive (94%) and specific (68%) multivariate description of the data set than either logistic regression (87 and 48%, respectively) or a simple additive risk model (46 and 93%, respectively). Patients with very high (> 50%), moderately elevated (10 to 15%), and very low < 5%) risk of hospitalization were identified on the basis of particular combinations of prior hospitalization history, level of respiratory impairment, and medication regimen. Overnight variability and mean evening PEF measured at home over a 2-wk period proved less informative for risk stratification than respiratory impairment determined once at baseline by office spirometry. The findings warrant replication and extension in other populations with the goal of developing decision rules for risk stratification and effective interventions for risk reduction.