Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study.
Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study.
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DOI：
10.1371/journal.pone.0150737
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Torres A
中科院分区：
文献类型：
--
作者：
Guerrero M;Crisafulli E;Liapikou A;Huerta A;Gabarrús A;Chetta A;Soler N;Torres A
20% 的慢性阻塞性肺病 (COPD) 患者在出院后 30 天内因急性加重 (AECOPD) 再次入院。早期再入院的预后意义尚不完全清楚。我们研究的目的是评估 COPD 患者出院 30 天内因急性加重再次入院相关的死亡风险。该队列 (n = 378) 分为出院 30 天内重新入院的患者 (n = 68) 和未重新入院的患者 (n = 310)。在入院和住院期间评估临床、实验室、微生物学和严重程度数据，并在随访期间的四个时间点记录死亡率数据：30天、6个月、1年和3年。 30天内再次入院的患者肺功能较差，呼吸困难感觉更差，临床严重程度更高。两次或两次以上既往 AECOPD（HR，2.47；95% CI，1.51-4.05）是与 30 天再入院独立相关的唯一变量。随访期间的死亡风险显示，与未重新入院的患者相比，30 天内重新入院的患者的死亡风险逐渐增加；此外，30 天再入院是 1 年死亡率的独立危险因素（HR，2.48；95% CI，1.10-5.59）。在 30 天内重新入院的患者中，死亡风险的绝对增加估计为 30 天时增加 4%（伤害 NNH 所需的人数，25），6 个月时增加 17%（NNH，6），1 年时增加 19%（NNH，6），3 年时增加 24%（NNH，5）。总之，30 天内因 AECOPD 再次入院与长期死亡风险逐渐增加相关。
Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients. The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years. Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5). In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death.