Impact of COPD exacerbations on patient-centered outcomes
Impact of COPD exacerbations on patient-centered outcomes
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DOI：
10.1378/chest.06-1610
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发表时间：
2007-03-01
期刊：
影响因子：
9.6
通讯作者：
Celli, Bartolome R.
中科院分区：
文献类型：
--
作者：
Cote, Claudia G.;Dordelly, Luis J.;Celli, Bartolome R.
背景：频繁的急性加重与FEV 1下降更快、健康状况受损和生存率下降相关。其影响和与其他结果的时间关系，如功能状态，呼吸困难，和多维体重指数，梗阻，呼吸困难，运动能力（BODE）指数仍然未知。假设：我们推断，急性加重影响BODE指数及其组成部分，BODE指数的变化可用于监测急性加重对宿主的影响。研究设计：在退伍军人事务部医疗中心进行的前瞻性观察研究。我们研究了205例COPD患者（平均[+/- SD] FEV 1，43 +/- 15%预测值），并记录体重指数、FEV 1预测值百分比、改良医学研究理事会呼吸困难量表、6分钟步行距离、和BODE指数在基线时，在急性加重期间，并在第一次发作后6，12和24个月，并记录所有急性加重后2年。（每例患者每年0.85次急性加重）; 48例患者（23%）发生1次急性加重，82例患者（40%）发生2次或以上急性加重，50例患者需要住院治疗。在进入研究时，急性加重者的平均基线BODE指数评分更差（分别为4.2 +/- 2.1 vs 3.57 +/- 2.3; p < 0.03）。病情加重期间，BODE指数评分恶化了1.38分，并在1年和2年时分别比基线高出0.8和1.1分。在2年的nonaccelerators.Conclusion：COPD急性加重对BODE指数及其组成部分产生负面影响的BODE指数评分变化不大。BODE指数是一种敏感的工具，用于评估病情加重的影响并监测COPD疾病进展。
Background: Frequent exacerbations are associated with a faster decline in FEV1, impaired health status, and worse survival. Their impact and temporal relationship with other outcomes such as functional status, dyspnea, and the multidimensional body mass index, obstruction, dyspnea, exercise capacity (BODE) index remain unknown.Hypothesis: We reasoned that exacerbations affect the BODE index and its components, and that changes in the BODE index could be used to monitor the effect of exacerbations on the host.Study design: Prospective observational study in a Veterans Affairs medical center.Methods: We studied 205 patients with COPD (mean [+/- SD] FEV1, 43 +/- 15% predicted), and recorded the body mass index, FEV1 percent predicted, modified Medical Research Council dyspnea scale, 6-min walk distance, and the BODE index at baseline, during the exacerbation, and at 6, 12, and 24 months following the first episode, and documented all exacerbations for 2 years after the first acute exacerbation.Results: From the cohort, 130 patients (63%) experienced 352 exacerbations or (0.85 exacerbations per patient per year); 48 patients (23%), experienced one episode, 82 patients (40%) experienced 2 or more exacerbations, And 50 patients required hospitalization. At study entry, exacerbators had a worse mean baseline BODE index score (4.2 +/- 2.1 vs 3.57 +/- 2.3, respectively; p < 0.03). The BODE index score worsened by 1.38 points during the exacerbation, and remained 0.8 and 1.1 points above baseline at 1 and 2 years, respectively. There was little change in BODE index score at 2 years in nonexacerbators.Conclusion: COPD exacerbations negatively impact on the BODE index and its components. The BODE index is a sensitive tool used to assess the impact of exacerbations and to monitor COPD disease progression.