Almagro Pedro, Barreiro Bienvenido, Ochoa de Echaguen Anna, Quintana Salvador, Rodríguez Carballeira Mónica, Heredia José L, Garau Javier
Department of Internal Medicine, Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
Respiration. 2006;73(3):311-7. doi: 10.1159/000088092. Epub 2005 Sep 6.
Hospital readmissions for acute exacerbation of chronic obstructive pulmonary disease (COPD) are one of the leading causes of health care expenditures worldwide.
To identify risk factors for hospital readmission in COPD patients.
We prospectively evaluated 129 consecutive patients hospitalized for acute exacerbation of COPD. Clinical, spirometric and arterial blood gas variables were measured during hospitalization. Socioeconomic characteristics, comorbidity, dyspnea, functional dependence, depression, social support and quality of life were also analyzed. Readmission was defined as one or more hospitalizations in the following year.
During the follow-up period, 75 (58.5%) patients were readmitted. In bivariate analysis, readmission was associated with previous hospitalization for COPD in the past year, dyspnea scale, PaCO(2) at discharge, depression, cor pulmonale, chronic domiciliary oxygen and quality of life measured by the St. George's Respiratory Questionnaire. In multivariate analysis, the best predictor of readmission was the combination of hospitalization for COPD in the previous year (odds ratio, OR: 4.27; 95% confidence interval, CI: 1.5-12), the total score of the St. George's Respiratory Questionnaire >or=50 points (OR: 2.36; 95% CI: 1.03-5.04) and PaCO(2) at discharge >or=45 mm Hg (OR: 2.18; 95% CI: 0.84-5.06). With this model, the probability of readmission for patients without any of these variables was 7%, while it was 70% for the patients with all three variables present.
The combination of quality of life, hospitalization for COPD in the previous year and hypercapnia at discharge are useful predictors of readmission at 1 year.
慢性阻塞性肺疾病（COPD）急性加重导致的医院再入院是全球医疗保健支出的主要原因之一。
确定COPD患者医院再入院的风险因素。
我们前瞻性评估了129例因COPD急性加重而住院的连续患者。在住院期间测量临床、肺功能和动脉血气变量。还分析了社会经济特征、合并症、呼吸困难、功能依赖、抑郁、社会支持和生活质量。再入院定义为次年一次或多次住院。
在随访期间，75例（58.5%）患者再次入院。在双变量分析中，再入院与过去一年因COPD先前住院、呼吸困难量表、出院时的PaCO₂、抑郁、肺心病、长期家庭氧疗以及通过圣乔治呼吸问卷测量的生活质量有关。在多变量分析中，再入院的最佳预测因素是前一年因COPD住院（比值比，OR：4.27；95%置信区间，CI：1.5 - 12）、圣乔治呼吸问卷总分≥50分（OR：2.36；95%CI：1.03 - 5.04）和出院时PaCO₂≥45 mmHg（OR：2.18；95%CI：0.84 - 5.06）。使用该模型，没有这些变量的患者再入院概率为7%，而存在所有三个变量的患者再入院概率为70%。
生活质量、前一年因COPD住院和出院时高碳酸血症相结合是1年再入院的有用预测因素。
