Rivera-Fernández Ricardo, Navarrete-Navarro Pedro, Fernández-Mondejar Enrique, Rodriguez-Elvira Manuel, Guerrero-López Francisco, Vázquez-Mata Guillermo
Santa Ana Hospital, Motril, Granada, Spain.
Crit Care Med. 2006 Sep;34(9):2317-24. doi: 10.1097/01.CCM.0000233859.01815.38.
To study the mortality and quality of life (QOL) of survivors at 6 yrs after intensive care unit (ICU) admission for chronic obstructive pulmonary disease.
Prospective, multiple-center cohort study.
A total of 86 ICUs throughout Spain.
Patients in the Project for the Epidemiological Analysis of Critical Care Patients (PAEEC) project with chronic obstructive pulmonary disease were included.
The sample comprised 742 patients; 508 of them were admitted for acute exacerbation of chronic obstructive pulmonary disease, and 379 of these required intermittent positive-pressure ventilation. The mean age of the patients was 65.2 +/- 9.89 yrs, Acute Physiology and Chronic Health Evaluation (APACHE) III score was 66.6 +/- 21.04; preadmission QOL questionnaire score was 7 +/- 4.82 points, and hospital mortality was 31.8%. At 6 yrs, 32.2% had died after hospital discharge, 21.6% could not be traced, and 107 patients were alive (18.3% of the 582 followed-up patients). QOL of survivors was worse than preadmission (6.55 +/- 5.6 vs. 4.92 +/- 4.5 points, p < .05), but 72% of patients were self-sufficient. Among the 379 patients admitted to the ICU for acute chronic obstructive pulmonary disease exacerbation and requiring intermittent positive-pressure ventilation, 36.7% died in the hospital; at 6 yrs after hospital discharge, 31.4% had died, 18.7% could not be traced, and 50 patients (16.2% of followed-up patients) were alive. Multivariate analysis with logistic regression showed that the mortality at 6 yrs was related to age (odds ratio, 1.046; 95% confidence interval, 1.023-1.071), APACHE III score (odds ratio, 1.013; 95% confidence interval, 1.001-1.024), and preadmission QOL score (odds ratio, 1.139; 95% confidence interval, 1.078-1.204).
The 6-yr mortality of patients with chronic obstructive pulmonary disease requiring ICU admission is high. Mortality is mainly influenced by pre-ICU admission QOL. At 6 yrs, at least 15% are alive; survivors have a worse QOL compared with pre-ICU admission, although three quarters of them are self-sufficient.
研究因慢性阻塞性肺疾病入住重症监护病房（ICU）6年后幸存者的死亡率及生活质量（QOL）。
前瞻性、多中心队列研究。
西班牙全国共86个ICU。
纳入危重症患者流行病学分析项目（PAEEC）中患有慢性阻塞性肺疾病的患者。
样本包括742例患者；其中508例因慢性阻塞性肺疾病急性加重入院，其中379例需要间歇性正压通气。患者的平均年龄为65.2±9.89岁，急性生理与慢性健康状况评分系统（APACHE）Ⅲ评分为66.6±21.04；入院前生活质量问卷评分为7±4.82分，医院死亡率为31.8%。6年后，32.2%在出院后死亡，21.6%无法追踪到，107例患者存活（在582例接受随访的患者中占18.3%）。幸存者的生活质量比入院前差（6.55±5.6对4.92±4.5分，p<0.05），但72%的患者能够自理。在379例因慢性阻塞性肺疾病急性加重入住ICU并需要间歇性正压通气的患者中，36.7%在医院死亡；出院6年后，31.4%死亡，18.7%无法追踪到，50例患者（在接受随访的患者中占16.2%）存活。logistic回归多因素分析显示，6年死亡率与年龄（比值比，1.046；95%置信区间，1.023 - 1.071）、APACHEⅢ评分（比值比，1.013；95%置信区间，1.001 - 1.024）及入院前生活质量评分（比值比，1.139；95%置信区间，1.078 - 1.204）有关。
因慢性阻塞性肺疾病需要入住ICU的患者6年死亡率较高。死亡率主要受入住ICU前生活质量的影响。6年后，至少15%的患者存活；与入住ICU前相比，幸存者的生活质量较差，尽管其中四分之三能够自理。
