Bhatt Surya Prakash, Khandelwal Pooja, Nanda Sudip, Stoltzfus Jill C, Fioravanti Gloria T
Department of Internal Medicine, St. Luke's Hospital, 801, Ostrum Street, Bethlehem, PA 18015, USA.
Respir Med. 2008 Jul;102(7):999-1003. doi: 10.1016/j.rmed.2008.02.010. Epub 2008 Apr 8.
Predictors of readmission for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not well defined. Identifying modifiable predictors may help reduce the burden of readmissions. This study was done to evaluate the role of serum magnesium in frequent readmissions.
One hundred patients admitted with a diagnosis of AECOPD to a tertiary care center from April 2004 to March 2006 were retrospectively followed from the time of index admission until the next admission or death. Number of admissions was calculated for the year after index admission, and frequent readmission was defined as > or =3 per year. Patients with other respiratory diseases, renal failure, and congestive heart failure were excluded. Serum magnesium was assayed at the time of admission by the colorimetric method. Logistic regression analysis was used to find independent risk factors for readmission.
The mean age of patients was 71.9 (+/-10.9 standard deviation (SD)) years. Fifty-seven were females. Ninety percent were current or ex-smokers. The median duration of time to next admission was 108 days (range 2-842). A total of 87 patients were readmitted at least once during the first year of follow-up, while 5% died; 23% had frequent readmissions; 85% had received pneumococcal vaccine within 5 years; and 29% received influenza vaccine in the current season. Frequency of readmissions was not influenced by the administration of inhaled or oral steroids, and diuretics at the time of discharge. Vaccination did not protect against frequent readmissions. The sole predictor of frequent readmissions was serum magnesium level (1.77+/-0.19 vs. 1.86+/-0.24mEq/L; adjusted odds ratio 0.003, 95% Confidence intervals <0.001-0.55; p=0.03).
Lower serum magnesium level independently predicts readmission for AECOPD. This is an easily modifiable risk factor.
慢性阻塞性肺疾病急性加重（AECOPD）再入院的预测因素尚未明确界定。识别可改变的预测因素可能有助于减轻再入院负担。本研究旨在评估血清镁在频繁再入院中的作用。
回顾性随访了2004年4月至2006年3月期间因AECOPD诊断入住三级护理中心的100例患者，从首次入院时起直至下次入院或死亡。计算首次入院后一年的入院次数，频繁再入院定义为每年≥3次。排除患有其他呼吸系统疾病、肾衰竭和充血性心力衰竭的患者。入院时采用比色法测定血清镁。采用逻辑回归分析来寻找再入院的独立危险因素。
患者的平均年龄为71.9（±10.9标准差（SD））岁。57例为女性。90%为现吸烟者或既往吸烟者。下次入院的中位时间为108天（范围2 - 842天）。在随访的第一年，共有87例患者至少再次入院一次，5%的患者死亡；23%的患者频繁再入院；85%的患者在5年内接种了肺炎球菌疫苗；29%的患者在当季接种了流感疫苗。再入院频率不受出院时吸入或口服类固醇以及利尿剂使用的影响。接种疫苗并不能预防频繁再入院。频繁再入院的唯一预测因素是血清镁水平（1.77±0.19 vs. 1.86±0.24mEq/L；调整后的优势比为0.003，95%置信区间<0.001 - 0.55；p = 0.03）。
较低的血清镁水平独立预测AECOPD的再入院。这是一个易于改变的危险因素。
