Internal Medicine, Hospital Mútua de Terrassa, Pza. Dr. Robert no. 5, Terrassa 08221, Barcelona, Spain.
Thorax. 2010 Apr;65(4):298-302. doi: 10.1136/thx.2009.124818.
Evidence-based international guidelines on chronic obstructive pulmonary disease (COPD), and their corresponding recommendations, were established to improve individual COPD prognosis, and ultimately to improve survival. The aim of this study was to determine whether the long-term mortality after discharge from a COPD hospitalisation has improved recently, and the effect of co-morbidity treatment in improving COPD prognosis.
In a prospective cohort study design of two cohorts 7 years apart, patients discharged from the same university hospital after a COPD exacerbation were followed-up, and their outcomes compared. Demographic and clinical variables, as well as lung function, were collected with the same protocol by the same investigators. Comprehensive assessments of co-morbidities and treatments were undertaken. Kaplan-Meier survival curves were estimated, and outcomes were compared by means of Cox regression methods.
Overall, 135 participants in the 1996-7 cohort and 181 participants in the 2003-4 cohort were studied. Both cohorts were comparable in their baseline demographic and clinical variables, and median follow-up was 439 days. The 3-year mortality was lower in the 2003-4 cohort (38.7%) than in the 1996-7 cohort (47.4%) (p=0.017), and the RR of death after adjustment for gender, age, body mass index, co-morbidities, lung function and mMRC (modified Medical Research Council scale) dyspnoea was 0.66 (95% CI 0.45 to 0.97). Long-term survival improved in the second cohort for patients with COPD with heart failure or cancer (p<0.001).
A recent trend towards better prognosis of patients with COPD after hospital discharge is described and is likely to be associated with better management and treatment of COPD and co-morbidities.
有循证国际指南针对慢性阻塞性肺疾病（COPD），并提出相应的建议，以改善个体 COPD 预后，并最终提高生存率。本研究旨在确定 COPD 住院患者出院后长期死亡率是否有所改善，以及共病治疗对改善 COPD 预后的效果。
采用前瞻性队列研究设计，对 7 年前后两个队列的患者进行随访，并对其结果进行比较。采用相同的方案和相同的研究人员收集人口统计学和临床变量以及肺功能数据。对共病和治疗进行全面评估。通过 Kaplan-Meier 生存曲线估计和 Cox 回归方法比较结果。
共有 1996-7 年队列的 135 名参与者和 2003-4 年队列的 181 名参与者纳入本研究。两个队列在基线人口统计学和临床变量方面具有可比性，中位随访时间为 439 天。2003-4 年队列的 3 年死亡率（38.7%）低于 1996-7 年队列（47.4%）（p=0.017），性别、年龄、体重指数、共病、肺功能和 mMRC（改良医学研究委员会呼吸困难量表）调整后的死亡风险比为 0.66（95% CI 0.45 至 0.97）。对于患有心力衰竭或癌症的 COPD 患者，第二队列的长期生存率有所提高（p<0.001）。
描述了 COPD 住院患者出院后预后改善的近期趋势，这可能与 COPD 及其共病的更好管理和治疗有关。
