Lusuardi M, Blasi F, Terzano C, Cricelli C, Crispino N, Comarella L, De Benedetto F, Sanguinetti C M, Allegra L, Donner C F
Unit of Pulmonary Rehabilitation, San Sebastiano Hospital, Local Health Authority (AUSL) of Reggio Emilia, Correggio, I, Italy.
Monaldi Arch Chest Dis. 2009 Dec;71(4):153-60. doi: 10.4081/monaldi.2009.347.
Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbations are major events in the natural history of the disease in terms of survival, quality of life and risk of further episodes of exacerbation. The aims of study were to evaluate: 1. adherence to recommended standards of care; and 2. clinical factors influencing major outcomes during hospitalisation for an episode of COPD exacerbation and within a 6-month follow-up.
An observational, prospective study was conducted in 68 centres. Assessment of standards of care included diagnostic procedures (such as pulmonary function tests and microbiology) and management options (such as drug therapies, vaccinations and rehabilitation). Outcome measures relevant to the hospitalisation were: survival, need for mechanical ventilation, and length of stay (LOS). Outcomes at 6-months were: survival, exacerbations and hospitalisations for an exacerbation. Multivariate logistic regression was applied to evaluate the relation between clinical factors and outcomes.
931 patients were enrolled. Only 556 patients (59.7%) were diagnosed COPD and stratified for severity with the support of spirometry (FEV1/VC < or = 0.7) and were considered for outcome analysis. Among treatments, pulmonary rehabilitation and anti-smoking counselling were applied infrequently (14.5 and 8.1% of patients, respectively). Within six months 63 COPD patients (17.7%) had at least one episode of exacerbation prompting a further hospitalisation and 19 died (5.3%). Predictor of mortality was the co-morbidity Charlson index (odds ratio, OR 10.3, p=0.03 CI: 1.25-84.96). A further hospitalisation was predicted by hospitalisation for an exacerbation in the previous 12 months (OR 3.59, p=0.003 CI: 1.54-8.39).
Standards of care were far lower than recommended, in particular 40% of patients were labelled as COPD without spirometry. COPD patients with a second hospitalisation in 12 months for an exacerbation had about 3 times the risk of suffering a new episode and hospitalisation in the following six months.
慢性阻塞性肺疾病（COPD）急性加重导致的住院是该疾病自然史中的重大事件，关乎生存、生活质量以及再次急性加重的风险。本研究的目的是评估：1. 对推荐治疗标准的依从性；2. 在COPD急性加重住院期间及6个月随访期内影响主要结局的临床因素。
在68个中心开展了一项观察性前瞻性研究。对治疗标准的评估包括诊断程序（如肺功能测试和微生物学检查）和管理措施（如药物治疗、疫苗接种和康复治疗）。与住院相关的结局指标为：生存情况、机械通气需求和住院时长（LOS）。6个月时的结局指标为：生存情况、急性加重次数和因急性加重住院情况。采用多因素逻辑回归分析评估临床因素与结局之间的关系。
共纳入931例患者。仅556例患者（59.7%）被诊断为COPD，并在肺量计检查（FEV1/VC≤0.7）的支持下进行了严重程度分层，且纳入结局分析。在治疗方面，肺康复治疗和戒烟咨询的应用较少（分别占患者的14.5%和8.1%）。6个月内有63例COPD患者（17.7%）至少发生一次急性加重并导致再次住院，19例死亡（5.3%）。死亡的预测因素是合并症查尔森指数（比值比，OR 10.3，p = ０.03，CI：１.25 - 84.96）。前12个月因急性加重住院可预测再次住院（OR 3.59，p = ０.003，CI：１.54 - 8.39）。
治疗标准远低于推荐标准，特别是４０％的患者在未进行肺量计检查的情况下被诊断为COPD。在12个月内因急性加重再次住院的COPD患者在接下来6个月内出现新的急性加重和再次住院的风险约为3倍。
