Public Helath College, Nantong University, China.
Fam Pract. 2011 Oct;28(5):474-81. doi: 10.1093/fampra/cmr024. Epub 2011 May 20.
Cardiovascular diseases are the major cause of mortality in patients with chronic obstructive pulmonary disease (COPD), however, are rarely considered in prediction models in patients with COPD.
To quantify the effect of cardiovascular determinants on mortality in patients with a GP's diagnosis of COPD.
Four hundred and five patients aged ≥65 years with a diagnosis of COPD (244 with COPD by spirometry) were followed up for an average period of 4.2 (SD 1.4) years. Cox proportional hazard regression analyses with bootstrapping techniques were performed to identify independent predictors of all-cause mortality.
In multivariable analysis, all-cause mortality was best predicted by age [hazard ratio (HR) 1.05 [95% confidence interval (CI): 1.01-1.10] per year of age], angina pectoris on history taking [HR 2.32 (95% CI: 1.50-3.58)], airflow obstruction [HR 1.02 (95% CI: 1.01-1.03) per percentage decrease in level of forced expiratory volume in one second (FEV(1)) as % predicted] and C-reactive protein [HR 1.04 (95% CI: 1.02-1.05] per milligram per millilitre increase), respectively. The final model had a C statistic of 0.78 (95% CI: 0.72-0.83) after bootstrapping, and the calibration of the model was very good. The model performed similarly in the subgroup of 244 patients with COPD according to the GOLD criteria (post-dilatory FEV(1)/forced vital capacity < 0.70).
Physicians should consider ischaemic heart disease in the clinical evaluation of any patient with a GP's diagnosis of COPD. Angina pectoris on history taking is a strong predictor of all-cause mortality in these patients and should be treated adequately to improve prognosis.
心血管疾病是慢性阻塞性肺疾病（COPD）患者死亡的主要原因，但在 COPD 患者的预测模型中很少考虑到这些因素。
定量评估心血管决定因素对全科医生诊断为 COPD 的患者死亡率的影响。
对 405 名年龄≥65 岁的 COPD 患者（244 名通过肺量计诊断为 COPD）进行了平均 4.2（SD 1.4）年的随访。采用 Cox 比例风险回归分析和自举技术，确定全因死亡率的独立预测因素。
多变量分析显示，全因死亡率与年龄呈最佳相关性[每增加 1 岁，风险比（HR）为 1.05（95%置信区间（CI）：1.01-1.10）]、询问病史时的心绞痛[HR 2.32（95%CI：1.50-3.58）]、气流阻塞[HR 1.02（95%CI：1.01-1.03），每下降 1%预测的 1 秒用力呼气量（FEV1）水平]和 C 反应蛋白[HR 1.04（95%CI：1.02-1.05），每毫克/毫升增加]。自举后最终模型的 C 统计量为 0.78（95%CI：0.72-0.83），模型的校准非常好。在根据 GOLD 标准（后扩张 FEV1/用力肺活量<0.70）诊断的 244 名 COPD 患者亚组中，该模型的表现也相似。
医生在对任何一位全科医生诊断为 COPD 的患者进行临床评估时，都应考虑缺血性心脏病。询问病史时的心绞痛是这些患者全因死亡率的一个强有力预测因素，应充分治疗以改善预后。
