VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA.
Psychosomatics. 2011 Sep-Oct;52(5):441-9. doi: 10.1016/j.psym.2011.03.005.
Studies investigating associations between chronic obstructive pulmonary disease (COPD) outcomes and psychiatric comorbidity have yielded mixed findings. We examined a national sample of hospitalized COPD patients to evaluate the impact of three psychiatric conditions on mortality and readmission.
Department of Veterans Affairs (VA) administrative and laboratory data were used to identify 26,591 consecutive patients admitted for COPD during October 2006 to September 2008. Associations between psychiatric comorbidity and both 30-day mortality and readmission were examined using generalized estimating equations and Cox proportional hazards regression, respectively, with adjustments for patient demographics, medical comorbidities, illness severity, and clustering within hospitals.
Unadjusted 30-day mortality was higher in patients with anxiety (5.3% vs. 3.8% [P < 0.001]) and depression (6.2% vs. 3.8% [<0.001]). In multivariable analyses, adjusted odds of 30-day mortality were higher for patients with depression (OR, 1.53; 95% CI, 1.28-1.82) and anxiety (OR, 1.72; 1.42 -2.10), but not for patients with PTSD (OR, 1.19; 0.92-1.55). Unadjusted 30-day readmission rates also varied by diagnosis; depression and PTSD were associated with lower rates of readmission (10.4% vs. 11.6% [<0.05] and 8.6% vs. 11.6% [<0.001], respectively), whereas anxiety was not (11.3% vs. 11.5% [NS]). However, after covariate adjustment using multivariable models, anxiety and depression (but not PTSD) were associated with increased risk for readmission (HR, 1.22; 1.03 -1.43 and HR, 1.35; 1.18 -1.54, respectively).
Comorbid anxiety and depression may have an adverse impact on COPD hospital prognosis or may be indicative of more severe illness.
研究慢性阻塞性肺疾病（COPD）结局与精神共病之间关系的研究得出的结果并不一致。我们对一个全国性的住院 COPD 患者样本进行了评估，以研究三种精神疾病对死亡率和再入院率的影响。
利用退伍军人事务部（VA）的行政和实验室数据，确定了 2006 年 10 月至 2008 年 9 月期间连续收治的 26591 例 COPD 住院患者。使用广义估计方程和 Cox 比例风险回归分别评估了精神共病与 30 天死亡率和再入院率之间的关系，调整了患者人口统计学、合并症、疾病严重程度以及医院内的聚类因素。
未经调整的 30 天死亡率在焦虑症患者中更高（5.3%比 3.8%[P<0.001]）和抑郁症患者中更高（6.2%比 3.8%[<0.001]）。在多变量分析中，抑郁症（OR，1.53；95%CI，1.28-1.82）和焦虑症（OR，1.72；1.42-2.10）患者发生 30 天死亡的调整比值比更高，但创伤后应激障碍（OR，1.19；0.92-1.55）患者的比值比并无显著差异。未经调整的 30 天再入院率也因诊断而异；抑郁症和创伤后应激障碍与较低的再入院率相关（10.4%比 11.6%[<0.05]和 8.6%比 11.6%[<0.001]），而焦虑症则无此关联（11.3%比 11.5%[NS]）。然而，使用多变量模型进行协变量调整后，焦虑症和抑郁症（但不是创伤后应激障碍）与再入院风险增加相关（HR，1.22；1.03-1.43 和 HR，1.35；1.18-1.54）。
合并焦虑症和抑郁症可能对 COPD 住院患者的预后产生不利影响，或者可能表明病情更严重。
