Service of Internal Medicine, Hospital Universitari Mutua de Terrassa, University of Barcelona, Barcelona, Spain.
Respiration. 2012;84(1):36-43. doi: 10.1159/000331224. Epub 2011 Oct 12.
Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD).
The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was associated with a poorer prognosis after discharge.
We prospectively studied all patients with COPD exacerbation admitted between June 2003 and September 2004. A sputum culture was obtained at admission. Comorbidity, functional dependence, hospitalizations during the previous year, dyspnea, quality of life and other variables previously associated with mortality in COPD were studied. Spirometry and a 6-min walking test were performed 1 month after discharge. Mortality was evaluated 3 years after discharge.
A total of 181 patients were included in the study. Of these, 29 (16%) had PA in the sputum. The mean age was 72 years, and mean basal postbronchodilator forced expiratory volume in 1 s was 45.2% predicted (SD 14.4). The mean point value on the BODE index was 5.1 (SD 2.5). At 3 years, 17 of 29 patients (58.6%) in the PA group had died, compared to 53 of the 152 non-PA patients [34.9%; p < 0.004; hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.29-3.86]. In the multivariate analysis, PA remained statistically related to posthospital mortality (p = 0.02; HR 2.2, 95% CI 1.2-4.2) after adjustment for age (p < 0.02; HR 1.04, 95% CI 1.007-1.07), BODE index (p < 0.02; HR 1.15, 95% CI 1.02-1.3) and comorbidity (p < 0.02; HR 1.24, 95% CI 1.03-1.5).
PA isolation in sputum in patients hospitalized for acute exacerbation of COPD is a prognostic marker of 3-year mortality. Poor prognosis is independent of other significant predictors of mortality such as BODE index, age and comorbidity, as measured by the Charlson index.
铜绿假单胞菌（PA）在慢性阻塞性肺疾病（COPD）的晚期被分离出来。
我们的研究目的是确定在 COPD 加重住院期间分离出 PA 是否与出院后的预后较差有关。
我们前瞻性研究了 2003 年 6 月至 2004 年 9 月期间因 COPD 加重而入院的所有患者。入院时获得痰培养。研究了先前与 COPD 死亡率相关的合并症、功能依赖、前一年的住院次数、呼吸困难、生活质量和其他变量。出院后 1 个月进行了肺量计和 6 分钟步行试验。出院后 3 年评估死亡率。
共纳入 181 例患者。其中，29 例（16%）痰中检出 PA。平均年龄为 72 岁，基础支气管扩张剂后用力呼气 1 秒率为预计值的 45.2%（SD 14.4）。BODE 指数的平均得分点为 5.1（SD 2.5）。3 年后，PA 组 29 例患者中有 17 例（58.6%）死亡，而 152 例非 PA 患者中有 53 例[34.9%；p <0.004；风险比（HR）2.23，95%置信区间（CI）1.29-3.86]。多变量分析表明，在调整年龄（p<0.02；HR 1.04，95%CI 1.007-1.07）、BODE 指数（p<0.02；HR 1.15，95%CI 1.02-1.3）和合并症（p<0.02；HR 1.24，95%CI 1.03-1.5）后，PA 与出院后 3 年死亡率仍呈统计学相关。
在因 COPD 急性加重而住院的患者的痰中分离出 PA 是 3 年死亡率的预后标志物。不良预后独立于其他重要的死亡率预测因素，如 BODE 指数、年龄和 Charlson 指数测量的合并症。
