Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Respiration. 2013;85(1):15-26. doi: 10.1159/000342036. Epub 2012 Oct 2.
Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are related to high mortality, especially in hospitalized patients. Predictors for severe outcomes are still not sufficiently defined.
To assess the mortality rate and identify potential determinants of mortality in a cohort of patients hospitalized for AE-COPD.
A retrospective, observational cohort study including all consecutive patients admitted between January 1, 2009, and April 1, 2010, for AE-COPD. Potential predictors were assessed at initial presentation at the emergency room. The primary outcome was mortality during 1-year follow-up. Univariate and multivariate time-to-event analyses using Cox proportional hazard models were employed for statistical analysis.
A total of 260 patients were enrolled in this study. Mean age was 70.5 ± 10.8 years, 50.0% were male and 63.4% had severe COPD. The in-hospital mortality rate was 5.8% and the 1-year mortality rate was 27.7%. Independent risk factors for mortality were age [hazard ratio (HR) = 1.04; 95% confidence interval (CI) = 1.01-1.07], male sex (HR = 2.00; 95% CI = 1.15-3.48), prior hospitalization for AE-COPD in the last 2 years (HR = 2.56; 95% CI = 1.52-4.30), prior recorded congestive heart failure (HR = 1.75; 95% CI = 1.03-2.97), PaCO₂ ≥6.0 kPa (HR = 2.90; 95% CI = 1.65-5.09) and urea ≥8.0 mmol/l (HR = 2.38; 95% CI = 1.42-3.99) at admission.
Age, male sex, prior hospitalization for AE-COPD in the last 2 years, prior recorded congestive heart failure, hypercapnia and elevated levels of urea at hospital admission are independent predictors of mortality within the first year after admission.
慢性阻塞性肺疾病（COPD）急性加重（AE-COPD）与高死亡率相关，尤其是在住院患者中。严重结局的预测因素仍未得到充分明确。
评估住院 COPD 急性加重患者的死亡率，并确定死亡的潜在决定因素。
这是一项回顾性、观察性队列研究，纳入了 2009 年 1 月 1 日至 2010 年 4 月 1 日期间因 AE-COPD 住院的所有连续患者。在急诊室初始就诊时评估潜在预测因素。主要结局为 1 年随访期间的死亡率。采用 Cox 比例风险模型进行单变量和多变量时间事件分析。
这项研究共纳入了 260 名患者。平均年龄为 70.5 ± 10.8 岁，50.0%为男性，63.4%患有严重 COPD。住院期间的死亡率为 5.8%，1 年死亡率为 27.7%。死亡率的独立危险因素包括年龄[风险比（HR）=1.04；95%置信区间（CI）=1.01-1.07]、男性（HR=2.00；95%CI=1.15-3.48）、过去 2 年内因 AE-COPD 住院（HR=2.56；95%CI=1.52-4.30）、既往记录的充血性心力衰竭（HR=1.75；95%CI=1.03-2.97）、入院时 PaCO₂≥6.0 kPa（HR=2.90；95%CI=1.65-5.09）和尿素≥8.0 mmol/l（HR=2.38；95%CI=1.42-3.99）。
年龄、男性、过去 2 年内因 AE-COPD 住院、既往记录的充血性心力衰竭、入院时高碳酸血症和尿素水平升高是入院后 1 年内死亡的独立预测因素。
