Internal Medicine Service, Hospital Universitario Mutua De Terrassa, Barcelona.
Internal Medicine Service, Hospital General Universitario Gregorio Marañón, Madrid.
Chest. 2012 Nov;142(5):1126-1133. doi: 10.1378/chest.11-2413.
Comorbidities are frequent in patients hospitalized for COPD exacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge.
A longitudinal, observational, multicenter study of patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge.
We studied 606 patients, 594 men (89.9%), with a mean (SD) age of 72.6 (9.9) years and a postbronchodilator FEV1 of 43.2% (21.2). The mean Charlson index score was 3.1 (2.0). On admission, 63.4% of patients had arterial hypertension, 35.8% diabetes mellitus, 32.8% chronic heart failure, 20.8% ischemic heart disease, 19.3% anemia, and 34% dyslipemia. Twenty-seven patients (4.5%) died within 3 months. The Charlson index was an independent predictor of mortality (P < .003; OR,1.23; 95% CI, 1.07-1.40), even after adjustment for age, FEV1, and functional status measured with the Katz index. Comorbidity was also related with the need for hospitalization from the ED, length of stay, and hospital readmissions for COPD or other causes.
Comorbidities are common in patients hospitalized for a COPD exacerbation, and they are related to short-term prognosis.
合并症在因 COPD 加重而住院的患者中很常见，但它们与短期死亡率和再入院之间的关系知之甚少。我们的假设是，合并症的频率和类型会在出院后 12 周内影响预后。
对经肺功能检查证实患有 COPD 加重且接受住院治疗的患者进行了一项纵向、观察性、多中心研究。使用 Charlson 指数和一份包含该指数中未包含的其他常见疾病的问卷收集合并症信息。研究了呼吸困难、功能状态以及因 COPD 或其他原因住院等其他变量。收集了出院后 3 个月内的死亡率和因 COPD 或其他原因再入院的信息。
我们研究了 606 名患者，其中 594 名男性（89.9%），平均（标准差）年龄为 72.6（9.9）岁，支气管扩张剂后 FEV1 为 43.2%（21.2）。Charlson 指数平均得分为 3.1（2.0）。入院时，63.4%的患者有动脉高血压，35.8%有糖尿病，32.8%有慢性心力衰竭，20.8%有缺血性心脏病，19.3%有贫血，34%有血脂异常。出院后 3 个月内有 27 名患者（4.5%）死亡。Charlson 指数是死亡率的独立预测因子（P <.003；OR，1.23；95% CI，1.07-1.40），即使在校正了年龄、FEV1 和用 Katz 指数测量的功能状态后也是如此。合并症也与需要从急诊室住院、住院时间以及因 COPD 或其他原因再次住院有关。
在因 COPD 加重而住院的患者中，合并症很常见，并且与短期预后有关。
