Institute of Social and Preventive Medicine, Department of Epidemiology, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland; Institute of General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
Horten Centre for Patient-Oriented Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
J Clin Epidemiol. 2014 Aug;67(8):904-11. doi: 10.1016/j.jclinepi.2014.03.005. Epub 2014 Apr 29.
This study aimed to identify those comorbidities with greatest impact on patient-reported health status in patients with chronic obstructive pulmonary disease (COPD) and to develop a comorbidity index that reflects their combined impact.
We included 408 Swiss and Dutch primary care patients with COPD from the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) in this cross-sectional analysis. Primary outcome was the Feeling Thermometer, a patient-reported health status instrument. We assessed the impact of comorbidities at five cohort assessment times using multiple linear regression adjusted for FEV1, retaining comorbidities with associations P ≤ 0.1. We developed an index that reflects strength of association of comorbidities with health status.
Depression (prevalence: 13.0%; regression coefficient: -9.00; 95% CI: -13.52, -4.48), anxiety (prevalence: 11.8%; regression coefficient: -5.53; 95% CI -10.25, -0.81), peripheral artery disease (prevalence: 6.4%; regression coefficient: -5.02; 95% CI-10.64, 0.60), cerebrovascular disease (prevalence: 8.8%; regression coefficient: -4.57; 95% CI -9.43, 0.29), and symptomatic heart disease (prevalence: 20.3%; regression coefficient: -3.81; 95% CI -7.23, -0.39) were most strongly associated with the Feeling Thermometer. These five comorbidities, weighted, compose the COMorbidities in Chronic Obstructive Lung Disease (COMCOLD) index.
The COMCOLD index reflects the combined impact of five important comorbidities from patients' perspective and complements existing comorbidity indices that predict death. It may help clinicians focus on comorbidities affecting patients' health status the most.
本研究旨在确定对慢性阻塞性肺疾病（COPD）患者报告健康状况影响最大的合并症，并开发一种反映其综合影响的合并症指数。
我们对来自国际慢性阻塞性肺疾病协作努力：加重风险指数队列（ICE COLD ERIC）的 408 名瑞士和荷兰初级保健 COPD 患者进行了这项横断面分析。主要结局是患者报告健康状况的体温计。我们使用多元线性回归在 FEV1 调整后，在五个队列评估时间评估合并症的影响，保留与健康状况关联 P≤0.1 的合并症。我们开发了一个反映合并症与健康状况关联强度的指数。
抑郁（患病率：13.0%；回归系数：-9.00；95%置信区间：-13.52，-4.48）、焦虑（患病率：11.8%；回归系数：-5.53；95%置信区间：-10.25，-0.81）、外周动脉疾病（患病率：6.4%；回归系数：-5.02；95%置信区间：-10.64，0.60）、脑血管疾病（患病率：8.8%；回归系数：-4.57；95%置信区间：-9.43，0.29）和有症状的心脏病（患病率：20.3%；回归系数：-3.81；95%置信区间：-7.23，-0.39）与体温计最密切相关。这五种合并症，加权后，构成慢性阻塞性肺疾病合并症（COMCOLD）指数。
COMCOLD 指数从患者的角度反映了五种重要合并症的综合影响，补充了预测死亡的现有合并症指数。它可以帮助临床医生更关注影响患者健康状况的合并症。
