Li Lok Sze Katrina, Caughey Gillian, Johnston Kylie
School of Health Sciences (Ms Li and Dr Johnston), and School of Pharmacy and Medical Sciences (Dr Caughey), University of South Australia, Adelaide, Australia.
J Cardiopulm Rehabil Prev. 2014 Nov-Dec;34(6):430-6. doi: 10.1097/HCR.0000000000000080.
Comorbid conditions are common in people with chronic obstructive pulmonary disease (COPD) and may affect therapeutic management. The aim of this study was to examine the association of comorbidity in people with COPD with referral to a pulmonary rehabilitation (PR) program.
An analysis of data was conducted from an observational study of 88 people admitted to hospital with a primary diagnosis of COPD. Demographic and admission-related data were extracted and comorbidity scores (Charlson and Rx-Risk-V) were calculated.
Total comorbidity scores were not associated with referral to PR; however specific comorbid conditions were. The presence of anxiety (from medical records) was more frequent in those referred to PR (χ = 4.20; P = .04; OR, 7.0; 95% CI, 0.8-59.0). The presence of hypertension (as determined by Rx-Risk-V) was more likely to result in PR referral (χ = 6.69; P = .01; OR, 6.8; 95% CI, 1.6-29.1), and, in those with arrhythmia, PR referral was less likely (χ = 4.22; P = .04; OR, 0.28; 95% CI, 0.08-0.99). Patients who had been referred to PR had lower forced expiratory volume in 1 second (FEV1 percent predicted) (P < .001) and greater hospital bed days in previous 3 years (P = .051). In a multivariate analysis, FEV1 percent predicted, bed days in the last 3 years, and Rx-Risk-V categories of hypertension and arrhythmia accounted for 25% of variance in referral to PR.
In addition to COPD disease severity and hospital utilization, specific comorbidities identified with a comprehensive system (ie, the Rx-Risk score) were associated with referral to PR in this sample.
合并症在慢性阻塞性肺疾病（COPD）患者中很常见，可能会影响治疗管理。本研究的目的是探讨COPD患者的合并症与转介至肺康复（PR）项目之间的关联。
对88例以COPD为主要诊断入院的患者进行观察性研究，并对数据进行分析。提取人口统计学和入院相关数据，并计算合并症评分（Charlson和Rx-Risk-V）。
合并症总分与转介至PR无关；然而，特定的合并症则有关联。在转介至PR的患者中，焦虑症（根据病历记录）的发生率更高（χ=4.20；P=0.04；OR，7.0；95%CI，0.8-59.0）。高血压（由Rx-Risk-V确定）的存在更有可能导致转介至PR（χ=6.69；P=0.01；OR，6.8；95%CI，1.6-29.1），而对于有心律失常的患者，转介至PR的可能性较小（χ=4.22；P=0.04；OR，0.28；95%CI，0.08-0.99）。转介至PR的患者1秒用力呼气量（FEV1预测百分比）较低（P<0.001），且过去3年的住院天数较多（P=0.051）。在多变量分析中，FEV1预测百分比、过去3年的住院天数以及高血压和心律失常的Rx-Risk-V类别占转介至PR差异的25%。
在本样本中，除了COPD疾病严重程度和医院利用率外，通过综合系统（即Rx-Risk评分）确定的特定合并症与转介至PR有关。
