Grolimund Eva, Kutz Alexander, Marlowe Robert J, Vögeli Alaadin, Alan Murat, Christ-Crain Mirjam, Thomann Robert, Falconnier Claudine, Hoess Claus, Henzen Christoph, Zimmerli Werner, Mueller Beat, Schuetz Philipp
1Medical University Clinic, Kantonsspital Aarau , Aarau , Switzerland.
COPD. 2015 Jun;12(3):295-305. doi: 10.3109/15412555.2014.949002. Epub 2014 Sep 17.
Long-term outcome prediction in COPD is challenging. We conducted a prospective 5-7-year follow-up study in patients with COPD to determine the association of exacerbation type, discharge levels of inflammatory biomarkers including procalctionin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and plasma proadrenomedullin (ProADM), alone or combined with demographic/clinical characteristics, with long-term all-cause mortality in the COPD setting. The analyzed cohort comprised 469 patients with index hospitalization for pneumonic (n = 252) or non-pneumonic (n = 217) COPD exacerbation. Five-to-seven-year vital status was ascertained via structured phone interviews with patients or their household members/primary care physicians. We investigated predictive accuracy using univariate and multivariate Cox regression models and area under the receiver operating characteristic curve (AUC). After a median [25th-75th percentile] 6.1 [5.6-6.5] years, mortality was 55% (95%CI 50%-59%). Discharge ProADM concentration was strongly associated with 5-7-year non-survival: adjusted hazard ratio (HR)/10-fold increase (95%CI) 10.4 (6.2-17.7). Weaker associations were found for PCT and no significant associations were found for CRP or WBC. Combining ProADM with demographic/clinical variables including age, smoking status, BMI, New York Heart Association dyspnea class, exacerbation type, and comorbidities significantly improved long-term predictive accuracy over that of the demographic/clinical model alone: AUC (95%CI) 0.745 (0.701-0.789) versus 0.727 (0.681-0.772), (p) = .043. In patients hospitalized for COPD exacerbation, discharge ProADM levels appeared to accurately predict 5-7-year all-cause mortality and to improve long-term prognostic accuracy of multidimensional demographic/clinical mortality risk assessment.
慢性阻塞性肺疾病（COPD）的长期预后预测具有挑战性。我们对COPD患者进行了一项为期5至7年的前瞻性随访研究，以确定单独或与人口统计学/临床特征相结合的加重类型、炎症生物标志物（包括降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）和血浆肾上腺髓质素原（ProADM））的出院水平与COPD环境中全因长期死亡率之间的关联。分析的队列包括469例因肺炎型（n = 252）或非肺炎型（n = 217）COPD加重而住院的患者。通过与患者或其家庭成员/初级保健医生进行结构化电话访谈来确定5至7年的生命状态。我们使用单变量和多变量Cox回归模型以及受试者操作特征曲线下面积（AUC）来研究预测准确性。在中位[第25 - 75百分位数]6.1[5.6 - 6.5]年后，死亡率为55%（95%CI 50% - 59%）。出院时ProADM浓度与5至7年生存率密切相关：调整后的风险比（HR）/增加10倍（95%CI）为10.4（6.2 - 17.7）。发现PCT的关联较弱，而CRP或WBC未发现显著关联。将ProADM与包括年龄、吸烟状况、体重指数、纽约心脏协会呼吸困难分级、加重类型和合并症在内的人口统计学/临床变量相结合，与仅使用人口统计学/临床模型相比，显著提高了长期预测准确性：AUC（95%CI）为0.745（0.701 - 0.789），而单独的人口统计学/临床模型为0.727（0.681 - 0.772），（p）= 0.043。在因COPD加重住院的患者中，出院时ProADM水平似乎能准确预测5至7年全因死亡率，并提高多维人口统计学/临床死亡风险评估的长期预后准确性。
