Crisafulli Ernesto, Torres Antoni, Huerta Arturo, Méndez Raúl, Guerrero Mónica, Martinez Raquel, Liapikou Adamantia, Soler Néstor, Sethi Sanjay, Menéndez Rosario
1 Cardio-Thoracic Department, Pneumology and Respiratory Intensive Care Unit, "Carlo Poma" Hospital , Mantova , Italy.
COPD. 2015 Jun;12(3):306-14. doi: 10.3109/15412555.2014.933954. Epub 2014 Oct 3.
Recurrent hospitalizations in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients have clinical and economic consequences; particularly those readmitted soon after discharge. The aim of our observational study was to determine predictors of early readmission to hospital (30 days from discharge). Prospective data on 125 hospitalized AECOPD patients were collected over a 30-month period at two Spanish university hospitals. Based on readmission after discharge, patients were divided into non-readmitted (n = 96) and readmitted (n = 29). Measures of serum inflammatory biomarkers were recorded on admission to hospital, at day 3 and at discharge; data on clinical, laboratory, microbiological and severity features were also recorded. In a multivariate model, C-reactive protein (CRP) at discharge ≥ 7.6 mg/L, presence of diabetes and ≥ 1 hospitalization for AECOPD during previous year were significant risk factors for predicting readmission. Presence of all 3 risk factors perfectly identified the readmitted patients (positive and negative predictive values of 1.000; 95% CI, 1.00-1.00). A combination of 3 readily available clinical and biochemical parameters is accurate in identifying hospitalized AECOPD patients at risk for early readmission.
慢性阻塞性肺疾病急性加重期(AECOPD)患者的再次住院具有临床和经济后果;尤其是那些出院后不久就再次入院的患者。我们这项观察性研究的目的是确定早期再入院(出院后30天内)的预测因素。在西班牙的两家大学医院,我们在30个月的时间里收集了125例住院AECOPD患者的前瞻性数据。根据出院后的再入院情况,将患者分为未再入院组(n = 96)和再入院组(n = 29)。记录患者入院时、第3天和出院时血清炎症生物标志物的测量值;还记录了临床、实验室、微生物学和严重程度特征的数据。在多变量模型中,出院时C反应蛋白(CRP)≥7.6 mg/L、患有糖尿病以及前一年因AECOPD住院≥1次是预测再入院的显著危险因素。所有这3个危险因素的存在能完美识别再入院患者(阳性和阴性预测值均为1.000;95%可信区间,1.00 - 1.00)。3个易于获得的临床和生化参数的组合能准确识别有早期再入院风险的住院AECOPD患者。