VanDevanter Donald R, Pasta David J, Konstan Michael W
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
ICON Clinical Research, San Francisco, CA, USA.
J Cyst Fibros. 2015 Nov;14(6):763-9. doi: 10.1016/j.jcf.2015.02.007. Epub 2015 Mar 6.
Pulmonary exacerbations (PEx) are important CF clinical events.
We studied time to next PEx following intravenous (IV) antibiotic PEx treatment among Cleveland Ohio CF center patients occurring between January 2010 and September 2014. Patient demographics, clinical presentations, and treatments were modeled by Cox proportional hazards regression to identify covariates associated with time to next PEx.
193 patients were treated for PEx; 155 had a subsequent IV-treated PEx. Six covariates were associated with future PEx hazard: number of PEx in the prior year (hazard ratio 25.1 for ≥3 and 4.4 for 1-2 prior-year PEx versus none; P<.0001), IV treatment duration in weeks (1.2; P=.0004), percent hospital treatment (1.1; P=.0018), and chronic inhaled aminoglycosides (2.5; P<.0001), leukotriene modifiers (1.8; P=.0031), and high dose ibuprofen (0.52; P=.0006).
Time to next PEx was profoundly associated with prior-year PEx, suggestive of high-risk PEx phenotypes that warrant recognition and further study.
肺部加重（PEx）是重要的囊性纤维化（CF）临床事件。
我们研究了2010年1月至2014年9月期间俄亥俄州克利夫兰CF中心患者在接受静脉（IV）抗生素治疗PEx后至下一次PEx的时间。通过Cox比例风险回归对患者人口统计学、临床表现和治疗进行建模，以确定与至下一次PEx时间相关的协变量。
193例患者接受了PEx治疗；155例随后接受了IV治疗的PEx。六个协变量与未来PEx风险相关：前一年的PEx次数（前一年≥3次的风险比为25.1，1 - 2次的风险比为4.4，而无PEx者为1；P <.0001）、以周为单位的IV治疗持续时间（1.2；P =.0004）、住院治疗百分比（1.1；P =.0018）、慢性吸入氨基糖苷类药物（2.5；P <.0001）、白三烯调节剂（1.8；P =.0031）和高剂量布洛芬（0.52；P =.0006）。
至下一次PEx的时间与前一年的PEx密切相关，提示存在需要识别和进一步研究的高风险PEx表型。
