Blumenthal James A, Smith Patrick J, Durheim Michael, Mabe Stephanie, Emery Charles F, Martinu Tereza, Diaz Philip T, Babyak Michael, Welty-Wolf Karen, Palmer Scott
From the Departments of Psychiatry and Behavioral Sciences (Blumenthal, Smith, Mabe, Babyak) and Medicine (Durheim, Martinu, Welty-Wolf, Palmer), Duke University Medical Center, Durham, North Carolina; and Departments of Psychology (Emery) and Medicine (Diaz), Ohio State University, Columbus, Ohio.
Psychosom Med. 2016 Feb-Mar;78(2):153-62. doi: 10.1097/PSY.0000000000000260.
To examine the prognostic value of select biobehavioral factors in patients with chronic obstructive pulmonary disease (COPD) in a secondary analysis of participants from the INSPIRE-II trial.
Three hundred twenty-six outpatients with COPD underwent assessments of pulmonary function, physical activity, body mass index, inflammation, pulmonary symptoms, depression, and pulmonary quality of life and were followed up for up to 5.4 years for subsequent clinical events. The prognostic value of each biobehavioral factor, considered individually and combined, also was examined in the context of existing Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 risk stratification.
Sixty-nine individuals experienced a hospitalization or died over a mean follow-up period of 2.4 (interquartile range = 1.6) years. GOLD classification was associated with an increased risk of clinical events (hazard ratio [HR] = 2.72 [95% confidence interval = 1.63-4.54], per stage); 6-minute walk (HR = 0.50 [0.34-0.73] per 500 ft), total steps (HR = 0.82 [0.71-0.94] per 1000 steps), high-sensitivity C-reactive protein (HR = 1.44 [1.01-2.06] per 4.5 mg/l), depression (HR = 1.12 [1.01-1.25] per 4 points), and pulmonary quality of life (HR = 1.73 [1.14-2.63] per 25 points) were each predictive over and above the GOLD assessment. However, only GOLD group and 6-minute walk were predictive of all-cause mortality and COPD hospitalization when all biobehavioral variables were included together in a multivariable model.
Biobehavioral factors provide added prognostic information over and above measures of COPD severity in predicting adverse events in patients with COPD.
在对INSPIRE-II试验参与者进行的二次分析中，研究特定生物行为因素对慢性阻塞性肺疾病（COPD）患者的预后价值。
326例COPD门诊患者接受了肺功能、身体活动、体重指数、炎症、肺部症状、抑郁及肺生活质量评估，并随访长达5.4年以观察后续临床事件。还在现有的慢性阻塞性肺疾病全球倡议（GOLD）2011风险分层背景下，单独及综合考量了各生物行为因素的预后价值。
在平均2.4年（四分位间距=1.6）的随访期内，69例患者出现住院或死亡。GOLD分级与临床事件风险增加相关（风险比[HR]=2.72[95%置信区间=1.63 - 4.54]，每升高一个阶段）；6分钟步行距离（每500英尺HR=0.50[0.34 - 0.73]）、总步数（每1000步HR=0.82[0.71 - 0.94]）、高敏C反应蛋白（每4.5mg/l HR=1.44[1.01 - 2.06]）、抑郁（每4分HR=1.12[1.01 - 1.25]）及肺生活质量（每25分HR=1.73[1.14 - 2.63]）在GOLD评估之外均具有预测价值。然而，当所有生物行为变量纳入多变量模型时，仅GOLD分组和6分钟步行距离可预测全因死亡率及COPD住院情况。
在预测COPD患者不良事件方面，生物行为因素在COPD严重程度测量之外还提供了额外的预后信息。
