Medina-Mirapeix Francesc, Bernabeu-Mora Roberto, García-Guillamón Gloria, Valera Novella Elisa, Gacto-Sánchez Mariano, García-Vidal José Antonio
Department of Physical Therapy, Universidad of Murcia, Murcia, Spain.
Division of Pneumology, Hospital Morales Meseguer, Murcia, Spain.
PLoS One. 2016 Jun 14;11(6):e0157377. doi: 10.1371/journal.pone.0157377. eCollection 2016.
Hospitalization for acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) is common, but little is known about the impact of hospitalization on the development of disability. The purpose of this study was to determine the rate and time course of functional changes 3 months after hospital discharge for AE-COPD compared with baseline levels 2 weeks before admission, and to identify predictors of functional decline.
This was a prospective study including 103 patients (age mean, 71 years; standard deviation, 9.1 years) who were hospitalized with AE-COPD. Number of dependencies in Activities of Daily Living (ADLs) was measured at the preadmission baseline and at weeks 6 and 12 after discharge. Patterns of improvement, no change, and decline were defined over 3 consecutive intervals (baseline and weeks 6 and 12). Trajectories grouped patients with similar time courses of disability. Recovery was defined as returning to baseline function after functional decline. Univariate and multivariate multiple logistic regression was used to determine predictors of functional decline after week 12.
Six trajectories of functional changes were found. From baseline to 12 weeks, 50% of patients continued to have the same function whereas 31% experienced functional decline after 6 weeks; 16.7% recovered over subsequent weeks. At week 12, as a consequence of all trajectories, 38% of patients showed functional declines compared with baseline function, 57% had not declined, and 6 improved. Length of stay (odds ratio [OR] = 1.12;95% [confidence interval] CI 1.03-1.22), dyspnea (OR = 1.85; 95% CI 1.05-3.26), and frailty (OR = 3.97; 95% CI 1.13-13.92) were independent predictors of functional decline after 12 weeks.
Hospitalization for AE-COPD is a risk factor for the progression of disability. More than one third of patients hospitalized for AE-COPD declined during the 12 weeks following discharge, with most of this decline occurring by week 6.
慢性阻塞性肺疾病（COPD）急性加重（AE）导致的住院很常见，但关于住院对残疾发展的影响却知之甚少。本研究的目的是确定与入院前2周的基线水平相比，AE-COPD患者出院后3个月功能变化的速率和时间进程，并确定功能下降的预测因素。
这是一项前瞻性研究，纳入了103例因AE-COPD住院的患者（平均年龄71岁；标准差9.1岁）。在入院前基线以及出院后第6周和第12周测量日常生活活动（ADL）中的依赖项目数量。在连续3个时间段（基线以及第6周和第12周）定义改善、无变化和下降的模式。轨迹将具有相似残疾时间进程的患者分组。恢复定义为功能下降后恢复到基线功能。采用单因素和多因素多项逻辑回归来确定第12周后功能下降的预测因素。
发现了6种功能变化轨迹。从基线到12周，50%的患者功能持续不变，而31%的患者在6周后出现功能下降；16.7%的患者在随后几周恢复。在第12周时，综合所有轨迹来看，与基线功能相比，38%的患者出现功能下降，57%未下降，6例有所改善。住院时间（比值比[OR]=1.12；95%[置信区间]CI 1.03 - 1.22）、呼吸困难（OR = 1.85；95%CI 1.05 - 3.26）和衰弱（OR = 3.97；95%CI 1.13 - 13.92）是12周后功能下降的独立预测因素。
AE-COPD导致的住院是残疾进展的一个危险因素。超过三分之一因AE-COPD住院的患者在出院后的12周内出现功能下降，且大部分下降发生在第6周。
