贫血对重度慢性阻塞性肺疾病急性加重期短期生存的影响：一项队列研究
Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study.
作者信息
Ergan Begum, Ergün Recai
机构信息
Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
Medical Intensive Care Unit, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey.
出版信息
Int J Chron Obstruct Pulmon Dis. 2016 Aug 1;11:1775-83. doi: 10.2147/COPD.S111758. eCollection 2016.
PURPOSE
Anemia is reported to be an independent predictor of hospitalizations and survival in COPD. However, little is known of its impact on short-term survival during severe COPD exacerbations. The primary objective of this study was to determine whether the presence of anemia increases the risk of death in acute respiratory failure due to severe COPD exacerbations.
PATIENTS AND METHODS
Consecutive patients with COPD exacerbation who were admitted to the intensive care unit with the diagnosis of acute respiratory failure and required either invasive or noninvasive ventilation (NIV) were analyzed.
RESULTS
A total of 106 patients (78.3% male; median age 71 years) were included in the study; of them 22 (20.8%) needed invasive ventilation immediately and 84 (79.2%) were treated with NIV. NIV failure was observed in 38 patients. Anemia was present in 50% of patients, and 39 patients (36.8%) died during hospital stay. When compared to nonanemic patients, hospital mortality was significantly higher in the anemic group (20.8% vs 52.8%, respectively; P=0.001). Stepwise multivariate logistic regression analysis showed that presence of anemia and NIV failure were independent predictors of hospital mortality with odds ratios (95% confidence interval) of 3.99 ([1.39-11.40]; P=0.010) and 2.56 ([1.60-4.09]; P<0.001), respectively. Anemia was not associated with long-term survival in this cohort.
CONCLUSION
Anemia may be a risk factor for hospital death in severe COPD exacerbations requiring mechanical ventilatory support.
目的
据报道，贫血是慢性阻塞性肺疾病（COPD）患者住院和生存的独立预测因素。然而，关于其对严重COPD急性加重期短期生存的影响知之甚少。本研究的主要目的是确定贫血是否会增加严重COPD急性加重导致的急性呼吸衰竭患者的死亡风险。
患者与方法
对因急性呼吸衰竭诊断而入住重症监护病房且需要有创或无创通气（NIV）的连续性COPD急性加重患者进行分析。
结果
本研究共纳入106例患者（男性占78.3%；中位年龄71岁）；其中22例（20.8%）立即需要有创通气，84例（79.2%）接受NIV治疗。38例患者出现NIV失败。50%的患者存在贫血，39例（36.8%）患者在住院期间死亡。与非贫血患者相比，贫血组的医院死亡率显著更高（分别为20.8%和52.8%；P = 0.001）。逐步多因素逻辑回归分析显示，贫血和NIV失败是医院死亡率的独立预测因素，比值比（95%置信区间）分别为3.99（[1.39 - 11.40]；P = 0.010）和2.56（[1.60 - 4.09]；P < 0.001）。在该队列中，贫血与长期生存无关。
结论
贫血可能是需要机械通气支持的严重COPD急性加重患者医院死亡的危险因素。
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