Pascual-Guardia Sergi, Badenes-Bonet Diana, Martin-Ontiyuelo Clara, Zuccarino Flavio, Marín-Corral Judith, Rodríguez Alejandro, Barreiro Esther, Gea Joaquim
Department of Respiratory Medicine, Hospital del Mar-IMIM, Barcelona, Spain.
Department CEXS, Universitat Pompeu Fabra, Barcelona, Spain.
Int J Chron Obstruct Pulmon Dis. 2017 Jun 21;12:1837-1845. doi: 10.2147/COPD.S129213. eCollection 2017.
Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known.
To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF.
Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers).
From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th-75th percentiles, 2-8] vs 3 [1-6] admissions, <0.01; 12 [6-30] vs 9 [6-18] days, <0.05; and 50 vs 32.1% deaths, <0.01, respectively). The risk of dying in the two following years was also higher in VCF patients (odds ratio: 2.11 [1.2-3.6], <0.01). The validation cohort consisted of 250 patients who showed very similar results. The logistic regression analysis indicated that both VCF and age were factors independently associated with mortality.
Although VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.
椎体压缩性骨折（VCF）在慢性阻塞性肺疾病（COPD）患者中很常见，骨质疏松是主要原因。VCF的临床影响主要源于疼痛和胸廓畸形，这可能导致通气和身体活动受限。令人惊讶的是，VCF对医院护理质量结果的影响却鲜为人知。
评估因慢性阻塞性肺疾病急性加重（ECOPD）住院且患有VCF的患者的这些指标。
在两个为期一年的时间段内评估临床特征和质量护理指标，一个是回顾性（探索性）的，一个是前瞻性（验证性）的，针对所有因ECOPD连续住院的患者。VCF的诊断基于标准胸部侧位X线片评估的椎体高度降低>20%（由三名独立观察者进行）。
在探索性阶段收治的248例患者中，三分之一至少有一处VCF。漏诊率为97.6%，与无VCF的患者相比，有VCF的患者入院次数更多（根据生存率进行标准化）、住院时间更长且死亡率更高（4次[第25 - 75百分位数，2 - 8次] vs 3次[1 - 6次]入院，<0.01；12天[6 - 30天] vs 9天[6 - 18天]，<0.05；死亡率分别为50% vs 32.1%，<0.01）。VCF患者在接下来两年内死亡的风险也更高（比值比：2.11[1.2 - 3.6]，<0.01）。验证队列由250例患者组成，结果非常相似。逻辑回归分析表明，VCF和年龄都是与死亡率独立相关的因素。
尽管在因ECOPD住院的患者中VCF经常被漏诊，但它与更差的预后和质量护理结果密切相关。
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