Duffy Sean, Barnett Shari, Civic Brian, Mamary A James, Criner Gerard J
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
Chronic Obstr Pulm Dis. 2015 Jan 1;2(1):17-22. doi: 10.15326/jcopdf.2.1.2014.0129.
Chronic obstructive pulmonary disease (COPD) hospitalizations increase short and long-term mortality; multiple COPD hospitalizations track with even higher mortality. While comorbidities such as coronary artery disease (CAD) and congestive heart failure (CHF) are common in COPD, their contribution to mortality risk after a sentinel COPD hospitalization is unknown. Assess the effect on mortality of comorbid conditions prompting rehospitalization following COPD exacerbation hospitalization. We performed a retrospective cohort analysis of patients hospitalized for COPD exacerbations in Pennsylvania from 1990-2010 using the Pennsylvania Health Care Cost Containment Council (PHC4) database. We included patients > 40 years old hospitalized for an acute exacerbation of COPD (AECOPD; International Classification of Diseases-Ninth Edition, [ICD-9] #491, 492, 496) by discharge diagnosis. Thirty-day mortality in patients with COPD hospitalization for acute exacerbation who were rehospitalized for COPD < 30days post-discharge was compared to those primarily readmitted for comorbid conditions. Relative risk of death after readmission was determined by diagnosis. Primary end-point was mortality 30 days post-readmission for 14 most common non-COPD diagnoses, including heart failure, pneumonia, pulmonary embolus (PE), and myocardial infarction. Patients were nearly 2 times more likely to die within 30 days when readmitted for pneumonia (p<0.0001) or myocardial infarction (p<0.0001) rather than COPD. Septicemia conferred the highest mortality. COPD patients rehospitalized for comorbid conditions such as myocardial infarction, pneumonia, septicemia or pulmonary heart disease (includes PE) were significantly more likely to die within 30 days than patients readmitted for COPD. Great emphasis is already placed on preventing COPD rehospitalization; however, more attention should focus on preemptive risk reduction for comorbidities in COPD patients.
慢性阻塞性肺疾病（COPD）住院会增加短期和长期死亡率；多次COPD住院的患者死亡率更高。虽然冠状动脉疾病（CAD）和充血性心力衰竭（CHF）等合并症在COPD患者中很常见，但在首次COPD住院后，它们对死亡风险的影响尚不清楚。评估COPD急性加重住院后因合并症再次住院对死亡率的影响。我们使用宾夕法尼亚医疗成本控制委员会（PHC4）数据库，对1990年至2010年在宾夕法尼亚因COPD急性加重住院的患者进行了回顾性队列分析。我们纳入了出院诊断为COPD急性加重（AECOPD；国际疾病分类第九版，[ICD-9]#491、492、496）且年龄大于40岁的患者。将出院后30天内因COPD再次住院的COPD急性加重住院患者与主要因合并症再次住院的患者的30天死亡率进行比较。再次入院后的死亡相对风险由诊断确定。主要终点是再次入院后30天内14种最常见的非COPD诊断（包括心力衰竭、肺炎、肺栓塞[PE]和心肌梗死）的死亡率。因肺炎（p<0.0001）或心肌梗死（p<0.0001）而非COPD再次入院的患者在30天内死亡的可能性几乎是前者的2倍。败血症的死亡率最高。因心肌梗死、肺炎、败血症或肺心病（包括PE）等合并症再次住院的COPD患者在30天内死亡的可能性明显高于因COPD再次入院的患者。目前已经非常重视预防COPD再次住院；然而，应更多地关注COPD患者合并症的预防性风险降低。
