Hoogendoorn Martine, Feenstra Talitha L, Boland Melinde, Briggs Andrew H, Borg Sixten, Jansson Sven-Arne, Risebrough Nancy A, Slejko Julia F, Rutten-van Mölken Maureen Pmh
Institute for Medical Technology Assessment (iMTA)/Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands.
Department for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Int J Chron Obstruct Pulmon Dis. 2017 Nov 1;12:3183-3194. doi: 10.2147/COPD.S142378. eCollection 2017.
Exacerbations are important outcomes in COPD both from a clinical and an economic perspective. Most studies investigating predictors of exacerbations were performed in COPD patients participating in pharmacological clinical trials who usually have moderate to severe airflow obstruction. This study was aimed to investigate whether predictors of COPD exacerbations depend on the COPD population studied.
A network of COPD health economic modelers used data from five COPD data sources - two population-based studies (COPDGene and The Obstructive Lung Disease in Norrbotten), one primary care study (RECODE), and two studies in secondary care (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoint and UPLIFT) - to estimate and validate several prediction models for total and severe exacerbations (= hospitalization). The models differed in terms of predictors (depending on availability) and type of model.
FEV% predicted and previous exacerbations were significant predictors of total exacerbations in all five data sources. Disease-specific quality of life and gender were predictors in four out of four and three out of five data sources, respectively. Age was significant only in the two studies including secondary care patients. Other significant predictors of total exacerbations available in one database were: presence of cough and wheeze, pack-years, 6-min walking distance, inhaled corticosteroid use, and oxygen saturation. Predictors of severe exacerbations were in general the same as for total exacerbations, but in addition low body mass index, cardiovascular disease, and emphysema were significant predictors of hospitalization for an exacerbation in secondary care patients.
FEV% predicted, previous exacerbations, and disease-specific quality of life were predictors of exacerbations in patients regardless of their COPD severity, while age, low body mass index, cardiovascular disease, and emphysema seem to be predictors in secondary care patients only.
从临床和经济角度来看，急性加重都是慢性阻塞性肺疾病（COPD）的重要结局。大多数研究COPD急性加重预测因素的研究是在参与药物临床试验的COPD患者中进行的，这些患者通常存在中度至重度气流受限。本研究旨在调查COPD急性加重的预测因素是否取决于所研究的COPD人群。
一个COPD健康经济建模网络使用了来自五个COPD数据源的数据——两项基于人群的研究（COPDGene研究和北博滕阻塞性肺病研究）、一项初级保健研究（RECODE研究）以及两项二级保健研究（纵向评估COPD以识别预测替代终点研究和UPLIFT研究）——来估计和验证针对总体急性加重和严重急性加重（=住院）的几种预测模型。这些模型在预测因素（取决于数据可用性）和模型类型方面存在差异。
在所有五个数据源中，预测的第1秒用力呼气容积（FEV%）和既往急性加重是总体急性加重的重要预测因素。特定疾病的生活质量和性别分别在四个数据源中的四个和五个数据源中的三个中是预测因素。年龄仅在纳入二级保健患者的两项研究中具有显著性。在一个数据库中可用的总体急性加重的其他重要预测因素包括：咳嗽和喘息的存在、吸烟包年数、6分钟步行距离、吸入糖皮质激素的使用以及血氧饱和度。严重急性加重的预测因素总体上与总体急性加重相同，但此外，低体重指数、心血管疾病和肺气肿是二级保健患者急性加重住院的重要预测因素。
预测的FEV%、既往急性加重和特定疾病的生活质量是患者急性加重的预测因素，无论其COPD严重程度如何，而年龄、低体重指数、心血管疾病和肺气肿似乎仅在二级保健患者中是预测因素。
