Pulmonary Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain.
Network and Health Services Research Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain.
BMC Pulm Med. 2018 Jan 25;18(1):18. doi: 10.1186/s12890-018-0574-z.
Hospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Identifying factors related to mortality 1 year after hospitalization could help determine interventions to reduce mortality.
In a prospective, observational, multicentre study, we evaluated data from two cohorts: the Spanish audit of hospital COPD exacerbation care (our derivation sample) and the Spanish cohort of the European audit of COPD exacerbation care (our validation sample). The endpoint was all-cause mortality. Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain.
In the multivariate analysis, factors independently related to an increase in mortality were older age, cardio-cerebro-vascular and/or dementia comorbidities, PaCO2 > 55 mmHg measured at emergency department arrival, hospitalizations for COPD exacerbations in the previous year, and hospital characteristics. The area under the receiver-operating curve for this model was 0.75 in the derivation cohort and 0.76 in the validation cohort.
One-year mortality following the index hospitalization for an exacerbation of COPD was related to clinical characteristics of the patient and of the index event, previous events of similar severity, and characteristics of the hospital where the patient was treated.
COPD（慢性阻塞性肺疾病）重度加重住院是 COPD 自然病程中的一个重要事件。确定与住院后 1 年死亡率相关的因素有助于确定降低死亡率的干预措施。
在一项前瞻性、观察性、多中心研究中，我们评估了来自两个队列的数据：西班牙 COPD 加重护理审核（我们的推导样本）和欧洲 COPD 加重护理审核的西班牙队列（我们的验证样本）。终点是全因死亡率。死亡率由参与医院的当地研究经理确定，并与西班牙的官方国家索引记录相匹配。
在多变量分析中，与死亡率增加相关的独立因素是年龄较大、心肺血管和/或痴呆合并症、急诊科到达时 PaCO2>55mmHg、前一年 COPD 加重住院以及医院特征。该模型在推导队列中的受试者工作特征曲线下面积为 0.75，在验证队列中为 0.76。
COPD 加重住院后的 1 年死亡率与患者和指数事件的临床特征、类似严重程度的先前事件以及患者接受治疗的医院特征有关。
