慢性阻塞性肺疾病（COPD）加重住院后的长期生存：与普通人群的比较。
Long term survival after admission for COPD exacerbation: A comparison with the general population.
机构信息
Department of Pulmonary Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands; Department of Pulmonary Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Respiratory Medicine/Center of Home Mechanical Ventilation, Maastricht University Medical Center (MUMC), P. Debeyelaan 25, 6229 HX, Maastricht, The Netherlands.
出版信息
Respir Med. 2018 Apr;137:77-82. doi: 10.1016/j.rmed.2018.02.015. Epub 2018 Feb 24.
BACKGROUND AND OBJECTIVE
Life expectancy data of COPD patients in comparison to the general population are primarily based upon long-term population cohort studies. These studies are limited by a poor definition of clinically significant COPD. The key element in the course of COPD is a clinical exacerbation. Therefore, this study investigated 15-year survival following hospitalization for an exacerbation of COPD in comparison to the general population.
METHODS
A number of 4229 subjects was studied, including 845 hospitalized COPD patients and 3384 age and sex matched controls. Mortality risks were assessed using Kaplan-Meier survival curves, and hazard rate ratios for death were estimated using Cox proportional hazards regression models, for each Gold Class separately.
RESULTS
Overall 15-year survival was 7.3% in the COPD group and 40.6% in the general population. Survival was 24%, 11.1%, 5.3% and 0% for COPD GOLD I-IV. The mean life expectancy following hospitalization was 9.7, 7.1, 6.1 and 3.4 years for stage GOLD I-IV and 10.2 years for the general population. Overall, negative prognostic factors were age, male gender, low FEV1, low TLCO, respiratory insufficiency, Charlson comorbidity class, ICU-admission and exacerbation frequency. Factors differed among GOLD stages.
CONCLUSIONS
The 15-year survival for hospitalized COPD patients is reduced by 82% in comparison to the general population. This indicates a more deleterious course of clinically significant COPD in comparison to population cohorts. As such, every possible effort should be taken to reduce exacerbations in a personalized way.
背景与目的
关于慢性阻塞性肺疾病（COPD）患者的预期寿命数据，主要基于长期人群队列研究。这些研究受到 COPD 临床定义不佳的限制。COPD 病程的关键因素是临床加重。因此，本研究调查了因 COPD 加重而住院的患者与普通人群相比 15 年的生存率。
方法
研究纳入了 4229 名受试者，包括 845 名住院 COPD 患者和 3384 名年龄和性别匹配的对照者。使用 Kaplan-Meier 生存曲线评估死亡率，使用 Cox 比例风险回归模型分别估计每个 Gold 分级的死亡风险比。
结果
COPD 组的总体 15 年生存率为 7.3%，普通人群为 40.6%。COPD Gold I-IV 组的生存率分别为 24%、11.1%、5.3%和 0%。COPD Gold I-IV 组患者住院后平均预期寿命分别为 9.7、7.1、6.1 和 3.4 年，普通人群为 10.2 年。总体而言，负性预后因素包括年龄、男性、低 FEV1、低 TLCO、呼吸衰竭、Charlson 合并症评分、入住 ICU 和加重频率。这些因素在不同的 Gold 分期中存在差异。
结论
与普通人群相比，住院 COPD 患者的 15 年生存率降低了 82%。这表明与人群队列相比，有临床意义的 COPD 病程更具危害性。因此，应尽一切可能采取个性化措施来减少加重。
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