Pavlov Nikolay, Haynes Alan Gary, Stucki Armin, Jüni Peter, Ott Sebastian Robert
Department of Pulmonary Medicine, University Hospital (Inselspital), University of Bern, Bern, Switzerland.
CTU Bern, University of Bern, Bern, Switzerland.
Int J Chron Obstruct Pulmon Dis. 2018 Mar 22;13:979-988. doi: 10.2147/COPD.S154749. eCollection 2018.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and is associated with a growing and substantial socioeconomic burden. Long-term oxygen therapy (LTOT), recommended by current treatment guidelines for COPD patients with severe chronic hypoxemia, has shown to reduce mortality in this population. The aim of our study was to assess the standardized mortality ratios of incident and prevalent LTOT users and to identify predictors of mortality.
We conducted a 2-year follow-up population-based cohort study comprising all COPD patients receiving LTOT in the canton of Bern, Switzerland. Comparing age- and sex-adjusted standardized mortality ratios, we examined associations between all-cause mortality and patient characteristics at baseline. To avoid immortal time bias, data for incident (receiving LTOT <6 months) and prevalent users were analyzed separately.
At baseline, 475 patients (20% incident users, n=93) were receiving LTOT because of COPD (48/100,000 inhabitants). Mortality of incident and prevalent LTOT users was 41% versus 27%, respectively, <0.007, and standardized mortality ratios were 8.02 (95% CI: 5.64-11.41) versus 5.90 (95% CI: 4.79-7.25), respectively. Type 2 respiratory failure was associated with higher standardized mortality ratios among incident LTOT users (60.57, 95% CI: 11.82-310.45, =0.038).
Two-year mortality rate of COPD patients on incident LTOT was somewhat lower in our study than in older cohorts but remained high compared to the general population, especially in younger patients receiving LTOT <6 months. Type 2 respiratory failure was associated with mortality.
慢性阻塞性肺疾病（COPD）是全球第四大致死原因，且与日益加重的巨大社会经济负担相关。长期氧疗（LTOT）是目前针对重度慢性低氧血症COPD患者的治疗指南所推荐的疗法，已证实可降低该人群的死亡率。我们研究的目的是评估新接受和已接受LTOT者的标准化死亡比，并确定死亡率的预测因素。
我们开展了一项为期2年的基于人群的队列研究，纳入了瑞士伯尔尼州所有接受LTOT的COPD患者。通过比较年龄和性别调整后的标准化死亡比，我们研究了全因死亡率与基线时患者特征之间的关联。为避免不朽时间偏倚，分别分析了新接受者（接受LTOT<6个月）和已接受者的数据。
基线时，475例患者（20%为新接受者，n = 93）因COPD接受LTOT（每10万居民中有48例）。新接受和已接受LTOT者的死亡率分别为41%和27%，P<0.007，标准化死亡比分别为8.02（95%CI：5.64 - 11.41）和5.90（95%CI：4.79 - 7.25）。在新接受LTOT者中，2型呼吸衰竭与更高的标准化死亡比相关（60.57，95%CI：11.82 - 310.45，P = 0.038）。
在我们的研究中，新接受LTOT的COPD患者的两年死亡率略低于较老队列，但与一般人群相比仍然较高，尤其是在接受LTOT<6个月的年轻患者中。2型呼吸衰竭与死亡率相关。
