慢性阻塞性肺疾病评估测试：在监测康复和预测加重后疾病不良进程方面的作用。

Chronic obstructive pulmonary disease assessment test: usefulness for monitoring recovery and predicting poor course of disease after exacerbations.

机构信息

Servicio de Urgencias, OSI-Barrualdea-Galdakao, Galdakao, Bizkaia. Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España. Unidad de Investigación, OSI Barrualde-Galdakao, Galdakao, Bizkaia. Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España.

Unidad de Investigación, OSI Barrualde-Galdakao, Galdakao, Bizkaia2 Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España.

出版信息

Emergencias. 2019 Feb;31(1):21-26.

PMID:30656869

Abstract

OBJECTIVES

To assess the usefulness of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) for evaluating recovery from an acute exacerbation of chronic COPD. To assess whether the CAT score used along with a COPD exacerbation severity scale can better predict risk of a poor course of disease.

METHODS

Prospective multicenter cohort study enrolling patients who attended hospital emergency departments with symptoms of exacerbated COPD. We recorded sociodemographic and clinical data and information from 2 questionnaires: the CAT and the modified dyspnea scale of the Medical Research Council (mMRC). Measures of clinical outcome in this study were the CAT score 2 months after the COPD exacerbation and poor course of disease during the hospital stay or 1 week after discharge from the emergency department if patients were not hospitalized.

RESULTS

The cohort included 501 patients. The median (interquartile range) CAT score was 13 (7-18) on the day before the exacerbation, 25 (19-30) during emergency care for the exacerbation, and 13 (7-18) 2 months later. The difference between the CAT scores before the exacerbation and 2 months later was not statistically significant when the cohort was stratified by severity of baseline COPD (mild, moderate, and severe/very severe) (P=.585, P=.419, and P=.4357). The short-term course of disease was poor for 91 patients (18.16%). Combining the mMRC and the CAT scores to predict poor short-term outcome gave an area under the receiver operating characteristic curve (AUC) of 0.701 (95% CI, 0.640-0.762). The AUC for the mMRC score without the CAT score was 0.667 (95% CI, 0.616- 0.737). The difference between the AUCs was not statistically significant (P=.088).

CONCLUSION

The CAT score may be useful for monitoring recovery from a COPD exacerbation. Combining the CAT score and a COPD severity score may be useful for predicting clinical course after an exacerbation.

摘要

目的

评估慢性阻塞性肺疾病（COPD）评估测试（CAT）在评估慢性 COPD 急性加重后的恢复情况中的作用。评估 CAT 评分与 COPD 加重严重程度量表联合使用是否能更好地预测疾病不良转归的风险。

方法

前瞻性多中心队列研究纳入因 COPD 加重症状而就诊于医院急诊科的患者。我们记录了社会人口学和临床数据以及来自 2 个问卷的信息：CAT 和改良的医学研究理事会呼吸困难量表（mMRC）。本研究的临床结局测量是 COPD 加重后 2 个月的 CAT 评分和住院期间或急诊科出院后 1 周内的疾病不良转归。

结果

该队列包括 501 名患者。加重前 1 天的 CAT 评分中位数（四分位间距）为 13（7-18），加重时的 CAT 评分中位数为 25（19-30），2 个月后为 13（7-18）。当根据基线 COPD 严重程度（轻度、中度和重度/极重度）对队列进行分层时，CAT 评分在加重前和 2 个月后的差异无统计学意义（P=.585，P=.419，和 P=.4357）。91 名患者（18.16%）的短期疾病转归较差。联合 mMRC 和 CAT 评分预测短期不良结局的受试者工作特征曲线下面积（AUC）为 0.701（95%CI，0.640-0.762）。不包括 CAT 评分的 mMRC 评分的 AUC 为 0.667（95%CI，0.616-0.737）。AUC 之间的差异无统计学意义（P=.088）。