Cabrera López Carlos, Casanova Macario Ciro, Marín Trigo José María, de-Torres Juan P, Torres Rebeca Sicilia, González Jesús María, Polverino Francesca, Divo Miguel, Pinto Plata Víctor, Zulueta Javier, Callejas Francisco Javier, Celli Bartolomé
Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
Servicio de Neumología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España.
Arch Bronconeumol (Engl Ed). 2019 Aug;55(8):409-413. doi: 10.1016/j.arbres.2018.12.002. Epub 2019 Feb 2.
The Spanish COPD guidelines (GesEPOC) have been recently modified. The aim of this study is to assess this revision and evaluate the prognosis of patients according to the new classification of severity.
A total of 700 COPD patients (83.9% men) were prospectively followed up for a mean period of 5 years in tertiary hospitals in Spain and the USA. Anthropometric data, lung function tests, dyspnea (according to the mMRC scale), BODE and Charlson index were collected. We calculated mortality at 5 years following the risk criteria proposed by the new GesEPOC.
Mean age was 66±9.6 years and mean FEV% was 59.7±20.2. The proportion of patients in the low-risk group was 40.43%. Patients in the high-risk group had a significantly higher BODE index than those in the low-risk group (2.92±0,66 vs. 0.52±1.91, p<0.001), while the Charlson index score was similar in both groups. Mortality at 60 months was significantly higher in the high-risk group (31.7% vs. 15.5%, p<0.001). Dyspnea and FEV% were also independent predictors of mortality (p<0.001), and neither was inferior to the risk classification proposed by GesEPOC.
The new severity index proposed by GesEPOC accurately predicts 5-year mortality. However, dyspnea and FEV% have the same strength in predicting mortality.
西班牙慢性阻塞性肺疾病（COPD）指南（GesEPOC）最近进行了修订。本研究旨在评估此次修订，并根据新的严重程度分类评估患者的预后。
在西班牙和美国的三级医院对总共700例COPD患者（83.9%为男性）进行了为期5年的前瞻性随访。收集了人体测量数据、肺功能测试、呼吸困难情况（根据mMRC量表）、BODE指数和查尔森指数。我们根据新的GesEPOC提出的风险标准计算了5年死亡率。
平均年龄为66±9.6岁，平均第1秒用力呼气容积（FEV%）为59.7±20.2。低风险组患者的比例为40.43%。高风险组患者的BODE指数显著高于低风险组（2.92±0.66对0.52±1.91，p<0.001），而两组的查尔森指数评分相似。高风险组60个月时的死亡率显著更高（31.7%对15.5%，p<0.001）。呼吸困难和FEV%也是死亡率的独立预测因素（p<0.001），且两者在预测死亡率方面均不逊色于GesEPOC提出的风险分类。
GesEPOC提出的新严重程度指数能准确预测5年死亡率。然而，呼吸困难和FEV%在预测死亡率方面具有相同的效力。
