查尔森合并症指数作为急性或亚急性特发性间质性肺炎及胶原血管病相关间质性肺炎急性加重患者预后参数的临床意义。
Clinical significance of Charlson comorbidity index as a prognostic parameter for patients with acute or subacute idiopathic interstitial pneumonias and acute exacerbation of collagen vascular diseases-related interstitial pneumonia.
作者信息
Murohashi Kota, Hara Yu, Saigusa Yusuke, Kobayashi Nobuaki, Sato Takashi, Yamamoto Masaki, Kudo Makoto, Kaneko Takeshi
机构信息
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan.
出版信息
J Thorac Dis. 2019 Jun;11(6):2448-2457. doi: 10.21037/jtd.2019.05.46.
BACKGROUND
A prognostic factor for patients with acute or subacute idiopathic interstitial pneumonias (IIPs) or acute exacerbation (AE) of collagen vascular diseases-related interstitial pneumonia (CVD-IP) has not been established. We aimed to determine whether the Charlson comorbidity index (CCI) could serve as a prognostic factor for patients with these patients.
METHODS
We assessed baseline prognostic factors among patients with acute or subacute IIPs and AE of CVD-IP who were admitted to hospital between January 2014 and December 2017. We classified them as survivors and non-survivors at 3 months and compared their age, sex, CCI, blood parameters [lactate dehydrogenase (LDH), surfactant protein (SP)-D, Krebs von den Lungen-6, and partial pressure of oxygen in arterial blood/fraction of the inspiratory oxygen], high resolution CT (HRCT) scores and treatment.
RESULTS
Sixty eight patients with (mean age, 75 years), were assessed. All patients received steroid pulse therapy. We found that 45 of acute or subacute IIPs and 16 of AE of CVD-IP were included. Stepwise multivariate analysis selected CCI (OR, 1.306; 95% CI, 1.090-1.573; P=0.004), serum LDH (OR, 1.003; 95% CI, 1.001-1.005; P=0.002), and sex (OR, 8.555; 95% CI, 1.729-154.978; P=0.038) as significant predictors of 3-month mortality among these patients. Three-month mortality was significantly worse among patients with high (≥4) than low (<4) CCI (mortality rates: 63.2% 16.3%, P<0.001). Moreover, the composite scoring system including CCI, serum LDH, and sex was acceptable (Bootstrap AUC, 0.859; Bootstrap C-index, 0.747).
CONCLUSIONS
The composite scoring system including CCI, sex, and serum LDH could be a useful mortality prediction tool for patients with acute or subacute IIPs and AE of CVD-IP requiring steroid pulse therapy.
背景
急性或亚急性特发性间质性肺炎（IIP）患者或胶原血管疾病相关间质性肺炎（CVD-IP）急性加重（AE）患者的预后因素尚未明确。我们旨在确定查尔森合并症指数（CCI）是否可作为这些患者的预后因素。
方法
我们评估了2014年1月至2017年12月期间入院的急性或亚急性IIP以及CVD-IP AE患者的基线预后因素。我们将他们在3个月时分为幸存者和非幸存者，并比较他们的年龄、性别、CCI、血液参数[乳酸脱氢酶（LDH）、表面活性蛋白（SP）-D、肺表面活性物质相关蛋白6和动脉血氧分压/吸入氧分数]、高分辨率CT（HRCT）评分和治疗情况。
结果
评估了68例患者（平均年龄75岁）。所有患者均接受了类固醇脉冲疗法。我们发现其中包括45例急性或亚急性IIP患者和16例CVD-IP AE患者。逐步多因素分析选择CCI（比值比，1.306；95%置信区间，1.090-1.573；P = 0.004）、血清LDH（比值比，1.003；95%置信区间，1.001-1.005；P = 0.002）和性别（比值比，8.555；95%置信区间，1.729-154.978；P = 0.038）作为这些患者3个月死亡率的显著预测因素。CCI高（≥4）的患者3个月死亡率显著高于CCI低（<4）的患者（死亡率：63.2%对16.3%，P<0.001）。此外，包括CCI、血清LDH和性别的综合评分系统是可接受的（自助法曲线下面积，0.859；自助法C指数，0.747）。
结论
包括CCI、性别和血清LDH的综合评分系统可能是需要类固醇脉冲疗法的急性或亚急性IIP以及CVD-IP AE患者有用的死亡率预测工具。
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