合并 COPD 和心力衰竭患者的住院和死亡率：系统评价和荟萃分析。
Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis.
机构信息
National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
出版信息
Respir Res. 2020 Feb 14;21(1):54. doi: 10.1186/s12931-020-1312-7.
BACKGROUND
Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients.
METHODS
MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR).
RESULTS
Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF.
CONCLUSIONS
In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
背景
研究表明，合并心力衰竭（HF）对慢性阻塞性肺疾病（COPD）患者的发病率和死亡率有影响，但不同研究的结果存在差异。
方法
使用预先指定的搜索策略，在 MEDLINE 和 Embase 中搜索比较 COPD 合并 HF 与不合并 HF 患者住院、再住院和死亡率的研究。研究必须报告未经调整和/或调整后的率比、风险比、比值比（OR）或风险比（HR）。
结果
共确定了 28 篇报告了 55 个效应估计值的文献，这些文献比较了 COPD 合并 HF 与不合并 HF 的患者。有 1 项研究报告了全因住院率（1 个率比）。有 2 项研究报告了 COPD 相关住院率（1 个率比，2 个 OR）。有 1 项研究报告了 COPD 或心血管相关住院率（4 个 HR）。有 1 项研究报告了 90 天全因再住院率（1 个风险比）。有 1 项研究报告了 3 年全因再住院率（2 个 HR）。有 4 项研究报告了 30 天 COPD 相关再住院率（1 个风险比；5 个 OR）。有 2 项研究报告了 1 年 COPD 相关再住院率（1 个风险比；1 个 HR）。有 1 项研究报告了 3 年 COPD 相关再住院率（2 个 HR）。有 18 项研究报告了全因死亡率（1 个风险比；4 个 OR；24 个 HR）。有 5 项研究报告了全因住院病死率（1 个风险比；4 个 OR）。由于缺乏所有个体效应测量值的数据，因此无法进行住院和再住院的荟萃分析。需要进行肺功能检查来诊断 COPD 的研究的荟萃分析发现，HF 合并症患者的全因死亡率比无 HF 合并症患者高 1.61（合并 HR；95%CI：1.38，1.83）。
结论
在这项系统评价中，我们研究了 HF 合并症对 COPD 患者住院和死亡率的影响。有大量证据表明，HF 合并症增加了 COPD 患者的 COPD 相关再住院率和全因死亡率。HF 合并症的影响可能因 COPD 表型、HF 类型或 HF 严重程度而异，应成为未来研究的主题。
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