Intensive Care Unit.
Department of Respiratory Medicine, and.
Ann Am Thorac Soc. 2020 Jun;17(6):736-745. doi: 10.1513/AnnalsATS.201911-821OC.
The characteristics and outcomes of patients presenting with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring intensive care unit (ICU) admission are poorly understood and there are sparse epidemiological data. The objectives were to describe epidemiology and outcomes of patients admitted to an ICU with COPD and to evaluate whether outcomes varied over time. We studied adult ICU admissions across Australia and New Zealand between 2005 and 2017 with a diagnosis of AECOPD and used an admission diagnosis of asthma as comparator for trends over time. We measured changes in characteristics and outcomes over time using logistic regression, adjusting for illness severity using the Australian New Zealand Risk of Death model. We studied 31,991 admissions with AECOPD and 11,096 with asthma. Mean (standard deviation) age for AECOPD patients was 68.3 (11.2) years, with 35.4% mechanically ventilated. For patients with AECOPD, the percentage of deaths in an ICU was 8.7% and in a hospital was 15.4% of admissions, with the proportion of 69.2% discharged home and 5.6% discharged to a high-level care facility. During the study period, the proportion of ICU admissions with AECOPD per 10,000 admissions decreased at an annual rate of 2.0 (95% confidence interval [CI], 0.8-3.2; = 0.009) but their admission rate per million population increased annually by 4.5 (95% CI, 3.7-5.3; < 0.0001). There was a linear reduction in mortality for AECOPD but not for asthma admissions (odds ratio annual decline: AECOPD, 0.94 [0.93-0.95] and asthma, 1.01 [0.97-1.05]; = 0.001) and an increase in AECOPD admissions discharged to home (odds ratio annual increase, AECOPD, 1.04 [1.03-1.05] and asthma, 1.01 [0.99-1.03]; = 0.01). The reduction in mortality was sustained after adjusting for illness severity. Across Australia and New Zealand, the rate of ICU admissions due to AECOPD is increasing but mortality rates are decreasing, with a corresponding increase in the home discharge rates.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）患者需要入住重症监护病房（ICU）的特征和结局了解甚少，且流行病学数据稀疏。本研究的目的是描述入住 ICU 的 COPD 患者的流行病学和结局，并评估其结局是否随时间变化。我们研究了 2005 年至 2017 年期间澳大利亚和新西兰的 ICU 成年患者，其诊断为 AECOPD，并使用哮喘的入院诊断作为随时间变化的比较。我们使用逻辑回归来测量特征和结局随时间的变化，使用澳大利亚新西兰死亡风险模型来调整疾病严重程度。我们研究了 31991 例 AECOPD 患者和 11096 例哮喘患者。AECOPD 患者的平均（标准差）年龄为 68.3（11.2）岁，35.4%接受机械通气。AECOPD 患者 ICU 死亡率为 8.7%，住院死亡率为 15.4%，出院回家的比例为 69.2%，出院至高护理设施的比例为 5.6%。在研究期间，AECOPD 患者 ICU 入院率以每年 2.0%（95%置信区间[CI]：0.8-3.2；=0.009）的速度下降，但每百万人口的入院率以每年 4.5%（95%CI：3.7-5.3；<0.0001）的速度增加。AECOPD 的死亡率呈线性下降，但哮喘患者的死亡率没有下降（每年下降的比值比：AECOPD，0.94[0.93-0.95]和哮喘，1.01[0.97-1.05]；=0.001），AECOPD 患者出院回家的比例增加（每年增加的比值比：AECOPD，1.04[1.03-1.05]和哮喘，1.01[0.99-1.03]；=0.01）。调整疾病严重程度后，死亡率的下降仍持续存在。在澳大利亚和新西兰，AECOPD 患者 ICU 入院率在增加，但死亡率在下降，相应的出院回家率也在增加。
