Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Praxis: Friedberger Anlage 31-32, 60316, Frankfurt, Germany.
Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, Member of the German Centre for Lung Research (DZL), 35043, Marburg, Germany.
Lung. 2020 Jun;198(3):507-514. doi: 10.1007/s00408-020-00357-y. Epub 2020 May 4.
A number of analyses have shown the immediate impact of COPD exacerbations on health status. However, none evaluated the long-term correlation between health status and the occurrence of exacerbations.
DACCORD is an observational study in patients with COPD recruited across Germany following initiation or change in COPD maintenance medication. Data collected include COPD Assessment Test (CAT) total score on entry and after 1 and 2 years, and the occurrence of exacerbations. We analysed the correlation between change from baseline in CAT total score and exacerbations, after excluding patients who exacerbated during the quarter immediately prior to the CAT assessment of interest.
The initial correlation analysis was performed in 6075 patients, 28% with ≥ 1 exacerbation over the 2-year follow-up, and 58% with a clinically relevant CAT improvement. There was a significant correlation between exacerbations over 2 years and CAT change from baseline at Year 2 (p = 0.0041). The Spearman's correlation coefficient was 0.03711, indicating very weak correlation-potentially driven by the high proportion of non-exacerbating patients. In a subsequent logistic regression, the probability of experiencing frequent (≥ 2 per year) or severe exacerbations was higher in patients with worsening in CAT total score (p < 0.001). However, the probability of a patient exacerbating in Year 1 or Year 2 did not correlate with CAT change.
In this population (initiating or changing maintenance COPD medication), patients with frequent or severe exacerbations had a long-term worsening in health status (beyond the acute effect of an exacerbation) compared with patients who do not exacerbate.
多项分析表明，COPD 加重对健康状况有直接影响。然而，尚无研究评估健康状况与加重事件之间的长期相关性。
DACCORD 是一项在德国开展的观察性研究，纳入了起始或改变 COPD 维持治疗后的患者。入组时和第 1、2 年收集 COPD 评估测试（CAT）总分以及加重事件。排除 CAT 评估前 1 个季度发生加重的患者，分析 CAT 总分从基线的变化与加重事件之间的相关性。
在 6075 例患者中进行了初步相关性分析，28%的患者在 2 年随访期间发生≥1 次加重，58%的患者 CAT 改善有临床意义。2 年内的加重次数与第 2 年 CAT 从基线的变化显著相关（p=0.0041）。Spearman 相关系数为 0.03711，表明相关性非常弱，可能是由于非加重患者的比例较高所致。在随后的逻辑回归分析中，CAT 总分恶化的患者发生频繁（≥2 次/年）或严重加重的概率更高（p<0.001）。然而，患者在第 1 年或第 2 年加重的概率与 CAT 变化无关。
在该人群（起始或改变维持 COPD 药物治疗）中，与未加重的患者相比，频繁或严重加重的患者健康状况长期恶化（超出加重的急性影响）。
