Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2020 Apr 17;15:831-839. doi: 10.2147/COPD.S242863. eCollection 2020.
Various comorbidities influence the prognosis of patients with chronic obstructive pulmonary disease (COPD). We investigated if liver fibrosis assessed using fibrosis-4 index (FIB-4) is associated with all-cause mortality in patients with COPD.
We included 756 patients diagnosed with COPD between 2006 and 2010. Medical records were retrospectively reviewed until 2018. FIB-4 was calculated using the following equation: [age (years) × aspartate aminotransferase (IU/L)/(platelet count (10/L) × √alanine aminotransferase (IU/L))].
From a total of 756 patients, 582 (76.9%) patients were categorized into survivor and 174 (23.1%) into non-survivor groups. The non-survivor group was significantly older with a higher proportion of male, smoker and lower FEV/FVC ratio than the survivor group (all P<0.05). Various comorbidities were more frequently observed in the non-survivor group (P<0.05). In addition, the non-survivor group had significantly higher FIB-4 than the survivor group (1.8 vs 1.4, P<0.001). In multivariate analysis, older age (hazard ratio [HR]=1.05), underlying malignancy (HR=2.94), coronary artery occlusive disease (HR=1.58), higher FIB-4 (HR=1.15), and higher GOLD stage (HR=1.26) were significantly associated with the increased risk of all-cause mortality (P<0.05), whereas body mass index (HR=0.95) was independently protective for all-cause mortality (all P<0.05). The high FIB-4 (>1.57) group showed a significantly lower cumulative survival rate than the low FIB-4 (≤1.05) group (P=0.031, Log-rank test). In multivariate regression analysis, higher FIB-4 independently predicted the risk of acute exacerbation (odds ratio=1.08, P=0.034).
Higher fibrotic burden assessed using FIB-4 was independently predictive of the increased risk of all-cause mortality and acute exacerbation in patients with COPD.
各种合并症影响慢性阻塞性肺疾病（COPD）患者的预后。我们研究了纤维化-4 指数（FIB-4）评估的肝纤维化是否与 COPD 患者的全因死亡率相关。
我们纳入了 2006 年至 2010 年间诊断为 COPD 的 756 例患者。回顾性分析病历直至 2018 年。使用以下公式计算 FIB-4：[年龄（岁）×天冬氨酸氨基转移酶（IU/L）/（血小板计数（10/L）×√丙氨酸氨基转移酶（IU/L）]。
756 例患者中，582 例（76.9%）患者分为存活组，174 例（23.1%）患者分为非存活组。非存活组年龄较大，男性、吸烟者比例较高，FEV/FVC 比值较低，与存活组相比差异均有统计学意义（均 P<0.05）。非存活组更常发生各种合并症（P<0.05）。此外，非存活组的 FIB-4 明显高于存活组（1.8 比 1.4，P<0.001）。多因素分析显示，年龄较大（风险比[HR]=1.05）、潜在恶性肿瘤（HR=2.94）、冠状动脉阻塞性疾病（HR=1.58）、较高的 FIB-4（HR=1.15）和较高的 GOLD 分期（HR=1.26）与全因死亡率增加显著相关（P<0.05），而体重指数（HR=0.95）独立保护全因死亡率（均 P<0.05）。高 FIB-4（>1.57）组的累积生存率明显低于低 FIB-4（≤1.05）组（P=0.031，Log-rank 检验）。多因素回归分析显示，较高的 FIB-4 独立预测 COPD 患者急性加重的风险（比值比=1.08，P=0.034）。
使用 FIB-4 评估的纤维化负担较高，可独立预测 COPD 患者全因死亡率和急性加重的风险增加。
