Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Respiratory Unit, AOU Sassari, Sassari, Italy.
Respir Med. 2020 Sep;171:106091. doi: 10.1016/j.rmed.2020.106091. Epub 2020 Aug 5.
Understanding the risk factors for exacerbations of COPD may help provide a more personalised approach to exacerbation prevention.
Observational, prospective, international, multicentre study aimed at identifying risk factors for exacerbations of COPD. Clinical variables, lung function and CAT scores were collected at baseline. In addition, routine blood biomarkers were also obtained, and patients were followed for 12 months.
A total of 326 patients were included. Of these, 155 (47.5%) presented at least one exacerbation. The median time to the first exacerbation was 147 days. Exacerbators had more respiratory symptoms, more impairment in FEV1(%), FVC(%) and a worse CAT score. Regarding biomarkers, only C-reactive protein was significantly higher in exacerbators (2.8 (standard deviation (SD):3.8) mg/dL vs. 1.9 (SD:2.6) mg/dL; p = 0.037). In multivariate analysis, only CAT scores, FEV1(%) and previous exacerbations were significantly associated with having an exacerbation during follow-up. In the equation of risk, patients with a CAT score ≥15, FEV1(%) <55% and at least one exacerbation the previous year had a probability of 76% of having an exacerbation during the next year, compared with 17% in patients who had none of the previous variables. No biomarkers showed a significant association in multivariate analysis.
Less than half of the patients presented an exacerbation during the one-year follow-up. CAT scores, FEV1(%) and previous exacerbations were the only variables associated with increased risk of exacerbations. Routine biomarkers did not provide additional information to evaluate the risk of exacerbations.
了解 COPD 加重的危险因素有助于为预防加重提供更个性化的方法。
这是一项观察性、前瞻性、国际性、多中心研究，旨在确定 COPD 加重的危险因素。在基线时收集了临床变量、肺功能和 CAT 评分。此外，还获得了常规血液生物标志物，并对患者进行了 12 个月的随访。
共纳入 326 例患者。其中，155 例（47.5%）至少发生了一次加重。首次加重的中位时间为 147 天。加重者的呼吸症状更多，FEV1（%）、FVC（%）和 CAT 评分更差。关于生物标志物，只有 C 反应蛋白在加重者中显著升高（2.8（标准差（SD）：3.8）mg/dL 比 1.9（SD：2.6）mg/dL；p=0.037）。多变量分析中，只有 CAT 评分、FEV1（%）和既往加重与随访期间发生加重显著相关。在风险方程中，CAT 评分≥15、FEV1（%）<55%和前一年至少有一次加重的患者，下一年发生加重的概率为 76%，而无上述所有变量的患者为 17%。多变量分析中无生物标志物显示显著相关性。
在为期一年的随访中，不到一半的患者出现加重。CAT 评分、FEV1（%）和既往加重是与加重风险增加相关的唯一变量。常规生物标志物无法提供额外信息来评估加重风险。
