Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Department of Respiratory Medicine, Tibet Autonomous Region People's Hospital, Tibet, China.
BMC Cardiovasc Disord. 2020 Dec 10;20(1):518. doi: 10.1186/s12872-020-01803-8.
It has been noted that there is an increase in the incidence of acute cardiovascular events (CVEs) in patients with chronic obstructive pulmonary disease (COPD) during an acute exacerbation (AE), thereby causing increased inpatient mortality. Thus, we have tried to identify predictors of acute CVEs in patients with AECOPD via a nested case-control study.
A total of 496 cases hospitalized for AECOPD were included in this study, and followed-up for up to 6 months after discharge. Acute CVEs in the AE period were defined as a new or worsening acute coronary syndrome (ACS), arrhythmia, or left ventricular disfunction (LVD). Predictors of CVEs were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period.
Thirty cases (6.05%) had acute CVEs, namely 2 had ACS, 13 had LVD and 19 experienced some form of arrhythmia. Four deaths were observed in the CVE group, with significantly increased death risk compared with the non-CVE group (P = 0.001, OR = 5.81). Moreover, patients who had CVEs were more prone to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P = 0.004, OR = 5.06), 20% increase in heart rate (HR) (P = 0.003, OR = 10.19), electrolyte disturbance (P = 0.01, OR = 4.24) and diuretics (P = 0.002, OR = 6.37) were independent predictors of CVEs. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs.
Our preliminary study indicates that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with regular electrolyte monitoring. These findings need to be confirmed in a large cohort.
据报道，慢性阻塞性肺疾病（COPD）患者在急性加重期（AE）中急性心血管事件（CVE）的发生率增加，从而导致住院病死率增加。因此，我们通过巢式病例对照研究试图确定 AECOPD 患者急性 CVE 的预测因素。
本研究共纳入 496 例因 AECOPD 住院的患者，出院后随访 6 个月。AE 期急性 CVE 定义为新发或恶化的急性冠状动脉综合征（ACS）、心律失常或左心室功能障碍（LVD）。从稳定期的基线特征和治疗以及 AE 期的症状、实验室检查、并发症和治疗中选择 CVE 的预测因素。
30 例（6.05%）发生急性 CVE，其中 2 例为 ACS，13 例为 LVD，19 例为心律失常。CVE 组有 4 例死亡，与非 CVE 组相比，死亡风险显著增加（P=0.001，OR=5.81）。此外，发生 CVE 的患者在 3 个月内更易再次加重。多变量分析显示，既往 LVD 病史（P=0.004，OR=5.06）、心率增加 20%（P=0.003，OR=10.19）、电解质紊乱（P=0.01，OR=4.24）和利尿剂（P=0.002，OR=6.37）是 CVE 的独立预测因素。此外，AE 期使用茶碱、氟喹诺酮类和吸入β激动剂与急性 CVE 无统计学关联。
我们的初步研究表明，因 AECOPD 住院的患者既往有 LVD 病史或心率增加，需要密切观察，利尿剂应谨慎使用，并定期监测电解质。这些发现需要在更大的队列中得到证实。
