GlaxoSmithKline plc., Epidemiology - Value, Evidence and Outcomes, Middlesex, UK.
GlaxoSmithKline plc., Research and Development, Middlesex, UK.
Int J Chron Obstruct Pulmon Dis. 2021 Feb 5;16:225-244. doi: 10.2147/COPD.S279315. eCollection 2021.
Understanding risk factors for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is important for optimizing patient care. We re-analyzed data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study (NCT00292552) to identify factors predictive of re-exacerbations and associated with prolonged AECOPDs.
Patients with COPD from ECLIPSE with moderate/severe AECOPDs were included. The end of the first exacerbation was the index date. Timing of re-exacerbation risk was assessed in patients with 180 days' post-index-date follow-up data. Factors predictive of early (1-90 days) vs late (91-180 days) vs no re-exacerbation were identified using a multivariable partial-proportional-odds-predictive model. Explanatory logistic-regression modeling identified factors associated with prolonged AECOPDs.
Of the 1,554 eligible patients from ECLIPSE, 1,420 had 180 days' follow-up data: more patients experienced early (30.9%) than late (18.7%) re-exacerbations; 50.4% had no re-exacerbation within 180 days. Lower post-bronchodilator FEV (=0.0019), a higher number of moderate/severe exacerbations on/before index date (<0.0001), higher St. George's Respiratory Questionnaire total score (=0.0036), and season of index exacerbation (autumn vs winter, =0.00164) were identified as predictors of early (vs late/none) re-exacerbation risk within 180 days. Similarly, these were all predictors of any (vs none) re-exacerbation risk within 180 days. Median moderate/severe AECOPD duration was 12 days; 22.7% of patients experienced a prolonged AECOPD. The odds of experiencing a prolonged AECOPD were greater for severe vs moderate AECOPDs (adjusted odds ratio=1.917, =0.002) and lower for spring vs winter AECOPDs (adjusted odds ratio=0.578, =0.017).
Prior exacerbation history, reduced lung function, poorer respiratory-related quality-of-life (greater disease burden), and season may help identify patients who will re-exacerbate within 90 days of an AECOPD. Severe AECOPDs and winter AECOPDs are likely to be prolonged and may require close monitoring.
了解慢性阻塞性肺疾病（COPD）急性加重（AECOPD）的危险因素对于优化患者治疗非常重要。我们重新分析了来自评估 COPD 纵向以识别预测替代终点（ECLIPSE）研究（NCT00292552）的数据，以确定预测复发的因素，并与延长的 AECOPD 相关。
纳入 ECLIPSE 中具有中/重度 AECOPD 的 COPD 患者。首次加重的结束日期为索引日期。在具有 180 天索引日期后随访数据的患者中评估再加重的风险时间。使用多变量部分比例优势预测模型确定预测早期（1-90 天）与晚期（91-180 天）与无再加重的因素。解释性逻辑回归模型确定与延长的 AECOPD 相关的因素。
来自 ECLIPSE 的 1554 名合格患者中，有 1420 名患者有 180 天的随访数据：更多患者经历早期（30.9%）而非晚期（18.7%）再加重；50.4%在 180 天内无再加重。支气管扩张剂后 FEV 较低（=0.0019），索引日期前（<0.0001）有更多的中/重度加重，圣乔治呼吸问卷总分较高（=0.0036），以及索引加重的季节（秋季与冬季，=0.00164）均被确定为 180 天内早期（与晚期/无）再加重风险的预测因素。同样，这些都是 180 天内任何（与无）再加重风险的预测因素。中/重度 AECOPD 持续时间的中位数为 12 天；22.7%的患者经历了延长的 AECOPD。严重 AECOPD 比中度 AECOPD 发生延长 AECOPD 的可能性更大（调整后的优势比=1.917，=0.002），而春季比冬季 AECOPD 发生延长 AECOPD 的可能性更小（调整后的优势比=0.578，=0.017）。
既往加重史、肺功能下降、更差的呼吸相关生活质量（疾病负担更大）和季节可能有助于识别在 AECOPD 后 90 天内再次加重的患者。严重的 AECOPD 和冬季的 AECOPD 可能会延长，需要密切监测。
