慢性阻塞性肺疾病急性加重严重程度的预后标志物：一氧化碳弥散量（D）和一秒用力呼气容积（FEV）分析。
Prognostic marker for severe acute exacerbation of chronic obstructive pulmonary disease: analysis of diffusing capacity of the lung for carbon monoxide (D) and forced expiratory volume in one second (FEV).
机构信息
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
出版信息
BMC Pulm Med. 2021 May 6;21(1):152. doi: 10.1186/s12890-021-01519-1.
BACKGROUND
It is important to assess the prognosis of patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD). Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (D) should be added to multidimensional tools for assessing COPD. This study aimed to compare the D and forced expiratory volume in one second (FEV) to identify better prognostic factors for admitted patients with AECOPD.
METHODS
We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD patients by severity of D and FEV (≤ vs. > 50% predicted). We tested the association of FEV and D with the following outcomes: in-hospital mortality, need for mechanical ventilation, need for intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.
RESULTS
In multivariate analyses, D was associated with mortality (odds ratio = 4.408; 95% CI 1.070-18.167; P = 0.040) and need for mechanical ventilation (odds ratio = 2.855; 95% CI 1.216-6.704; P = 0.016) and ICU care (odds ratios = 2.685; 95% CI 1.290-5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV classification (P = 0.075). In multivariate linear regression analyses, D (B = - 0.542 ± 0.121, P < 0.001) and FEV (B = - 0.106 ± 0.106, P = 0.006) were negatively associated with length of hospital stay. In addition, D showed better predictive ability than FEV in ROC curve analysis. The area under the curve (AUC) of D was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV was less than 0.68.
CONCLUSION
D was likely to be as good as or better prognostic marker than FEV in severe AECOPD.
背景
评估慢性阻塞性肺疾病（COPD）患者和 COPD 急性加重（AECOPD）患者的预后很重要。最近，有人提出，应将一氧化碳弥散量（D）加入到评估 COPD 的多维工具中。本研究旨在比较 D 和一秒用力呼气量（FEV），以确定 AECOPD 住院患者更好的预后因素。
方法
我们回顾性分析了 342 例接受住院治疗的 AECOPD 患者。我们根据 D 和 FEV（≤ 与 >50%预测值）的严重程度对 342 例重度 AECOPD 患者进行分类。我们通过多变量逻辑回归分析检测 FEV 和 D 与以下结局的关系：住院死亡率、机械通气需求、需要重症监护病房（ICU）治疗。此外，我们还进行了相关性分析和受试者工作特征（ROC）曲线分析。
结果
多变量分析显示，D 与死亡率（比值比=4.408；95%置信区间 1.070-18.167；P=0.040）、机械通气需求（比值比=2.855；95%置信区间 1.216-6.704；P=0.016）和 ICU 治疗（比值比=2.685；95%置信区间 1.290-5.590；P=0.008）相关。然而，使用 FEV 分类时，死亡率无统计学差异（P=0.075）。在多元线性回归分析中，D（B=-0.542±0.121，P<0.001）和 FEV（B=-0.106±0.106，P=0.006）与住院时间呈负相关。此外，ROC 曲线分析显示 D 的预测能力优于 FEV。D 的曲线下面积（AUC）对于所有预后因素均大于 0.68，而 FEV 的 AUC 小于 0.68。
结论
在重度 AECOPD 中，D 可能与 FEV 一样或更好地作为预后标志物。
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