Yang Lan, Zhang Yu, Yao Wei, Fang Fang, Li Weimin
Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery, West China Medical School/West China Hospital, Sichuan University, Chengdu, China.
Front Neurol. 2021 Nov 12;12:723115. doi: 10.3389/fneur.2021.723115. eCollection 2021.
Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2014 and 2019. Propensity score matching analysis and cox regression models was used to assess the association between COPD and mortality. The primary outcome was long-term mortality. Using a clinical database from a large university medical center, 2,925 patients with aSAH were identified, of whom 219 (7.5%) also had COPD. Patients were followed-up for a median of 3.8 years, and during follow-up 633 patients (21.6%) died. Long-term mortality was higher in patients with COPD compared to patients without COPD in the Cox regression models [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.14-2.02]. Propensity score matching analysis also showed similar associations between COPD and mortality in hospital, at 1 year, at 2 years, and at long-term. Similarly, patients with COPD had significantly higher incidence of infections, such as pneumonia [odds ratio (OR) 3.24, 95% CI 2.30-4.56], urinary tract infection (OR 1.81, 95% CI 1.20-2.73), bloodstream infection (OR 3.83, 95% CI 1.84-7.99), and hospital infection (OR 3.24, 95% CI 2.28-4.61). Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for infections. Given that these are preventable complications, our findings are of clinical relevance.
慢性阻塞性肺疾病（COPD）与急性病患者的多种并发症及死亡率相关。对于动脉瘤性蛛网膜下腔出血（aSAH）患者，COPD与临床结局之间的关联尚不清楚。在这项回顾性队列研究中，我们分析了2014年至2019年期间连续入住华西医院的aSAH患者。采用倾向评分匹配分析和Cox回归模型评估COPD与死亡率之间的关联。主要结局为长期死亡率。利用一所大型大学医学中心的临床数据库，共识别出2925例aSAH患者，其中219例（7.5%）同时患有COPD。患者的中位随访时间为3.8年，随访期间有633例患者（21.6%）死亡。在Cox回归模型中，与无COPD的患者相比，COPD患者的长期死亡率更高[调整后风险比（HR）为1.52，95%置信区间（CI）为1.14 - 2.02]。倾向评分匹配分析也显示，COPD与住院期间、1年、2年及长期的死亡率之间存在相似的关联。同样，COPD患者的感染发生率显著更高，如肺炎[比值比（OR）为3.24，95%CI为2.30 - 4.56]、尿路感染（OR为1.81，95%CI为1.20 - 2.73）、血流感染（OR为3.83，95%CI为1.84 - 7.99）及医院感染（OR为3.24，95%CI为2.28 - 4.61）。在aSAH患者中，COPD与死亡率增加相关。COPD是感染的一个重要危险因素。鉴于这些是可预防的并发症，我们的研究结果具有临床相关性。
