Peng L G, Zhou C, Zhou H X, Luo Y M, Ge H Q, Liu H G, Wei H L, Zhang J C, Pan P H, Zhang J R, Adili Aili, Liu Y, Cheng L N, Yi M Q, Yi Q
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2021 Dec 28;101(48):3932-3937. doi: 10.3760/cma.j.cn112137-20210709-01542.
To investigate the risk factors associated with in-hospital mortality in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A total of 6 668 patients hospitalized for AECOPD in seven tertiary hospitals from September 2017 to January 2021 were consecutively included, and clinical data related to medical history, laboratory tests, treatment and prognosis were collected, and patients were divided into death group and survival group according to whether they died during hospitalization. After univariate analysis, multivariate logistic regression analysis was then performed to explore the independent risk factors related to in-hospital mortality. Among 6 668 patients hospitalized for AECOPD, 128 patients experienced in-hospital death, with a mortality rate of 1.9%. The mean age of the death group was (81±9) years, which was significantly older than that of the survival group ((72±11) years <0.001). The proportion of patients in the AECOPD in-hospital death group with a combination of prolonged bed rest, hypertension, myocardial infarction within 3 months, cardiac insufficiency, chronic pulmonary heart disease, pneumonia, type 2 diabetes, venous thromboembolism (VTE), and chronic renal insufficiency was also significantly higher than in the survival group (all <0.05) The median length of stay in the in-hospital death group was 18 d, which was significantly longer than that in the survival group (9 d, <0.001), and the proportion of patients admitted to the ICU, receiving invasive mechanical ventilation and non-invasive mechanical ventilation was also significantly higher than that in the survival group (all <0.05). The white blood cell count, glutamic transaminase, blood creatinine, calcitoninogen, C-reactive protein, D-dimer, N-terminal B-type natriuretic and Pseudomonas aeruginosa infection rates were significantly higher than those in the survival group (all <0.05). Multifactorial analysis showed that age>80 years (=3.82, 95% 2.36 to 6.18, <0.001), prolonged bed rest (=2.95, 95%: 1.79 to 4.86, <0.001), chronic pulmonary heart disease (=1.85, 95%: 1.14 to 3.00, =0.012), and pneumonia (=2.75, 95%: 1.65 to 4.60, <0.001), invasive mechanical ventilation (=7.33, 95%: 4.40 to 12.21, <0.001), noninvasive mechanical ventilation (=3.73, 95%: 2.30 to 6.04, <0.001), anemia (=2.03. 95%: 1.21 to 3.42, =0.008), and calcitoninogen>0.5 ng/ml (=2.38, 95%: 1.41 to 4.02, =0.001) were independent risk factors for in-hospital mortality in patients with AECOPD. Advanced age (>80 years), prolonged bed rest, chronic pulmonary heart disease, pneumonia, invasive mechanical ventilation, noninvasive mechanical ventilation, anemia, and calcitoninogen>0.5 ng/ml were independent risk factors for in-hospital mortality in patients hospitalized with AECOPD.
为探讨慢性阻塞性肺疾病急性加重期(AECOPD)住院患者院内死亡的相关危险因素。连续纳入2017年9月至2021年1月期间在7家三级医院因AECOPD住院的6668例患者,收集与病史、实验室检查、治疗及预后相关的临床资料,并根据患者住院期间是否死亡分为死亡组和存活组。单因素分析后,进行多因素logistic回归分析以探讨与院内死亡相关的独立危险因素。在6668例因AECOPD住院的患者中,128例发生院内死亡,死亡率为1.9%。死亡组的平均年龄为(81±9)岁,显著高于存活组((72±11)岁,P<0.001)。AECOPD院内死亡组中合并长期卧床、高血压、3个月内心肌梗死、心功能不全、慢性肺源性心脏病、肺炎、2型糖尿病、静脉血栓栓塞症(VTE)及慢性肾功能不全的患者比例也显著高于存活组(均P<0.05)。院内死亡组的中位住院时间为18天,显著长于存活组(9天,P<0.001),入住重症监护病房(ICU)、接受有创机械通气和无创机械通气的患者比例也显著高于存活组(均P<0.05)。白细胞计数、谷丙转氨酶、血肌酐、降钙素原、C反应蛋白、D-二聚体、N末端B型利钠肽及铜绿假单胞菌感染率均显著高于存活组(均P<0.05)。多因素分析显示,年龄>80岁(P=3.82,95%CI:2.36至6.18,P<0.001)、长期卧床(P=2.95,95%CI:1.79至4.86,P<0.001)、慢性肺源性心脏病(P=1.85,95%CI:1.14至3.00,P=0.012)、肺炎(P=2.75,95%CI:1.65至4.60,P<0.001)、有创机械通气(P=7.33,95%CI:4.40至12.21,P<0.001)、无创机械通气(P=3.73,95%CI:2.30至6.04,P<0.001)、贫血(P=2.03,95%CI:1.21至3.42,P=0.008)及降钙素原>0.5 ng/ml(P=2.38,95%CI:1.41至4.02,P=0.001)是AECOPD患者院内死亡的独立危险因素。高龄(>80岁)、长期卧床、慢性肺源性心脏病、肺炎、有创机械通气、无创机械通气、贫血及降钙素原>0.5 ng/ml是AECOPD住院患者院内死亡的独立危险因素。