Servicio de Neumología, Hospital Universitario Lucus Augusti, Unidad Administrativa 4-A, C/Dr Ulises Romero, 1, 27002, Lugo, Spain.
Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
Lung. 2022 Oct;200(5):601-607. doi: 10.1007/s00408-022-00565-8. Epub 2022 Sep 5.
Acute exacerbations of COPD (AECOPD) are important factors contributing to mortality risk. The rate of exacerbations varies overtime. An inconsistent pattern of exacerbation occurrence is a common finding. The mortality risk associated with such a pattern is not entirely clear. Our objective was to assess the risk of mortality associated with various possible patterns of AECOPD trajectories.
This is a multicenter historical cohort study. Four different exacerbation trajectories were defined according to the incidence of severe AECOPD requiring hospital admission 2 years before and after the date of the first visit to the respiratory clinic-Consistent non-exacerbators (NEx): no AECOPD before or after the index date; consistent exacerbators (Ex): at least one AECOPD both before and after the index date; converters to exacerbators (CONV-Ex): no exacerbations before and at least one AECOPD after the index date; converters to non-exacerbators (CONV-NEx): at least one AECOPD before the index date, and no exacerbations after said date. All-cause mortality risk for these trajectories was assessed.
A total of 1713 subjects were included in the study: NEx: 1219 (71.2%), CONV-NEx: 225 (13.1%), CONV-Ex: 148 (8.6%), Ex: 121 (7.1%). After correcting for confounding variables, the group with the highest mortality risk was Ex. The CONV-Ex and CONV-Nex groups had a mortality risk between Ex and NEx, with no significant differences between them.
Different possible trajectories of severe AECOPD before and after a first specialized consultation are associated with different mortality risks. An inconsistent pattern of exacerbations has a mortality risk between Ex and NEx, with no clear differences between CONV-Ex and CONV-NEx.
COPD（慢性阻塞性肺疾病）急性加重（AECOPD）是导致死亡风险的重要因素。加重的发生率随时间而变化。加重发生的模式不一致是常见的发现。与这种模式相关的死亡风险尚不完全清楚。我们的目的是评估与各种可能的 AECOPD 轨迹模式相关的死亡风险。
这是一项多中心历史队列研究。根据首次就诊前 2 年和首次就诊后发生需要住院治疗的严重 AECOPD 的发生率，定义了四种不同的加重轨迹：一致非加重者（NEx）：在指数日期前后均无 AECOPD；一致加重者（Ex）：在指数日期前后均至少有一次 AECOPD；加重者转为非加重者（CONV-NEx）：在指数日期前无加重，且在指数日期后至少有一次 AECOPD；非加重者转为加重者（CONV-Ex）：在指数日期前至少有一次加重，且在指数日期后无加重。评估了这些轨迹的全因死亡风险。
共纳入 1713 例患者：NEx：1219（71.2%），CONV-NEx：225（13.1%），CONV-Ex：148（8.6%），Ex：121（7.1%）。在纠正混杂变量后，死亡风险最高的是 Ex 组。CONV-Ex 和 CONV-NEx 组的死亡风险介于 Ex 和 NEx 之间，两者之间无显著差异。
首次专科就诊前后严重 AECOPD 的不同可能轨迹与不同的死亡风险相关。加重模式不一致的患者的死亡风险介于 Ex 和 NEx 之间，CONV-Ex 和 CONV-NEx 之间无明显差异。
