Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Xishan People's Hospital of Wuxi City, Wuxi, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2022 Sep 20;17:2329-2341. doi: 10.2147/COPD.S376909. eCollection 2022.
Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups.
Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters.
The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, <0.001), the COPD Assessment Test (CAT) score (20 vs 17, <0.001), the blood eosinophil percentage (1.5 vs 2.0, <0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥9 years), more symptoms (CAT ≥10), and lower blood eosinophils (Eos <2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations.
These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.
因慢性阻塞性肺疾病（COPD）急性加重（AECOPD）而住院被认为是重度加重。因重度加重而再次入院是 COPD 患者的一个关键事件。然而，与重度加重再次入院相关的因素并不完整。本研究旨在调查重度和非重度加重组之间的不同特征。
纳入多中心因重度 AECOPD 住院的患者，并记录其出院后 12 个月内的加重情况。根据加重情况，患者分为重度加重组和非重度加重组。采用倾向评分匹配（PSM）和多变量分析比较两组的基线特征。采用 Hosmer-Lemeshow 检验和受试者工作特征曲线评估模型识别分组的能力。
该队列纳入了来自中国 27 个研究中心的 550 例重度 AECOPD 患者，最终分析了 465 例患者。共有 41.5%的患者在 1 年内因 AECOPD 再次入院。PSM 后两组的基线特征无显著差异。12 个月内发生重度加重与一些因素有关，如 COPD 病程（13 年比 8 年，<0.001）、COPD 评估测试（CAT）评分（20 分比 17 分，<0.001）、血嗜酸性粒细胞百分比（1.5%比 2.0%，<0.05）和吸入治疗。因 AECOPD 再次入院的患者诊断时间更长（≥9 年）、症状更多（CAT≥10）、血嗜酸性粒细胞更低（Eos<2%）。得出了一个临床模型，有助于识别有重度加重再次入院风险的患者。
这些分析证实了入院时 COPD 与未来重度加重有关。结合临床病史，血嗜酸性粒细胞百分比较低似乎与再次入院有关。需要进一步研究评估该研究是否可以预测加重风险。
