Crisafulli Ernesto, Sartori Giulia, Huerta Arturo, Gabarrús Albert, Fantin Alberto, Soler Néstor, Torres Antoni
Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Pulmonary and Critical Care Division, Clinica Sagrada Familia, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Chest. 2023 Dec;164(6):1422-1433. doi: 10.1016/j.chest.2023.07.021. Epub 2023 Jul 27.
Recently, the Rome proposal updated the definition of exacerbation of COPD (ECOPD). However, such severity grade has not yet demonstrated intermediate-term clinical relevance.
What is the association between the Rome severity classification and short-term and intermediate-term clinical outcomes?
We retrospectively grouped hospitalized patients with ECOPD according to the Rome severity classification (ie, mild, moderate, severe). Baseline, clinical, microbiologic, gas analysis, and laboratory variables were collected. In addition, data about the length of hospital stay and mortality (in-hospital and a follow-up time line from 6 months until 3 years) were assessed.
Of the 347 hospitalized patients, 39% were categorized as mild, 31% were categorized as moderate, and 30% were categorized as severe. Overall, patients with severe ECOPD had an extended length of hospital stay. Although in-hospital mortality was similar among groups, patients with severe ECOPD presented a worse prognosis in all follow-up time points. The Kaplan-Meier curves show the role of the severe classification in the cumulative survival at 1 and 3 years (Gehan-Breslow-Wilcoxon test, P = .032 and P = .004, respectively). The multivariable Cox regression analysis showed a higher risk of death at 1 year when patients presented a severe (hazard ratio, 1.99; 95% CI, 1.49-2.65) or moderate grade (hazard ratio, 1.47; 95% CI, 1.10-1.97) compared with a mild grade. Older patients (aged ≥ 80 years), patients requiring long-term oxygen therapy, or patients reporting previous ECOPD episodes had a higher mortality risk. A BMI between 25 and 29 kg/m was associated with a lower risk.
The Rome classification makes it possible to discriminate patients with a worse prognosis (severe or moderate) until a 3-year follow-up.
最近，罗马提议更新了慢性阻塞性肺疾病急性加重（ECOPD）的定义。然而，这种严重程度分级尚未显示出中期临床相关性。
罗马严重程度分类与短期和中期临床结果之间有何关联？
我们根据罗马严重程度分类（即轻度、中度、重度）对住院的ECOPD患者进行回顾性分组。收集了基线、临床、微生物学、气体分析和实验室变量。此外，还评估了住院时间和死亡率（住院期间以及6个月至3年的随访时间线）的数据。
在347例住院患者中，39%被归类为轻度，31%被归类为中度，30%被归类为重度。总体而言，重度ECOPD患者的住院时间延长。虽然各组的住院死亡率相似，但重度ECOPD患者在所有随访时间点的预后都较差。Kaplan-Meier曲线显示了重度分级在1年和3年累积生存中的作用（Gehan-Breslow-Wilcoxon检验，P分别为0.032和0.004）。多变量Cox回归分析显示，与轻度分级相比，重度（风险比，1.99；95%CI，1.49-2.65）或中度分级（风险比，1.47；95%CI，1.10-1.97）的患者在1年时死亡风险更高。老年患者（年龄≥80岁）、需要长期氧疗的患者或有既往ECOPD发作史的患者死亡风险更高。体重指数在25至29kg/m之间的患者风险较低。
罗马分类能够在3年随访期内鉴别出预后较差（重度或中度）的患者。
