Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
Value Evidence and Outcomes, GSK, Greater China and Intercontinental, Singapore.
BMJ Open. 2023 Sep 1;13(9):e072571. doi: 10.1136/bmjopen-2023-072571.
The long-term clinical trajectory of chronic obstructive pulmonary disease (COPD) in terms of year-to-year hospital utilisation rates can be highly variable and is not well studied. We investigated year-to-year trends of hospitalisation or emergency department (ED) visits among patients with COPD over 3 years, identified distinct trajectories and examined associated predictive factors.
A retrospective cohort study.
Data were extracted from the Changi General Hospital, Singapore COPD data warehouse.
Patients with COPD aged ≥40 years with 3 years of follow-up data.
The yearly rates of hospitalisations or ED visits, stratified by COPD-related or all-cause, were described. Group-based trajectory modelling was used to identify clinically distinct trajectories year-by-year. Baseline predictive factors associated with different trajectories were examined.
In total, 396 patients were analysed (median age 70 years; 87% male). Four trajectories were generated for year-to-year trends in COPD-related hospitalisations/ED visits (C1-C4: consistently frequent, consistently infrequent, improving and worsening); post-bronchodilator forced expiratory volume in 1 second (FEV) was a significant predictor of trajectory, with worse lung function being the main factor associated with less favourable trajectories. For all-cause hospitalisations/ED visits, four trajectories were identified (A1-A4: infrequent and stable, frequent and stable, frequent and decreasing, frequent and increasing); significant differences in age (p=0.041), sex (p=0.016) and ethnicity (p=0.005) were found between trajectories. Higher overall comorbidity burden was a key determinant in less favourable trajectories of all-cause hospitalisations/ED visits.
Distinct trajectories were demonstrated for hospitalisations/ED visits related to COPD or all causes, with predictive associations between FEV and COPD trajectory and between comorbidities and all-cause trajectory. Trajectories carry nuanced prognostic information and may be useful for clinical risk stratification to identify high-risk individuals for preventative treatments.
慢性阻塞性肺疾病（COPD）的长期临床轨迹表现在逐年的住院利用率上可能存在高度变异性，目前对此研究甚少。我们调查了 3 年内 COPD 患者的住院或急诊（ED）就诊的逐年趋势，确定了不同的轨迹，并研究了相关的预测因素。
回顾性队列研究。
数据来自新加坡樟宜综合医院 COPD 数据仓库。
年龄≥40 岁，有 3 年随访数据的 COPD 患者。
描述 COPD 相关或全因住院或 ED 就诊的逐年发生率。采用基于群组的轨迹建模方法，逐年确定临床明显的轨迹。检查与不同轨迹相关的基线预测因素。
共分析了 396 例患者（中位年龄 70 岁，87%为男性）。根据 COPD 相关住院/ED 就诊的逐年趋势，共产生了 4 种轨迹（C1-C4：持续频繁、持续不频繁、改善和恶化）；支气管扩张剂后 1 秒用力呼气量（FEV1）是轨迹的重要预测因素，肺功能越差与较差的轨迹相关。对于全因住院/ED 就诊，确定了 4 种轨迹（A1-A4：不频繁且稳定、频繁且稳定、频繁且减少、频繁且增加）；在轨迹之间发现了年龄（p=0.041）、性别（p=0.016）和种族（p=0.005）的显著差异。整体合并症负担较高是全因住院/ED 就诊较差轨迹的关键决定因素。
COPD 相关或全因住院/ED 就诊的轨迹存在明显差异，FEV1 与 COPD 轨迹之间以及合并症与全因轨迹之间存在预测关联。轨迹携带细微的预后信息，可用于临床风险分层，以识别高危个体进行预防性治疗。
