School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.
BMJ Open Respir Res. 2024 Jul 20;11(1):e002266. doi: 10.1136/bmjresp-2023-002266.
We sought to describe the long-term prognosis for a population-based cohort of people with hypercapnic respiratory failure (HRF) and the associations between underlying diagnoses and the risks of death and rehospitalisation.
We performed a historical cohort study of all persons with HRF in the Liverpool local government area in New South Wales, Australia, in the 3-year period from 2013 to 2015. Cohort members were identified using arterial blood gas results from Liverpool Hospital demonstrating pH ≤7.45 and PaCO >45 mm Hg within 24 hours of presentation. Linked health data were obtained from statewide registries with a minimum follow-up period of 6 years. The primary outcomes were time to death from any cause and the standardised mortality ratio (SMR) which compares the observed to the expected number of deaths in the same population. Secondary outcomes were time to rehospitalisation and the associations between death and/or hospitalisation and underlying diagnoses.
The cohort comprised 590 adults aged between 15 and 101 years. Overall, 415 (70.3%) participants died in the follow-up period. Among those who survived the index admission, the probability of survival at 1, 3 and 5 years was 81%, 59% and 45%, respectively. The overall SMR was 9.2 (95% CI 7.6 to 11.0), indicating a near 10-fold risk of death than otherwise expected for age. Most (91%) survivors experienced rehospitalisation, with median (IQR) time to readmission of 3.9 (1.2-10.6) months. Congestive cardiac failure and neuromuscular disease were associated with an increased risk of death, whereas chronic obstructive pulmonary disease and sleep disordered breathing increased the risk of rehospitalisation.
HRF is associated with poor survival and high risk of rehospitalisation in the 5 years following an index event. The underlying disease appears to have some influence on overall survival and subsequent hospitalisations.
我们旨在描述基于人群的高碳酸血症性呼吸衰竭（HRF）患者队列的长期预后，以及潜在诊断与死亡和再入院风险之间的关系。
我们对 2013 年至 2015 年期间澳大利亚新南威尔士州利物浦地方政府区域内所有 HRF 患者进行了一项历史性队列研究。队列成员通过利物浦医院的动脉血气结果确定，该结果显示 pH 值≤7.45 和 PaCO >45 mm Hg，且在就诊后 24 小时内出现。通过全州性登记处获得了至少 6 年随访期的相关健康数据。主要结局是任何原因导致的死亡时间和标准化死亡率（SMR），该比值将观察到的死亡人数与同一人群的预期死亡人数进行比较。次要结局是再入院时间以及死亡和/或住院与潜在诊断之间的关系。
该队列包含 590 名年龄在 15 至 101 岁之间的成年人。在随访期间，共有 415 名（70.3%）参与者死亡。在那些存活下来的患者中，1 年、3 年和 5 年的生存率分别为 81%、59%和 45%。总体 SMR 为 9.2（95%CI 7.6 至 11.0），表明死亡风险比预期高近 10 倍。大多数（91%）幸存者经历了再入院，中位（IQR）再入院时间为 3.9（1.2-10.6）个月。充血性心力衰竭和神经肌肉疾病与死亡风险增加相关，而慢性阻塞性肺疾病和睡眠呼吸障碍增加了再入院的风险。
在指数事件发生后的 5 年内，HRF 与生存率差和再入院风险高相关。潜在疾病似乎对总生存率和随后的住院治疗有一定影响。
