Golpe Rafael, Figueira-Gonçalves Juan-Marco, Arias-Zas Laura, Dacal-Rivas David, Blanco-Cid Nagore, Castro-Añón Olalla
Servicio de Neumología. Hospital Universitario Lucus Augusti, Lugo, Spain.
Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
Respir Med Res. 2024 Nov;86:101135. doi: 10.1016/j.resmer.2024.101135. Epub 2024 Aug 7.
Pneumonias are events of great prognostic significance in COPD, so it is important to identify predictive factors.
To determine whether poor glycemic control is related to an increased risk of pneumonia in COPD.
A historical cohort study conducted in a COPD clinic. The first severe exacerbation after the first visit was analyzed. Exacerbations that presented with pulmonary infiltrates were identified. A Cox proportional hazards analysis was performed including the values of glycosylated hemoglobin (Hb1Ac) in patients with diabetes mellitus (DM) and variables that could plausibly be related to the risk of pneumonia. The best Hb1Ac value to predict pneumonia was assessed using receiver-operating characteristics analysis.
There were 1124 cases included in the study. A total of 411 patients were admitted to the hospital at least once and 87 were diagnosed with pneumonia. Variables associated with the risk of pneumonia were previous admissions due to COPD and Hb1Ac values (HR: 2.33, 95% CI: 1.06 - 5.08, p = 0.03). A higher body mass index (BMI) was associated with a lower risk of pneumonia. The optimal cutoff point for Hb1Ac to predict pneumonia risk was 7.8 %. The patients were classified into 3 groups: (1) no DM, (2) controlled DM (Hb1AC < 7.8 %), (3) uncontrolled DM (Hb1AC ≥ 7.8 %). The risk of pneumonia for group 2 was not different from group 1, while the risk for group 3 was significantly higher than for groups 1 and 2 (HR: 4.52, 95 % CI: 1.57 - 13.02).
Poor control of DM is a predictor of the risk of pneumonia in COPD. The cutoff point of 7.8 % for this variable seems to be the most useful to identify patients at risk.
肺炎在慢性阻塞性肺疾病（COPD）中具有重要的预后意义，因此识别预测因素很重要。
确定血糖控制不佳是否与COPD患者肺炎风险增加有关。
在一家COPD诊所进行的历史性队列研究。分析首次就诊后的首次严重加重情况。识别出现肺部浸润的加重情况。进行Cox比例风险分析，纳入糖尿病（DM）患者的糖化血红蛋白（Hb1Ac）值以及可能与肺炎风险相关的变量。使用受试者工作特征分析评估预测肺炎的最佳Hb1Ac值。
该研究共纳入1124例病例。共有411例患者至少入院一次，87例被诊断为肺炎。与肺炎风险相关的变量是既往因COPD入院和Hb1Ac值（风险比：2.33，95%置信区间：1.06 - 5.08，p = 0.03）。较高的体重指数（BMI）与较低的肺炎风险相关。预测肺炎风险的Hb1Ac最佳临界值为7.8%。将患者分为3组：（1）无DM，（2）DM控制良好（Hb1AC < 7.8%），（3）DM控制不佳（Hb1AC≥7.8%）。第2组的肺炎风险与第1组无差异，而第3组的风险显著高于第1组和第2组（风险比：4.52，95%置信区间：1.57 - 13.‘02）。
DM控制不佳是COPD患者肺炎风险的预测因素。该变量7.8%的临界值似乎是识别高危患者最有用的指标。
