慢性阻塞性肺疾病患者住院急性加重期CCQ及其子领域的预测价值：一项为期3年的观察性前瞻性研究。
Predictive Value of CCQ and its Subdomains for Hospitalized Exacerbations in Chronic Obstructive Pulmonary Disease: A 3-Year Observational Prospective Study.
作者信息
Zhou Zijing, Cheng Wei, Liu Cong, Song Qing, Lin Ling, Zeng Yuqin, Deng Dingding, Ma Libing, Yu Zhiping, Yi Rong, Chen Ping
机构信息
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Renmin Middle Road, No. 139, Changsha, 410011, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
出版信息
J Gen Intern Med. 2025 May;40(7):1550-1558. doi: 10.1007/s11606-024-09067-0. Epub 2024 Oct 1.
BACKGROUND
The prediction capacity of the Clinical COPD Questionnaire (CCQ) and its functional, symptom, and mental subdomain for COPD hospitalized exacerbation were rarely studied.
OBJECTIVE
To examine the prognostic capacity of the total CCQ and its three subdomains for 3-year COPD hospitalized exacerbations.
METHODS
We analyzed the predictive ability of total CCQ score and its subdomains for hospitalized exacerbations in an observational cohort of 987 subjects with stable COPD from the RealDTC, an ongoing multicenter prospective study. Hospitalized exacerbations were prospectively collected every 6 month for a maximum of 3 years.
RESULTS
The total CCQ and its functional and symptom domain, but not the mental domain, were significantly associated with 3-year hospitalized exacerbations by multivariate Cox regression analysis. The predictive capacity of functional domain was similar to that of the total CCQ, but significantly stronger than the symptom and mental domain by ROC analysis (P < 0.05). ROC curves also showed that the AUC of exacerbation history combined with CCQ functional domain was larger than that of exacerbation history alone (P < 0.0001). Additionally, the predictive value of multivariable models that contains CCQ functional domain was significantly better than the corresponding model without CCQ functional domain (P < 0.05).
CONCLUSIONS
The total CCQ and its functional and symptom domain were independent risk factors of 3-year hospitalized exacerbations. The prognostic capacity of the functional domain was similar to that of total CCQ, and was significantly stronger than the symptom and mental domain. The CCQ functional domain was able to increase the predictive power of exacerbation history and other multivariable prediction models, indicating it may have an important role in the multivariable prediction tool for hospitalized exacerbation, and its combination with other clinical variables might be used as a low-cost approach for assessments of the disease severity and severe exacerbation in COPD patients in the future.
背景
临床慢性阻塞性肺疾病问卷（CCQ）及其功能、症状和心理子领域对慢性阻塞性肺疾病住院加重的预测能力鲜有研究。
目的
探讨CCQ总分及其三个子领域对慢性阻塞性肺疾病住院加重3年的预后能力。
方法
我们在一项正在进行的多中心前瞻性研究RealDTC中，分析了987例稳定期慢性阻塞性肺疾病患者的观察队列中，CCQ总分及其子领域对住院加重的预测能力。每6个月前瞻性收集住院加重情况，最长3年。
结果
通过多变量Cox回归分析，CCQ总分及其功能和症状领域（而非心理领域）与3年住院加重显著相关。功能领域的预测能力与CCQ总分相似，但通过ROC分析，其显著强于症状和心理领域（P<0.05）。ROC曲线还显示，加重病史与CCQ功能领域相结合的AUC大于单独加重病史的AUC（P<0.0001）。此外，包含CCQ功能领域的多变量模型的预测价值显著优于不包含CCQ功能领域的相应模型（P<0.05）。
结论
CCQ总分及其功能和症状领域是3年住院加重的独立危险因素。功能领域的预后能力与CCQ总分相似，且显著强于症状和心理领域。CCQ功能领域能够提高加重病史和其他多变量预测模型的预测能力，表明其可能在住院加重的多变量预测工具中发挥重要作用，其与其他临床变量的结合可能成为未来评估慢性阻塞性肺疾病患者疾病严重程度和严重加重的低成本方法。
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