Chest Diseases Department, Başkent University School of Medicine, Ankara, Turkey.
Department of Pulmonary Medicine, Gazi University School of Medicine, Mevlana Bulvarı No 29, Emniyet Mah, Yenimahalle, Ankara, 06560, Turkey.
BMC Pulm Med. 2024 Nov 28;24(1):590. doi: 10.1186/s12890-024-03399-7.
Exacerbation is an independent risk factor for chronic obstructive pulmonary disease (COPD)-related morbidity and mortality. Despite optimal care, there may be risk factors that lead to difficulties in managing exacerbations that may be associated with prolongation of length of hospital stay (LOS).
This is a multicenter prospective observational study of COPD patients hospitalized with exacerbations. Prolonged LOS was calculated according to the 50th percentile and defined as ≥ 9 days. Potentially predicting factors of LOS were stratified into 4 pillars as patient-related, disease and exacerbation-related, treatment-related and, hospital utility-related. These categories were systematically documented throughout the duration of the hospitalization.
A total of 434 patients, 361 males and 73 females, with a mean age of 69.2 ± 9.3 years, were included in the study. Variables of each pillar were tested with univariate analysis to identify potential risk factors for prolonged LOS. Subsequently significant factors excluding factors associated with hospital utility were tested with multivariate logistic regression analysis for detecting potential associated factors for difficult-to-manage COPD exacerbation. Biomass exposure, past history of non-invasive mechanical ventilation (NIMV), low bicarbonate levels at admission, antibiotic switching, need for theophylline, increasing oxygen requirement, need for in-hospital non-invasive mechanical ventilation, nutritional support and physiotherapy were found as defining factors.
The DiMECO study can help to identify COPD exacerbators who are at risk for prolonged hospitalizations that may associate with difficult-to-manage COPD exacerbations. Difficult to manage COPD exacerbation may serve as a provocative framework, underscoring the necessity for a better understanding of the multifaceted approaches to the management of COPD exacerbations. This conceptualization warrants further investigation across diverse clinical settings to validate its applicability and efficacy.
加重是慢性阻塞性肺疾病（COPD）相关发病率和死亡率的独立危险因素。尽管进行了最佳治疗，但仍可能存在导致加重管理困难的危险因素，这可能与住院时间（LOS）延长有关。
这是一项多中心前瞻性观察性研究，纳入了因加重而住院的 COPD 患者。根据第 50 百分位数计算 LOS 延长，并将其定义为≥9 天。将 LOS 的潜在预测因素分为 4 个支柱，包括患者相关、疾病和加重相关、治疗相关以及医院利用相关。在整个住院期间系统地记录了这些类别。
共有 434 名患者（361 名男性和 73 名女性），平均年龄为 69.2±9.3 岁，纳入了本研究。对每个支柱的变量进行了单因素分析，以确定 LOS 延长的潜在危险因素。随后，对排除与医院利用相关因素的显著因素进行多变量逻辑回归分析，以检测难以管理的 COPD 加重的潜在相关因素。生物量暴露、既往无创机械通气（NIMV）史、入院时低碳酸氢盐水平、抗生素转换、茶碱需求、氧需求增加、需要院内无创机械通气、营养支持和物理治疗被确定为定义因素。
DiMECO 研究可以帮助识别 COPD 加重者，他们有住院时间延长的风险，这可能与难以管理的 COPD 加重有关。难以管理的 COPD 加重可能作为一个有争议的框架，强调需要更好地理解 COPD 加重管理的多方面方法。这种概念化需要在不同的临床环境中进一步研究，以验证其适用性和有效性。
