Zimmermann Maximilian, Vocht Franziska, Kroppen Doreen, Majorski Daniel S, Berger Melanie P, Stanzel Sarah B, Holle Johannes F, Schumacher Falk, Matthes Tim, Windisch Wolfram, Wollsching-Strobel Maximilian
Cologne Merheim Hospital, Department of Pneumology, Witten/Herdecke University, Kliniken der Stadt Köln gGmbH, Cologne, Germany.
Cologne Merheim Hospital, Department of Neurology, Kliniken der Stadt Köln gGmbH, Cologne, Germany.
BMC Pulm Med. 2025 Jun 7;25(1):284. doi: 10.1186/s12890-025-03737-3.
Non-invasive ventilation (NIV) is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). While studies have demonstrated benefits for mortality, hospitalization rates, and health related quality of life (HRQL), evidence is particularly sparse regarding HRQL determinants in the older population.
In a prospective, monocentric observational study, HRQL was assessed using the established Severe Respiratory Insufficiency Questionnaire (SRI). The study was prospectively registered in the German Clinical Trials Register on 17 June 2015 under the registration number DRKS00008759. Patients were categorized into two age-based groups: older patients (≥ 65 years) and younger patients (< 65 years). Multiple linear regression analyses were used to analyze factors on HRQL, including SRI scores, anemia, autonomy impairment, exacerbation history and other factors.
237 Patients with COPD with CHRF receiving NIV therapy were included. The mean SRI summary score was 49.9 ± 16.8. with 23.2% (N = 55) suffering from anemia and 36.7% (N = 87) experiencing ≥ 2 exacerbations annually. Autonomy impairment was observed in 49.4% (N = 117) of patients. The updated Charlson Comorbidity Index (uCCI) was 2.2 ± 1.86. No significant differences were found in SRI Summary Scale scores between age groups (p = 0.581), but notable disparities were present in the uCCI (p = 0.014). Multiple regression analysis revealed a negative association of exacerbation history (Young group: -9.2; 95% CI = -14.8/ -3.55 vs. Older group: -6.17; 95% CI = -11.91/ -0.43) and level of autonomy impairment (e.g. Level of Care 2 Young group: -13.91; 95% CI = -21.4/ -6.43 vs. Older group: -14.94; 95% CI = -22.64/ -7.24) on SRI scores with age-related differences. Anemia only had a negative association on the SRI scores in younger patients with COPD (Young group: -7.9; 95% CI = -14.0/ -1.75 vs. Older group: -1.78; 95% CI = -9.21/ 5.65).
Frequent exacerbations and a higher level of autonomy impairment had a negative association on HRQL across all ages. However only higher levels of impairment (≥ 2) have a detrimental impact on older patients. Anemia was a negative HRQL factor in younger patients, where it was more prevalent. Overall, HRQL was found to be comparably favorable in both older and younger patients, despite age-specific differences in influencing factors.
The study from which the data were analyzed was prospectively registered in the German Clinical Trials Register (DRKS00008759) on June 17, 2015.
无创通气（NIV）是治疗慢性高碳酸血症呼吸衰竭（CHRF）的一种成熟疗法。虽然研究已证明其对死亡率、住院率及健康相关生活质量（HRQL）有益，但关于老年人群HRQL决定因素的证据尤其匮乏。
在一项前瞻性、单中心观察性研究中，使用已确立的严重呼吸功能不全问卷（SRI）评估HRQL。该研究于2015年6月17日在德国临床试验注册中心前瞻性注册，注册号为DRKS00008759。患者被分为两个基于年龄的组：老年患者（≥65岁）和年轻患者（<65岁）。采用多元线性回归分析来分析影响HRQL的因素，包括SRI评分、贫血、自主能力受损、急性加重病史及其他因素。
纳入237例接受NIV治疗的慢性阻塞性肺疾病（COPD）合并CHRF患者。SRI总分均值为49.9±16.8。23.2%（N = 55）的患者患有贫血，36.7%（N = 87）的患者每年发生≥2次急性加重。49.4%（N = 117）的患者存在自主能力受损。更新的Charlson合并症指数（uCCI）为2.2±1.86。各年龄组间SRI总分量表评分无显著差异（p = 0.581），但uCCI存在显著差异（p = 0.014）。多元回归分析显示，急性加重病史（年轻组：-9.2；95%置信区间=-14.8/-3.55，老年组：-6.17；95%置信区间=-11.91/-0.43）和自主能力受损程度（如护理级别2，年轻组：-13.91；95%置信区间=-21.4/-6.43，老年组：-14.94；95%置信区间=-22.64/-7.24）与SRI评分呈负相关，且存在年龄相关差异。贫血仅与年轻COPD患者的SRI评分呈负相关（年轻组：-7.9；95%置信区间=-14.0/-1.75，老年组：-1.78；95%置信区间=-9.21/5.65）。
在所有年龄段中，频繁急性加重和较高的自主能力受损程度与HRQL呈负相关。然而，仅较高程度的受损（≥2级）对老年患者有不利影响。贫血是年轻患者中HRQL的负面因素，且在年轻患者中更常见。总体而言，尽管影响因素存在年龄特异性差异，但老年和年轻患者的HRQL相当。
分析数据的研究于2015年6月17日在德国临床试验注册中心（DRKS00008759）前瞻性注册。
