慢性阻塞性肺疾病评估测试（COTE）与肺部合并症可预测慢性阻塞性肺疾病（COPD）的中重度急性加重和住院情况。

COTE and Pulmonary Comorbidities Predict Moderate-to-Severe Acute Exacerbation and Hospitalization in COPD.

作者信息

Chen Qinglin, Wang Xinmao, Yao Xiujuan, Zhang Luo, Liu Xiaofang

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.

Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission, Beijing, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2025 Jun 11;20:1893-1913. doi: 10.2147/COPD.S518218. eCollection 2025.

DOI:10.2147/COPD.S518218

PMID:40524721

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12169424/

Abstract

PURPOSE

The aim of this study was to explore the predictive value of the chronic obstructive pulmonary disease (COPD) specific comorbidity test index (COTE) and pulmonary comorbidities for moderate-to-severe acute exacerbation and hospitalization in COPD patients.

PATIENTS AND METHODS

This was a retrospective cohort study. We included 470 patients with stable COPD. Patients were divided into high or low-risk comorbidity group according to whether COTE score ≥4, and pulmonary comorbidities and extrapulmonary comorbidities group according to comorbidity origin. Moderate-to-severe acute exacerbation events and other clinical parameters were compared between groups. Multifactorial analysis and Lasso regression were used to screen risk factors and establish predictive models for moderate-to-severe acute exacerbation and hospitalization. The receiver operating characteristic (ROC) curve was used to assess the value COTE score and pulmonary comorbidities in predicting moderate-to-severe acute exacerbation and hospitalization.

RESULTS

When compared with the low-risk comorbidity and extrapulmonary comorbidities group, the rate of patients with ≥2 moderate-to-severe acute exacerbations and requiring hospitalization due to acute exacerbations is higher in high-risk comorbidity and pulmonary comorbidities group (χ²=18.45, χ²=40.15, χ²=8.82, χ²=23.68). Multifactorial analysis showed that comorbid with asthma, lung cancer were risk factors for moderate-to-severe acute exacerbations, while asthma, bronchiectasis, lung cancer, and high COTE score were risk factors for patients requiring hospitalization due to acute exacerbations. The AUC for COTE > 5.5 and a combination of at least one pulmonary comorbidity as potential indication of moderate-to-severe acute exacerbations of COPD and hospitalization due to acute exacerbations was 0.667 (95% CI: 0.615, 0.719) and 0.740 (95% CI: 0.688, 0.792), respectively. The prediction models including COTE and pulmonary comorbidities can predict moderate-to-severe acute exacerbations (internal validation of AUC: 0.984, 95CI%: 0.964-1) and hospitalization (internal validation of AUC: 0.978, 95CI%: 0.959-0.998) of COPD.

CONCLUSION

COTE score and a combination of at least one pulmonary disease can predict the risk of moderate-to-severe acute exacerbations and hospitalization due to acute exacerbations in patients with COPD.

摘要

目的

本研究旨在探讨慢性阻塞性肺疾病（COPD）特异性合并症检测指数（COTE）及肺部合并症对COPD患者中重度急性加重和住院治疗的预测价值。

患者与方法

这是一项回顾性队列研究。我们纳入了470例稳定期COPD患者。根据COTE评分是否≥4将患者分为高或低风险合并症组，并根据合并症来源分为肺部合并症组和肺外合并症组。比较各组间中重度急性加重事件及其他临床参数。采用多因素分析和Lasso回归筛选危险因素，并建立中重度急性加重和住院治疗的预测模型。采用受试者工作特征（ROC）曲线评估COTE评分和肺部合并症在预测中重度急性加重和住院治疗方面的价值。

结果

与低风险合并症和肺外合并症组相比，高风险合并症和肺部合并症组中≥2次中重度急性加重且因急性加重需要住院治疗的患者比例更高（χ²=18.45，χ²=40.15，χ²=8.82，χ²=23.68）。多因素分析显示，合并哮喘、肺癌是中重度急性加重的危险因素，而哮喘、支气管扩张、肺癌及高COTE评分是因急性加重需要住院治疗患者的危险因素。COTE>5.5以及至少一种肺部合并症联合作为COPD中重度急性加重和因急性加重住院治疗的潜在指征时，其AUC分别为0.667（95%CI：0.615，0.719）和0.740（95%CI：0.688，0.792）。包含COTE和肺部合并症的预测模型可预测COPD的中重度急性加重（AUC内部验证值：0.984，95CI%：0.964 - 1）和住院治疗（AUC内部验证值：0.978，95CI%：0.959 - 0.998）。