Feng Lin, Li Jiachen, Su Jian, Tong Zhaohui, Liang Lirong
Evidence-Based Medicine Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, Beijing, China.
School of Economics, Peking University, Beijing, Beijing, China.
BMJ Open Respir Res. 2025 Sep 15;12(1):e003110. doi: 10.1136/bmjresp-2024-003110.
Cardiovascular and cerebrovascular comorbidities are prevalent in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but their impact on in-hospital outcomes and the risk of readmission remains unclear. This study aimed to describe the proportions of these comorbidities and assess their influence on patient outcomes.
Hospital admission records from 2013 to 2020 with a primary discharge diagnosis of AECOPD were retrieved from Beijing Public Health Information Centre database. Comorbidities were identified through discharge diagnoses, while in-hospital outcomes and subsequent readmissions were tracked. Logistic regression model, generalised linear model and subdistributional hazard model were used to evaluate the associations between comorbidities and adverse outcomes.
Among 98 127 patients, cardiovascular comorbidities were present in 78.3% of cases and cerebrovascular comorbidities were present in 30.3% of cases. Patients with cardiovascular comorbidities or cerebrovascular comorbidities or both had prolonged length of stay (ORs: 1.29, 95% CI: 1.23 to 1.35; 1.20, 95% CI: 1.10 to 1.32; 1.52, 95% CI: 1.44 to 1.60) and higher in-hospital mortality (ORs: 1.39, 95% CI: 1.19 to 1.62; 1.34, 95% CI: 1.04 to 1.75; 1.25, 95% CI: 1.06 to 1.48) compared with those without these conditions. Patients with cardiovascular comorbidities and those with both cardiovascular and cerebrovascular comorbidities were at increased risk of readmission (HRs: 1.14, 95% CI: 1.10 to 1.19; 1.19, 95% CI: 1.14 to 1.25), whereas cerebrovascular comorbidities alone were not. The impact of individual comorbidity varied, with heart failure, ischaemic heart disease, arrhythmia, hypertension, ischaemic stroke and cerebrovascular sequelae showing positive associations with adverse outcomes, but the opposite was observed for peripheral arterial disease, arterial stenosis and other cerebrovascular diseases.
Most cardiovascular comorbidities and major cerebrovascular comorbidities are significant predictors of length of stay, in-hospital mortality and readmission in AECOPD patients. These findings highlight the need for targeted management strategies to improve outcomes in this high-risk population. Further research is needed to explore the mechanisms underlying these associations.
心血管和脑血管合并症在慢性阻塞性肺疾病急性加重期（AECOPD）患者中普遍存在，但其对住院结局和再入院风险的影响尚不清楚。本研究旨在描述这些合并症的比例，并评估其对患者结局的影响。
从北京公共卫生信息中心数据库中检索2013年至2020年以AECOPD为主要出院诊断的住院记录。通过出院诊断确定合并症，同时跟踪住院结局和随后的再入院情况。使用逻辑回归模型、广义线性模型和亚分布风险模型评估合并症与不良结局之间的关联。
在98127例患者中，78.3%的病例存在心血管合并症，30.3%的病例存在脑血管合并症。与无这些情况的患者相比，患有心血管合并症或脑血管合并症或两者皆有的患者住院时间延长（比值比：1.29，95%置信区间：1.23至1.35；1.20，95%置信区间：1.10至1.32；1.52，95%置信区间：1.44至1.60）且住院死亡率更高（比值比：1.39，95%置信区间：1.19至1.62；1.34，95%置信区间：1.04至1.75；1.25，95%置信区间：1.06至1.48）。患有心血管合并症的患者以及患有心血管和脑血管合并症的患者再入院风险增加（风险比：1.14，95%置信区间：1.10至1.19；1.19，95%置信区间：1.14至1.25），而单独的脑血管合并症则不然。个体合并症的影响各不相同，心力衰竭、缺血性心脏病、心律失常、高血压、缺血性中风和脑血管后遗症与不良结局呈正相关，但外周动脉疾病、动脉狭窄和其他脑血管疾病则相反。
大多数心血管合并症和主要脑血管合并症是AECOPD患者住院时间、住院死亡率和再入院的重要预测因素。这些发现凸显了需要有针对性的管理策略来改善这一高危人群的结局。需要进一步研究来探索这些关联背后的机制。
