Connors A F, Dawson N V, Thomas C, Harrell F E, Desbiens N, Fulkerson W J, Kussin P, Bellamy P, Goldman L, Knaus W A
Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA.
Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):959-67. doi: 10.1164/ajrccm.154.4.8887592.
In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective cohort of 1,016 adult patients from five hospitals who were admitted with an exacerbation of COPD and a PaCO2 of 50 mm Hg or more. Patient characteristics and acute physiology were determined. Outcomes were evaluated over a 6 mo period. Although only 11% of the patients died during the index hospital stay, the 60-d, 180-d, 1-yr, and 2-yr mortality was high (20%, 33%, 43%, and 49%, respectively). The median cost of the index hospital stay was $7,100 ($4,100 to $16,000; interquartile range). The median length of the index hospital stay was 9 d (5 to 15 d). After discharge, 446 patients were readmitted 754 times in the next 6 mo. At 6 mo, only 26% of the cohort were both alive and able to report a good, very good, or excellent quality of life. Survival time was independently related to severity of illness, body mass index (BMI), age, prior functional status, PaO2/FI(O2), congestive heart failure, serum albumin, and the presence of cor pulmonale. Patients and caregivers should be aware of the likelihood of poor outcomes following hospitalization for exacerbation of COPD associated with hypercarbia.
为了描述因重度慢性阻塞性肺疾病（COPD）急性加重而住院患者的预后情况，并确定患者特征与生存时长之间的关系，我们对来自五家医院的1016例成年患者进行了一项前瞻性队列研究，这些患者因COPD加重且动脉血二氧化碳分压（PaCO2）≥50 mmHg而入院。确定了患者特征和急性生理学指标。在6个月期间对预后进行评估。尽管仅11%的患者在本次住院期间死亡，但60天、180天、1年和2年的死亡率较高（分别为20%、33%、43%和49%）。本次住院的中位费用为7100美元（4100美元至16000美元；四分位间距）。本次住院的中位时长为9天（5至15天）。出院后，446例患者在接下来的6个月内再次入院754次。在6个月时，队列中仅有26%的患者存活且能够报告生活质量为良好、非常好或极佳。生存时间与疾病严重程度、体重指数（BMI）、年龄、既往功能状态、动脉血氧分压/吸入氧分数（PaO2/FI(O2)）、充血性心力衰竭、血清白蛋白以及肺心病的存在独立相关。患者及其照护者应意识到，因伴有高碳酸血症的COPD加重而住院后预后不良的可能性。
