Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, Pistelli R
Dept of Geriatrics, Catholic University, Rome, Italy.
Eur Respir J. 1997 Dec;10(12):2794-800. doi: 10.1183/09031936.97.10122794.
The aim of this study was to assess the prognostic role of co-morbidity in severe chronic obstructive pulmonary disease (COPD). A cohort of 270 COPD patients, mean (+/-SD) age 67+/-9 yrs, consecutively discharged from a University Hospital after an acute exacerbation was studied. Mean (+/-SD) forced expiratory volume in one second (FEV1) was 34+/-16% of predicted and FEV1/forced vital capacity (FVC) was 40.5+/-13.8%. The most common co-morbid diseases were: hypertension (28%), diabetes mellitus (14%), and ischaemic heart disease (10%). Clinical, electrocardiogram (ECG), and respiratory function data taken at the time of discharge were collected from the clinical records. The Charlson's index was used to quantify co-morbidity. Follow-up was conducted by means of telephone calls. Multivariate survival analysis was used to identify the independent predictors of death. The median survival of the cohort was 3.1 yrs. Death was predicted by the following variables: age (hazard rate (HR) 1.04; 95% confidence intervals (95% CI) 1.02-1.05), ECG signs of right ventricular hypertrophy (HR 1.76; 95% CI 1.30-2.38), chronic renal failure (HR 1.79; 95% CI 1.05-3.02), ECG signs of myocardial infarction or ischaemia (HR 1.42; 95% CI 1.02-1.96), FEV1 < 590 mL (HR 1.49; 95% CI 0.97-2.27). A score based upon these variables predicted mortality at 5 yrs with a sensitivity of 63% and a specificity of 77%. Selected co-morbid diseases and electrocardiogram signs of right ventricular hypertrophy play a major prognostic role in advanced chronic obstructive pulmonary disease. The clinical assessment of patients with chronic obstructive pulmonary disease should include these important and easily measurable variables.
本研究旨在评估合并症在重度慢性阻塞性肺疾病（COPD）中的预后作用。对270例COPD患者进行了研究，这些患者在急性加重后从一家大学医院连续出院，平均（±标准差）年龄为67±9岁。一秒用力呼气容积（FEV1）平均（±标准差）为预测值的34±16%，FEV1/用力肺活量（FVC）为40.5±13.8%。最常见的合并症包括：高血压（28%）、糖尿病（14%）和缺血性心脏病（10%）。从临床记录中收集出院时的临床、心电图（ECG）和呼吸功能数据。采用Charlson指数对合并症进行量化。通过电话进行随访。采用多因素生存分析确定死亡的独立预测因素。该队列的中位生存期为3.1年。以下变量可预测死亡：年龄（风险比（HR）1.04；95%置信区间（95%CI）1.02 - 1.05）、右心室肥厚的心电图表现（HR 1.76；95%CI 1.30 - 2.38）、慢性肾衰竭（HR 1.79；95%CI 1.05 - 3.02）、心肌梗死或缺血的心电图表现（HR 1.42；95%CI 1.02 - 1.96）、FEV1 < 590 mL（HR 1.49；95%CI 0.97 - 2.27）。基于这些变量的评分预测5年死亡率的敏感性为63%，特异性为77%。选定的合并症和右心室肥厚的心电图表现在晚期慢性阻塞性肺疾病中起主要的预后作用。慢性阻塞性肺疾病患者的临床评估应包括这些重要且易于测量的变量。
