查尔森合并症指数对老年慢性阻塞性肺疾病患者预后的评估价值

Predictive Value of Charlson Comorbidity Index in Prognosis of Aged Chronic Obstructive Pulmonary Disease Patients

目的探讨查尔森合并症指数(CCI)评估老年慢性阻塞性肺疾病(简称慢阻肺)预后的价值。方法回顾性分析2010年1月至2015年1月首都医科大学宣武医院呼吸科住院的350例大于65岁的慢阻肺患者的临床资料。采集年龄、体重指数(BMI)、合并症、第1秒用力呼气容积占预计值百分比(FEV1%pred)、入院前1年慢阻肺急性加重次数和出院时转归。计算CCI分值,分析慢阻肺急性加重及住院死亡的相关因素。结果慢阻肺急性加重次数≥2次/年患者177例,慢阻肺急性加重次数<2次/年患者173例。经多因素Logistic回归分析,CCI[OR=1.559,95%CI(1.309,1.856),P=0.000]及FEV1%pred[OR=0.979,95%CI(0.964,0.994),P=0.006]是慢阻肺急性加重的独立危险因素。住院死亡率为10.3%(36/314)。经多因素Logistic回归分析,CCI[OR=1.894,95%CI(1.422,2.523),P=0.000],年龄[OR=1.153,95%CI(1.063,1.251),P=0.001],FEV1%pred[OR=0.916,95%CI(0.878,0.955),P=0.000],BMI[OR=0.849,95%CI(0.749,0.962),P=0.011],慢阻肺急性加重≥2次/年[OR=6.340,95%CI(1.469,27.366),P=0.013]是慢阻肺患者死亡的独立危险因素。结论 CCI是慢阻肺急性加重及死亡的独立危险因素,对评估慢阻肺预后有一定价值。

Objective To explore the predictive value of Charlson comorbidity index（CCI） in the prognosis of aged chronic obstructive pulmonary disease（ COPD） patients. Methods A retrospective review was performed for 350 hospitalized aged COPD patients who admitted in Xuanwu Hospital of Capital Medical University from January 2010 to January 2015. The clinical data were recorded including age,body mass index（ BMI）,comorbidities（ CCI score）,FEV1% pred,the times of acute exacerbation of COPD a year before admission,and in-hospital mortality. The risk factors of acute exacerbation and in-hospital mortality were analyzed by multivariable logistic regression. Results There were 177 patients who had experienced acute exacerbation more than 2 times per year and 173 patients who had experienced acute exacerbation less than 2 times per year. Multivariable logistic regression analysis showed that CCI [OR = 1. 559,95% CI（1. 309,1. 856）,P = 0. 000] and FEV1% pred [OR = 0. 979,95% CI（ 0. 964,0. 994）,P = 0. 006] were the independent predictors for acute exacerbation of COPD. The in-hospital mortality rate was 10. 3%（36 /314）. Multivariable logistic regression analysis showed that CCI [OR = 1. 894,95% CI（1. 422,2. 523）,P = 0. 000],age [OR = 1. 153,95% CI（1. 063,1. 251）,P = 0. 001],FEV1% pred [OR = 0. 916,95% CI（0. 878,0. 955）,P = 0. 000 ],BMI [OR = 0. 849,95% CI（ 0. 749,0. 962）,P = 0. 011 ],acute exacerbation more than 2 times per year [OR = 6. 340,95% CI（ 1. 469,27. 366）,P = 0. 013] were the independent predictors for mortality. Conclusion CCI is an independent risk factor associated with in-hospital mortality and acute exacerbation of COPD.