衰弱对慢性阻塞性肺疾病急性发作再住院的影响

Effect of frailty on rehospitalization for acute exacerbations of COPD

目的通过分析老年医院呼吸科慢性阻塞性肺疾病(COPD)住院患者的临床资料、衰弱和再次因慢性阻塞性肺疾病急性发作(AECOPD)住院的情况,探讨老年患者衰弱与再次因AECOPD住院之间的关系。方法纳入2015年9月1日至2018年10月31日就诊于北京老年医院呼吸科的老年慢性阻塞性肺疾病住院患者117例。衰弱的诊断采用临床衰弱评分(CFS),在出院24时内进行评估,并据此将患者分为衰弱组和非衰弱组。收集患者入院时一般临床资料、疾病史、共病数量、用药情况等,对所有患者进行3个月AECOPD再住院情况随访。结果依据CFS评估结果,将117例患者分为两组:衰弱组(n=53,45.3%)和非衰弱组(n=64,54.7%)。与非衰弱组比较,衰弱组患者年龄偏大、心功能不全、脑梗死的比例增高(P<0.05),衰弱组共病数量(≥4)、服药品种数量(>5)多、COPD等级高。非衰弱组3个月内再次出现AECOPD住院6例(9.4%),对比衰弱组45例(84.9%),两组差异有统计学意义(P<0.05)。通过二元logistic回归分析,发现衰弱对再次AECOPD住院影响最大(OR值=35.247,95%CI=10.57～117.527,P<0.05)。结论衰弱的老年人有更高的风险在3个月内再次因AECOPD住院。

Objective To analyze of the clinical data of inpatients with COPD from Respiratory Department of Geriatric Hospital, and hospitalization survey on AECOPD and frailty, and to study the relationship between frailty and rehospitalized for AECOPD in elderly patients. Methods A total of 117 inpatients with AECOPD from September 1,2015 to October 31,2018 were prospectively recruited in this study. Diagnosis of frailty was evaluated with CFS within 24 hours of discharge, and then they were assigned into the frailty group and non-frailty group. General clinical data, disease history, number of comorbidities and drug use were collected. All patients were followed up for 3 months for AECOPD re-hospitalization. Results According to CFS evaluation results, 117 patients were divided into two groups, frailty group ( n =53, 45.3%) and non-frailty group ( n =64, 54.7%).The proportion of patients age, cardiac insufficiency and cerebral infarction in frail group was higher than that in non-frail group( P < 0.05 ), besides, the frailty group had larger numbers of comorbidities (≥4), of medications (>5) and of COPD level.There were 6 cases of AECOPD hospitalization in non-frail group within 3 months, compared with 45 cases in frailty group ( P < 0.05 ).Through binary logistic regression analysis, frailty was the greatest impact on rehospitalization of AECOPD ( OR = 35.247 , 95% CI = 10.57 - 117.527 , P < 0.05 ). Conclusion The fragile elderly people have higher risk of rehospitalization for AECOPD within three months.