慢性阻塞性肺疾病急性加重住院患者一年及长期死亡风险因素分析

Risk factors analysis for one-year and long-term mortality in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease

目的 探讨影响慢性阻塞性肺疾病(慢阻肺)急性加重住院患者一年及长期死亡的独立危险因素.方法 回顾性分析2013年1月至2014年12月于北京朝阳医院呼吸与危重症医学科第一诊断为慢阻肺急性加重住院患者的临床资料,并进行随访,随访截止日期为2018年3月1日,对影响患者全因死亡率的危险因素进行Cox回归分析.结果 共纳入慢阻肺急性加重患者890例,出院后随访时间为1~62个月,平均随访时间为(41±17)个月.一年内病死率为8.4%(75/890),整个长期随访期间病死率为37.2%(331/890).在上述两种情况下,最常见死亡原因为呼吸系统疾病,其次为心血管和肿瘤疾病.与出院一年慢阻肺急性加重患者病死率相关的独立危险因素包括:体重指数(HR=0.891,95%CI为0.838~0.947,P<0.01),住院天数(HR=1.031,95%CI为1.019~1.042,P<0.01),淋巴细胞计数(HR=0.295,95%CI为0.160~0.542,P<0.01),白蛋白浓度(HR=0.935,95%CI为0.880~0.994,P=0.031),心房颤动(HR=2.220,95%CI为1.038~4.747,P=0.04),肺癌(HR=5.865,95 %CI为2.608~13.192,尸<0.01).与长期慢阻肺急性加重患者病死率相关的独立危险因素包括:年龄(HR=1.046,95%CI为1.031~1.062,P<0.01),体重指数(HR=0.939,95%CI为0.914~0.964,P<0.01),住院天数(HR=1.028,95%CI为1.019~1.038,P<0.01),白蛋白浓度(HR=0.957,95%CI为0.929~0.986,P<0.01),二氧化碳分压(HR=1.019,95%CI为1.009~1.028,P<0.01),心力衰竭(HR=1.538,95%CI为1.180~2.005,P=0.001),肺癌(HR=3.443,95%CI为2.033~5.830,P<0.01).然而,高嗜酸细胞计数(≥300/μl)与慢阻肺急性加重住院患者一年病死率(HR=0.892,95%CI为0.309~2.579,P=0.834)以及长期病死率(HR=1.007,95% CI为0.682~1.486,P=0.973)无相关性.结论 高龄、较差的营养状态、较长的住院天数、心血管疾病、肺癌、低淋巴细胞计数、高碳酸血症是影响慢阻肺急性加重患者死亡的独立危险因素.

Objective To identify the independent risk factors that predict one-year mortality and long-term mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A retrospective review of medical records and long-term follow-up were performed for inpatients with the first diagnosis of AECOPD at Beijing Chaoyang Hospital between January 2013 and December 2014.The follow-up was completed on March 1,2018.Cox regression analysis was used to determine the independent risk factors for all-cause mortality of AECOPD patients.Results A total of 890 AECOPD patients were enrolled.The average follow-up was 41 months(range 1-62).One-year mortality was 8.4%(75/890)and long-term mortality was 37.2%(331/890).In both scenarios,the main cause of death was respiratory disorders,and the next ones were cardiovascular and tumor disorders.The risk factors independently associated with one-year mortality included body mass index(HR 0.891,95%CI 0.838-0.947,P<0.01),length of hospitalization(HR 1.031,95%CI 1.019-1.042,P<0.01),lymphocyte count(HR 0.295,95%CI 0.160-0.542,P<0.01),albumin(HR 0.935,95%CI 0.880-0.994,P=0.031),atrial fibrillation(HR 2.220,95%CI 1.038-4.747,P=0.040),and lung cancer(HR 5.865,95%CI 2.608-13.192,P<0.01).The risk factors independently associated with long-term mortality included age(HR 1.046,95%CI 1.031-1.062,P<0.001),body mass index(HR 0.939,95%CI 0.914-0.964,P<0.01),length of hospitalization(HR 1.028,95%CI 1.019-1.038,P<0.01),albumin(HR 0.957,95%CI 0.929-0.986,P<0.01),partial pressure of carbon dioxide(HR 1.019,95%CI 1.009-1.028,P<0.01),heart failure(HR 1.538,95%CI 1.180-2.005,P=0.001),lung cancer(HR 3.443,95%CI 2.033-5.830,P<0.01).However,blood eosinophil count(≥300 cells/μl)was not independently associated with one-year mortality(HR 0.892,95%CI 0.309-2.579,P=0.834)and long-term mortality of COPD patients(HR 1.007,95%CI 0.682-1.486,P=0.973).Conclusion Old age,poor nutritional status,long length of hospitalization,cardiovascular disorders,lung cancer,low lymphocyte count and hypercapnia were independent risk factors for mortality of AECOPD patients.