慢性阻塞性肺疾病30 d内再住院是频繁急性加重表型的特征

Rehospitalization within 30 days is the characteristic of the frequent-exacerbation phenotype of chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病急性加重(AECOPD)30 d内再住院患者的临床特征以及影响再住院的危险因素,以便更好地认识影响慢阻肺早期再住院的危险因素,帮助制定全面的干预措施来减少慢阻肺的短期再住院。方法本研究为回顾性病例研究。采用非随机抽样法,研究数据来自于重庆医科大学附属第三医院2017年1月至2021年12月期间以AECOPD为第一诊断住院的病例,按住院频次分为30 d内再住院组(67例,496例次)、非30 d内再住院组(311例,720例次)、无再住院组(845例,845例次)。分析出院后30 d内主因AECOPD再住院患者的平均年住院频次、临床特征以及影响30 d内再住院的危险因素。结果5年期间共有378例患者发生再住院,其中67例患者在30 d内再住院122例次,5年内总住院496例次,年平均住院频次为1.48次。其中,30 d内再住院≥2次的患者20例,年平均住院频次达到1.98次。以上2组患者的年平均住院频次分别为非30 d内再住院患者(311例,年平均住院频次为0.46次)的3.2倍和4.3倍。logistic回归分析显示,影响30 d内再住院的危险因素为呼吸衰竭(OR=2.28,P=0.004)、合并冠状动脉粥样硬化性心脏病(OR=3.15,P=0.001)、铜绿假单胞菌感染(OR=7.03,P<0.001)等。结论具有30 d内再住院病史的慢阻肺患者表现出明显频繁加重再住院的特征,是慢阻肺频繁加重表型的"标签"之一。

Objective To analyze the clinical characteristics and risk factors of 30-day readmission in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),so as to better understand the risk factors affecting early readmission of chronic obstructive pulmonary disease and to help develop comprehensive interventions to reduce short-term readmission of chronic obstructive pulmonary disease.Methods This was a retrospective study and non-random sampling method was used.The data in this study were obtained from the inpatients with AECOPD as first diagnosis in the Third Affiliated Hospital of Chongqing Medical University from January 2017 to December 2021.Based on the admission frequency,the patients were assigned to 30-day readmission group(67 cases,with 496 times),non 30-day readmission group(311 cases,with 720 times),and no more admission group(845 cases,with 845 times).The clinical characteristics and frequency of annual admission of patients with 30-day readmission due to AECOPD as main causes were analyzed.The potential risk factors that would affect the 30-day readmission were studied.Results A total of 378 patients were re-admitted over 5-year study period,among whom 67 patients had 122 readmissions within 30 days and 496 readmissions over 5 years,with the annual admission of 1.48 times.Twenty patients were readmitted twice or more within 30 days,with the admission frequency of 1.98 times per year during the 5 years.The annual hospitalization frequency of the above two groups were respectively 3.2 times and 4.3 times of those with non 30-day readmission(0.46 admission per year).Logistic regression analysis showed that the risk factors for 30-day readmission were respiratory failure(OR=2.28,P=0.004),coronary heart disease(OR=3.15,P<0.001),and pseudomonas aeruginosa infection(OR=7.03,P<0.001).Conclusions Patients with history of 30-day AECOPD readmission showed a distinct characteristic of frequent exacerbation,which is a"label"for the phenotype of frequent AECOPD.