慢性阻塞性肺疾病急性加重患者住院死亡影响因素研究

目的了解慢性阻塞性肺疾病急性加重（AECOPD）住院患者的短期预后,分析AECOPD住院患者住院期间死亡的影响因素。方法采用前瞻性队列研究方法,以2007年2月1日至2008年2月1日期间四川省某市3所二级综合性医院AECOPD住院患者为研究对象,符合纳入标准的患者进入队列随访。收集患者入院时临床资料,随访至出院,观察的结局事件是住院期间死亡,分析患者住院期间死亡的影响因素。结果共有257例符合纳入标准的AECOPD住院患者纳入观察队列,住院病死率5.84%（15/257）。单因素分析显示年龄、FEV1%pred、PaO2、SaO2、pH值、Charlson合并症指数是AECOPD住院死亡的影响因素,多因素Logistic回归模型分析显示PaO2和Charlson合并症指数是AECOPD住院死亡的独立预测因子,PaO2〈60 mm Hg的患者住院死亡危险增加4.775倍（OR 4.775;95%CI 1.545～14.757;P=0.007）,Charlson合并症指数≥3的患者住院死亡危险增加4.608倍（OR 4.608;95%CI 1.330～15.966;P=0.016）。结论 AECOPD住院患者的住院病死率为5.84%。PaO2、Charlson合并症指数是AECOPD住院死亡的独立预测因子。

Prognostic Factors of Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective To investigate the prognostic factors related to in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A prospective cohort study was carried out in AECOPD patients admitted in three district general hospitals of Jiangyou city, Sichuan province from February 2007 to February 2008. The clinical and epidemiological data at admission and all-cause death in hospital were recorded. The in-hospital mortality rate and potential determinants of mortality of AECOPD were analyzed using Logistic regression method. Results 257 AECOPD inpatients with AECOPD were recruited into the cohort study. The in-hospital mortality rate was 5.84% （15/257）. Univariate analysis showed in-hospital mortality was significantly associated with age, FEV~ % pred, arterial oxygen tension （ PaO2 ）, arterial oxygen saturation （ SaO2 ）, pH, and Charlson＇ s complication index. Multivariate logistic regression model showed that lower arterial oxygen tension （OR 4. 775 ;95% CI 1. 545 ~ 14. 757 ;P = 0. 007） and higher Charlson＇ s complication index （ OR 4. 608 ;95% CI 1. 330 - 15. 966 ;P = 0. 016） were significantly associated with in-hospital mortality after adjustment by age. Conclusion For in-patients with AECOPD, PaO2 and Charlson＇ s complication index are independent risk factors associated with in-hospital mortality.