金色COPD恶化史类别和疾病结果
Kiki Waeijen-Smit1,2, Daphne E M Peerlings1,2, Rudolf A Jörres3
1Department of Research and Development, Ciro, Horn, the Netherlands.
JAMA network open
|December 18, 2024
概括
全球慢性阻塞性肺病倡议 (GOLD) 标准用于识别患有COPD恶化 (ECOPD) 的高风险患者需要改进. 在12个月内出现一个中度或重度ECOPD病史,可以更好地预测未来的事件和死亡率.
科学领域:
- 肺部医学 肺部医学
- 临床流行病学临床流行病学
- 呼吸系统研究 呼吸系统研究
背景情况:
- 以前慢性阻塞性肺病 (ECOPD) 的恶化是已知的未来事件的预测因素.
- 全球慢性阻塞性肺病倡议 (GOLD) 目前的高风险患者定义是基于12个月内有2种或更中度的ECOPD,1种或更严重的ECOPD或两种病史.
- 这些GOLD切割值缺乏验证,需要对风险分层策略进行重新评估.
研究的目的:
- 为了验证由GOLD.定义的现有 ECOPD 病史类别.
- 探索用于识别未来中度和重度ECOPD高风险患者的替代切断点.
- 评估COPD病史与COPD患者全因死亡率之间的关联.
主要方法:
- 一项使用德国COPD和系统性后果-共同疾病网络 (COSYCONET) 研究数据的队列研究.
- 在4.5年的随访期内,分析了2291名COPD患者 (GOLD类别1-4) 的数据.
- 双项逻辑回归和接收器运行特征曲线 (AUROCs) 下的面积被用来评估ECOPD风险和全因死亡率.
主要成果:
- 黄金标准在预测未来中度 (AUROC,0.63) 和重度ECOPD (AUROC,0.62) 方面表现有限.
- 在12个月内单次中度性ECOPD的病史显示,对未来中度和重度ECOPD的预测准确性更好 (AUROC,0.66).
- 在12个月内患有3种或以上中度ECOPD或1种或以上严重ECOPD的患者,所有原因死亡的几率明显更高.
结论:
- 目前用于ECOPD风险分层的GOLD标准具有有限的预测价值.
- 其他切断点,例如12个月内有1种或多种中度或重度ECOPD病史,可以提供更好的风险识别.
- 修订后的风险类别可能会导致更准确的治疗分配,并可能改善COPD患者的治疗结果.
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