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COPD住院患者的气流阻塞情况

2017/11/20

   摘要
   背景:体重指数,阻塞性通气障碍,呼吸困难和运动能力(BODE)评分可用于预测慢性阻塞性肺疾病(COPD)患者肺移植的预后,但尚未得到验证。 COPD中大部分死亡原因可归因于肺移植手术的禁忌合并症。因此我们提出假设,入选行肺移植手术的COPD患者比采用传统BODE评分的患者拥有更好的生存率。
   方法:我们选取了两组队列进行回顾性生存分析,一组队列是提取肺移植候选人器官共享数据库UNOS中 4,377例根据BODE评分的COPD肺移植患者队列,另一组是625例进行了BODE评分的COPD患者队列作为验证队列 。
   结果:第四个四分位数的BODE得分的生存期分析结果为,UNOS队列为59个月(95% CI,51至77个月),BODE验证队列37个月(95%CI,29至42个月)。在以BODE评分和合并肺移植作为竞争终点的模型中,BODE验证队列(SHR 4.8,95% CI 4至5.7,P<0.001)的死亡风险较高。其中,风险差异最大的是得分在第四个四分位数的队列(SHR 6.1 , 95% CI 4.9至7.6,P<0.001)。
   结论:基于BODE的风险预测评分高估了COPD患者肺移植候选人的预后死亡率,这可能是由于肺移植评估筛查检查将相关并发症剔除所致。

 
(中日友好医院呼吸与危重症医学科 王圆方摘译 林江涛审校)
(Survival Of Lung Transplant Candidates With COPD: Bode Reconsidered[C]// ATS. 2016.)
 
 
 
Survival Of Lung Transplant Candidates With COPD: Bode Reconsidered
 
Eberlein M, Dransfield M T, Netzer G, et al.
 
Abstract


Background:The Body mass index, Obstruction, Dyspnea, and Exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for chronic obstructive pulmonary disease (COPD), but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized COPD patients selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate.

Methods:We performed a retrospective analysis of survival according to BODE score for COPD patients in the United Network of Organ Sharing database of lung transplant candidates (n=4,377) compared to the cohort of COPD patients in which the BODE score was validated (n=625).

Results:Median survival in the 4th quartile of BODE score was 59 months, (95% CI 51 to 77 months) in the UNOS cohort and 37 months (95% CI 29 to 42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing endpoint, the risk of death was higher in the BODE validation cohort (SHR 4.8, 95% CI 4.0 to 5.7, p<0.001). The risk difference was greatest in the 4th quartile of BODE scores (SHR 6.1 95% CI 4.9 to 7.6, p<0.001).

Conclusions:Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplant candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplant evaluation screening process.

 
 


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