阐明慢性阻塞性肺病恶化的心肺后果风险:德国 EXACOS-CV 研究结果。

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM
Claus F Vogelmeier, Kirsty Rhodes, Edeltraut Garbe, Melanie Abram, Marija Halbach, Hana Müllerová, Nils Kossack, Patrick Timpel, Nikolaus Kolb, Clementine Nordon
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引用次数: 0

摘要

背景:慢性阻塞性肺疾病(COPD)的加重期是一个脆弱期。本研究探讨了德国慢性阻塞性肺病加重后的一段时间与严重心血管(CV)事件或死亡风险之间的关系:方法:使用常规收集的医疗保健数据开展了一项纵向队列研究。2014年至2018年期间,对患有慢性阻塞性肺病的个体进行了鉴定。暴露为慢性阻塞性肺病中度或重度加重。风险期为入组后每次加重发病后的 1-7、8-14、15-30、31-180 和 181-365 天。关注的主要结果是首次因心血管事件住院或全因死亡。与时间相关的 Cox 比例危险度模型估算了亚时期与加重期以外时期之间的相关性和结果风险的 HR:在中位随访 36 个月期间,126 795 名患者中有 58 720 人(46.3%)至少病情恶化过一次,48 982 人(38.6%)至少发生过一次心血管事件或死亡。在重度病情加重后的 1-7 天内,预后率有所上升(HR 15.84,95% CI 15.26 至 16.45),并在长达一年的时间内保持升高(181-365 天 HR 1.17,95% CI 1.11 至 1.23)。在中度病情加重后的 1-7 天内,增加的比率为 HR 1.17,95% CI 1.05 至 1.31):结论:慢性阻塞性肺病中度和重度加重后的一段时间内,发生心血管事件或死亡的风险都会增加,因此需要在病情加重后及时控制发生心血管事件的风险,预防任何严重程度的病情加重,并更广泛地应对慢性阻塞性肺病患者的心肺风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Elucidating the risk of cardiopulmonary consequences of an exacerbation of COPD: results of the EXACOS-CV study in Germany.

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) represent a period of vulnerability. This study explored the association between time periods following an exacerbation and the risk of severe cardiovascular (CV) events or death in Germany.

Methods: A longitudinal cohort study was conducted using routinely collected healthcare data. Individuals with COPD were identified between 2014 and 2018. Exposure was moderate or severe exacerbation of COPD. Periods at risk were the 1-7, 8-14, 15-30, 31-180 and 181-365 days following each exacerbation onset occurring after cohort entry. The main outcome of interest was the first hospitalisation for a CV event or all-cause death. Time-dependent Cox proportional hazards models estimated the HR for the association between subperiods versus periods outside exacerbations, and the risk of outcome.

Results: Among 126 795 patients, 58 720 (46.3%) exacerbated at least once and 48 982 (38.6%) experienced at least one CV event or died during a median follow-up of 36 months. The rate of outcome was increased during 1-7 days following a severe exacerbation onset (HR 15.84, 95% CI 15.26 to 16.45), and remained elevated for up to a year (181-365 days HR 1.17, 95% CI 1.11 to 1.23). In the 1-7 days following a moderate exacerbation onset, the increased rate was HR 1.17, 95% CI 1.05 to 1.31).

Conclusion: The risk of a CV event or death increased in time periods following both moderate and severe exacerbations of COPD, emphasising the need to promptly manage the risk of CV events following the onset of an exacerbation, to prevent exacerbations of any severity, and more generally, to address the cardiopulmonary risk in patients with COPD.

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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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