Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Predictors of Long-term Mortality after Hospitalization for Acute Exacerbation of COPD

만성폐쇄성폐질환의 급성악화로 입원했던 환자에서 장기간 사망의 예측인자

  • Jung, Hae-Seon (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Lee, Jin Hwa (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Chun, Eun Mi (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Moon, Jin Wook (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Chang, Jung Hyun (Department of Internal Medicine, Ewha Womans University College of Medicine)
  • 정해선 (이화여자대학교 의과대학 내과학교실) ;
  • 이진화 (이화여자대학교 의과대학 내과학교실) ;
  • 천은미 (이화여자대학교 의과대학 내과학교실) ;
  • 문진욱 (이화여자대학교 의과대학 내과학교실) ;
  • 장중현 (이화여자대학교 의과대학 내과학교실)
  • Received : 2005.11.22
  • Accepted : 2006.02.01
  • Published : 2006.02.28
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Abstract

Background : Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported. The aim of this study was to determine predictors of long-term mortality after hospitalization for acute exacerbation of COPD. Methods : We performed a retrospective cohort study of consecutive patients admitted to the hospital for COPD exacerbation between 2000 through 2004. Patients who had died in hospital or within 6-months after discharge, had tuberculosis scar, pleural thickening or bronchiectasis by chest radiography or had been diagnosed with malignancy during follow-up periods were excluded. Results : Mean age of patients was 69.5 years, mean follow-up duration was 49 months, and mean $FEV_1$ was 1.00L (46% of predicted). Mortality was 35% (17/48). In the multivariate Cox regression analysis, heart rate of 100/min or more (p=0.003; relative risk [RR], 11.99; 95% confidence interval [CI], 2.34-61.44) and right ventricular systolic pressure (RVSP) of 35mmHg or more (p=0.019; RR, 6.85; 95% CI, 1.38-34.02) were independent predictors of mortality. Conclusion : Heart rate and RVSP in stable state may be useful in predicting long-term mortality for COPD patients admitted to hospital with acute exacerbation.

배 경 : 만성폐쇄성폐질환의 급성 악화는 주요한 사회경제적 부담이다. 이 질환의 높은 사망률이 잘 알려져 있지만, 아직까지 급성악화로 입원했던 환자의 장기 예후에 대해서는 잘 알려져 있지 않다. 본 연구의 목적은 만성폐쇄성폐질환의 급성악화로 입원했던 환자에서 장기간 사망의 예측인자를 알아보기 위함이다. 방 법 : 2000년부터 2004년 사이에 만성폐쇄성폐질환의 급성 악화로 입원한 환자를 대상으로 후향적으로 조사하였다. 입원 중 또는 퇴원 후 6개월 이내에 사망하거나 흉부 X-선 촬영에서 결핵반흔, 흉막비후나 기관지확장증이 동반된 경우, 추적기간 중 악성종양을 진단받은 환자는 제외하였다. 결 과 : 평균 연령은 69.5세였고, 추적기간은 49개월이었으며, 평균 $FEV_1$은 1.00L(예측치의 46%)였다. 사망률은 35%(17/48)였다. 다중 Cox 회귀분석 결과 분당 100회 이상의 빈맥과(p=0.003; 상대위험도, 11.99; 95% 신뢰구간, 2.34-61.44) 35mmHg이상의 우심실수축기압이(p=0.019; 상대위험도, 6.85; 95% 신뢰구간, 1.38-34.02) 사망 위험을 높이는 독립적인 예측인자였다. 결 론 : 만성폐쇄성폐질환의 급성악화로 입원했던 환자의 장기간 사망 위험을 예측하는 데 안정시 심장박동수와 우심실수축기압이 유용할 것이다.

Keywords

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