难治性/重症哮喘患者未来5年严重急性发作风险的不同轨迹
2017/12/13
摘要
背景：评估急性发作的未来风险是哮喘管理的重要组成部分。现有研究探讨了哮喘的短期风险而非长期风险。需要早期识别具有不良疾病发展轨迹和持续频繁严重急性发作的哮喘患者，以指导治疗。
目的：确定“疑难性哮喘”患者中严重急性发作率的不同轨迹，并制定风险评分来预测最不利的轨迹。
方法：我们追踪了177例在哮喘专科门诊治疗的“疑难性哮喘”患者5年严重急性发作率。使用基于群组的轨迹建模来识别严重急性发作率的不同轨迹。 确定轨迹的基线预测因子，并用于制定预测最不利轨迹的临床风险评分。
结果：发现三个不同的轨迹：58.5％的患者有少见的间歇性严重急性发作（“间歇性”），32.0％患者在基线时经常发生频繁严重急性发作但随后有改善（“非持续性频繁”），9.5％的患者表现出持续频繁的严重急性发作，并伴有发病率最高的近致命性哮喘（“持续频繁”）。 临床风险评分中过去一年≥2次严重急性发作（+2分），近致命性哮喘病史（+1分），体重指数≥25kg/ m2（+1分），阻塞性睡眠呼吸暂停（+1分），胃食管反流（+1分）和抑郁（+1分）可预测“持续频繁”严重急性发作轨迹（受试者工作特征曲线下面积为0.84，敏感性为72.2％，特异度为81.1％，截点值≥3分）。 轨迹和临床风险评分在独立验证队列中表现出卓越性能。
结论：疑难性哮喘患者在五年时间内遵循不同的疾病发展轨迹。我们已经导出并验证了临床风险评分，它能准确识别将来可能会持续频繁严重急性发作的患者。
Long-term future risk of severe exacerbations: Distinct 5-year trajectories of problematic asthma
A. C. A. Yii; J. H. Y. Tan; T. S. Lapperre ; A. K. W. Chan; S. Y. Low; T. H. Ong; K. L. Tan; S. H. Chotirmall; P. J. Sterk; M. S. Koh.
Allergy. 2017;72: 1398–1405
Abstract
BACKGROUND: Assessing future risk of exacerbations is an important component of asthma management. Existing studies have investigated short- but not long-term risk. Problematic asthma patients with unfavorable long-term disease trajectory and persistently frequent severe exacerbations need to be identified early to guide treatment. Aim: To identify distinct trajectories of severe exacerbation rates among “problematic asthma” patients and develop a risk score to predict the most unfavorable trajectory.
METHODS: Severe exacerbation rates over five years for 177 “problematic asthma” patients presenting to a specialist asthma clinic were tracked. Distinct trajectories of severe exacerbation rates were identified using group-based trajectory modeling. Baseline predictors of trajectory were identified and used to develop a clinical risk score for predicting the most unfavorable trajectory.
RESULTS: Three distinct trajectories were found: 58.5% had rare intermittent severe exacerbations (“infrequent”), 32.0% had frequent severe exacerbations at baseline but improved subsequently (“nonpersistently frequent”), and 9.5% exhibited persistently frequent severe exacerbations, with the highest incidence of near-fatal asthma (“persistently frequent”). A clinical risk score composed of ≥2 severe exacerbations in the past year (+2 points), history of near-fatal asthma (+1 point), body mass index ≥25kg/m2 (+1 point), obstructive sleep apnea (+1 point), gastroesophageal reflux (+1 point), and depression (+1 point) was predictive of the “persistently frequent” trajectory (area under the receiver operating characteristic curve: 0.84, sensitivity 72.2%, specificity 81.1% using cutoff ≥3 points). The trajectories and clinical risk score had excellent performance in an independent validation cohort.
CONCLUSIONS: Patients with problematic asthma follow distinct illness trajectories over a period of five years. We have derived and validated a clinical risk score that accurately identifies patients who will have persistently frequent severe exacerbations in the future.
背景：评估急性发作的未来风险是哮喘管理的重要组成部分。现有研究探讨了哮喘的短期风险而非长期风险。需要早期识别具有不良疾病发展轨迹和持续频繁严重急性发作的哮喘患者，以指导治疗。
目的：确定“疑难性哮喘”患者中严重急性发作率的不同轨迹，并制定风险评分来预测最不利的轨迹。
方法：我们追踪了177例在哮喘专科门诊治疗的“疑难性哮喘”患者5年严重急性发作率。使用基于群组的轨迹建模来识别严重急性发作率的不同轨迹。 确定轨迹的基线预测因子，并用于制定预测最不利轨迹的临床风险评分。
结果：发现三个不同的轨迹：58.5％的患者有少见的间歇性严重急性发作（“间歇性”），32.0％患者在基线时经常发生频繁严重急性发作但随后有改善（“非持续性频繁”），9.5％的患者表现出持续频繁的严重急性发作，并伴有发病率最高的近致命性哮喘（“持续频繁”）。 临床风险评分中过去一年≥2次严重急性发作（+2分），近致命性哮喘病史（+1分），体重指数≥25kg/ m2（+1分），阻塞性睡眠呼吸暂停（+1分），胃食管反流（+1分）和抑郁（+1分）可预测“持续频繁”严重急性发作轨迹（受试者工作特征曲线下面积为0.84，敏感性为72.2％，特异度为81.1％，截点值≥3分）。 轨迹和临床风险评分在独立验证队列中表现出卓越性能。
结论：疑难性哮喘患者在五年时间内遵循不同的疾病发展轨迹。我们已经导出并验证了临床风险评分，它能准确识别将来可能会持续频繁严重急性发作的患者。
(刘蕾1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Allergy. 2017;72: 1398–1405）
（Allergy. 2017;72: 1398–1405）
Long-term future risk of severe exacerbations: Distinct 5-year trajectories of problematic asthma
A. C. A. Yii; J. H. Y. Tan; T. S. Lapperre ; A. K. W. Chan; S. Y. Low; T. H. Ong; K. L. Tan; S. H. Chotirmall; P. J. Sterk; M. S. Koh.
Allergy. 2017;72: 1398–1405
Abstract
BACKGROUND: Assessing future risk of exacerbations is an important component of asthma management. Existing studies have investigated short- but not long-term risk. Problematic asthma patients with unfavorable long-term disease trajectory and persistently frequent severe exacerbations need to be identified early to guide treatment. Aim: To identify distinct trajectories of severe exacerbation rates among “problematic asthma” patients and develop a risk score to predict the most unfavorable trajectory.
METHODS: Severe exacerbation rates over five years for 177 “problematic asthma” patients presenting to a specialist asthma clinic were tracked. Distinct trajectories of severe exacerbation rates were identified using group-based trajectory modeling. Baseline predictors of trajectory were identified and used to develop a clinical risk score for predicting the most unfavorable trajectory.
RESULTS: Three distinct trajectories were found: 58.5% had rare intermittent severe exacerbations (“infrequent”), 32.0% had frequent severe exacerbations at baseline but improved subsequently (“nonpersistently frequent”), and 9.5% exhibited persistently frequent severe exacerbations, with the highest incidence of near-fatal asthma (“persistently frequent”). A clinical risk score composed of ≥2 severe exacerbations in the past year (+2 points), history of near-fatal asthma (+1 point), body mass index ≥25kg/m2 (+1 point), obstructive sleep apnea (+1 point), gastroesophageal reflux (+1 point), and depression (+1 point) was predictive of the “persistently frequent” trajectory (area under the receiver operating characteristic curve: 0.84, sensitivity 72.2%, specificity 81.1% using cutoff ≥3 points). The trajectories and clinical risk score had excellent performance in an independent validation cohort.
CONCLUSIONS: Patients with problematic asthma follow distinct illness trajectories over a period of five years. We have derived and validated a clinical risk score that accurately identifies patients who will have persistently frequent severe exacerbations in the future.
上一篇：
长期应用全身糖皮质激素对重症哮喘的影响：英国回顾性队列分析
下一篇：
严重过敏性哮喘患者应用奥马珠单抗后的现实研究
