因哮喘住院患者再入院和死亡的风险
2021/01/28
摘要
背景：哮喘是一种异质性炎症性气道疾病，在世界范围内有相当高的发病率，哮喘控制不佳导致住院治疗。
目的：本研究调查了因哮喘发作而住院的患者再入院的风险、死亡率和患者管理。
方法：纳入人群为2006年1月1日至2015年12月31日瑞典国家健康登记的年龄≥6岁的哮喘住院患者。哮喘发作被定义为哮喘相关的入院治疗、急诊就诊、或口服类固醇。随访患者12个月后的再入院指数、36个月的医疗资源利用和治疗情况以及研究结束时的死亡率。事件时间分析的回归模型用于评估再次入院和死亡率的危险因素。
结果：共纳入15691例患者（平均年龄51.5岁，女性占63%），其中1892例（12%）在12个月内因哮喘再次入院。与未再入院的患者相比，再入院的患者发生哮喘相关死亡的风险显著增加（校正HR 2.80，95%CI:1.95-4.01）。三分之二的患者没有得到医院专家的随访，60%的患者没有收集到足够的日常吸入糖皮质激素（ICS）治疗剂量。
结论：在本研究中，超过十分之一的患者在12个月内因哮喘再次入院，再次入院与哮喘相关的死亡率相关。很少有病人去医院看专科医师，也很少有人持续使用ICS。入院后的密切监测是需要的。
Risk of re-hospitalization and death in patients hospitalized due to asthma.
Magnus Ekström, Bright I Nwaru, Fredrik Wiklund, Gunilla Telg, Christer Janson.
Abstract
BACKGROUND:Asthma is a heterogeneous inflammatory airway disease that continues to cause considerable morbidity across the world, with poor asthma control leading to hospitalizations.
OBJECTIVE:The present study investigated the risk of re-hospitalization, mortality and the management of asthma patients that had been hospitalized due to an asthma exacerbation.
METHODS:National Swedish health registries were linked for patients aged ≥6 years who were admitted to hospital due to asthma (index date) between 01/01/06 and 12/31/15. Exacerbations were defined as asthma-related hospitalization, emergency visits, or collection of oral steroids. Patients were followed for re-hospitalizations 12-months post index, health care resource utilization and treatment for 36-months, and mortality to study end. Regression models for time-to-event analyses were applied to assess risk factors for re-hospitalization and mortality.
RESULTS:A total of 15,691 patients (mean age 51.5 years, 63% females) were included, of whom 1892 (12%) were re-hospitalized for asthma within 12-months. Re-hospitalized patients had a markedly increased risk of subsequent asthma related mortality (adjusted HR 2.80, 95% CI: 1.95 - 4.01) compared to those not re-hospitalized. Two thirds of the patients were not followed up by a hospital-based specialist and 60% did not collect enough inhaled corticosteroids (ICS) doses to cover daily treatment the year post index.
CONCLUSIONS:In this study, more than one in ten patients were re-hospitalized due to asthma within 12 months, re-hospitalizations were associated with asthma related mortality. Few patients were seen by a hospital-based specialist and few used ICS continuously. Closer monitoring after hospitalization is needed.
背景：哮喘是一种异质性炎症性气道疾病，在世界范围内有相当高的发病率，哮喘控制不佳导致住院治疗。
目的：本研究调查了因哮喘发作而住院的患者再入院的风险、死亡率和患者管理。
方法：纳入人群为2006年1月1日至2015年12月31日瑞典国家健康登记的年龄≥6岁的哮喘住院患者。哮喘发作被定义为哮喘相关的入院治疗、急诊就诊、或口服类固醇。随访患者12个月后的再入院指数、36个月的医疗资源利用和治疗情况以及研究结束时的死亡率。事件时间分析的回归模型用于评估再次入院和死亡率的危险因素。
结果：共纳入15691例患者（平均年龄51.5岁，女性占63%），其中1892例（12%）在12个月内因哮喘再次入院。与未再入院的患者相比，再入院的患者发生哮喘相关死亡的风险显著增加（校正HR 2.80，95%CI:1.95-4.01）。三分之二的患者没有得到医院专家的随访，60%的患者没有收集到足够的日常吸入糖皮质激素（ICS）治疗剂量。
结论：在本研究中，超过十分之一的患者在12个月内因哮喘再次入院，再次入院与哮喘相关的死亡率相关。很少有病人去医院看专科医师，也很少有人持续使用ICS。入院后的密切监测是需要的。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2020 Dec 24;S2213-2198(20)31362-3. doi: 10.1016/j.jaip.2020.12.030.)
(J Allergy Clin Immunol Pract. 2020 Dec 24;S2213-2198(20)31362-3. doi: 10.1016/j.jaip.2020.12.030.)
Risk of re-hospitalization and death in patients hospitalized due to asthma.
Magnus Ekström, Bright I Nwaru, Fredrik Wiklund, Gunilla Telg, Christer Janson.
Abstract
BACKGROUND:Asthma is a heterogeneous inflammatory airway disease that continues to cause considerable morbidity across the world, with poor asthma control leading to hospitalizations.
OBJECTIVE:The present study investigated the risk of re-hospitalization, mortality and the management of asthma patients that had been hospitalized due to an asthma exacerbation.
METHODS:National Swedish health registries were linked for patients aged ≥6 years who were admitted to hospital due to asthma (index date) between 01/01/06 and 12/31/15. Exacerbations were defined as asthma-related hospitalization, emergency visits, or collection of oral steroids. Patients were followed for re-hospitalizations 12-months post index, health care resource utilization and treatment for 36-months, and mortality to study end. Regression models for time-to-event analyses were applied to assess risk factors for re-hospitalization and mortality.
RESULTS:A total of 15,691 patients (mean age 51.5 years, 63% females) were included, of whom 1892 (12%) were re-hospitalized for asthma within 12-months. Re-hospitalized patients had a markedly increased risk of subsequent asthma related mortality (adjusted HR 2.80, 95% CI: 1.95 - 4.01) compared to those not re-hospitalized. Two thirds of the patients were not followed up by a hospital-based specialist and 60% did not collect enough inhaled corticosteroids (ICS) doses to cover daily treatment the year post index.
CONCLUSIONS:In this study, more than one in ten patients were re-hospitalized due to asthma within 12 months, re-hospitalizations were associated with asthma related mortality. Few patients were seen by a hospital-based specialist and few used ICS continuously. Closer monitoring after hospitalization is needed.
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生物治疗时代英国严重哮喘登记处严重哮喘患者的特征
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儿童哮喘严重程度的相关因素：来自法国COBRAPed队列的数据
