哮喘联盟

   摘要
   目的&背景：临床评价可鉴别哪类急性哮喘患者处于初始治疗无效的风险中。我们旨在确定3Mg临床研究中，哪种临床评价的因素能预测治疗无效(定义为需要急救护理或任何计划外的治疗)。
   方法：我们分析的数据来自一项大型多中心研究(3MG研究)。成人重症急性哮喘患者接受了标准的临床评估,包括开始治疗后2小时的呼气流量峰值(PEFR)评估。不论盲法随机分组到试验治疗或安慰剂组，患者均接受标准治疗。通过回顾记录30天随访。治疗失效被定义为需要(1)急救护理或(2)急救护理或7天时间内任何计划外的治疗。采用逻辑回归分析确定预测因素，推导每个结果的预测模型。
   结果：在1084例被分析的患者中，81例(7%)接受急救护理，157例(14%)接受急救护理或计划外的治疗。基线PEFR(p = 0.017),基线心率(p < 0.001),其他严重疾病(p = 0.019),PEFR的改变(p = 0.015)和心率改变(p < 0.001)能预测急救护理的需求。基线PEFR(p = 0.010),基线心率(p < 0.001),基线呼吸率(p = 0.017),其他严重疾病(p = 0.023),PEFR的改变(p = 0.003)和心率的改变(p = 0.001)能预测急救护理或计划外的治疗。基于这些特征的模型的c-statistic为0.77和0.69。
 

（刘国梁 审校）
 Emerg Med J. 2013 Oct;30(10):872-3. doi: 10.1136/emermed-2013-203113.15.


 

Prediction of unsuccessful treatment in patients with severe acute asthma: an analysis from the 3mg trial.

Gray A, Goodacre S, Braidburn M, Cohen J, Benger J, Coats T.
 

ABSTRACT
OBJECTIVES & BACKGROUND: Clinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. We aimed to determine, using data from the 3MG trial, which elements of clinical assessment predict unsuccessful treatment, defined as needing critical care or any unplanned additional treatment.
METHODS: We analysed data from a large multicentre trial (the 3Mg trial). Adults with severe acute asthma underwent standardised clinical assessment, including peak expiratory flow rate (PEFR), up to two hours after initiation of treatment. Standard care was provided other than blinded random allocation to trial treatment or placebo. Patients were followed up by record review up to 30 days. Unsuccessful treatment was defined as needing (1) critical care or (2) critical care or any unplanned additional treatment within seven days of presentation. Logistic regression was used to identify predictors and derive a prediction model for each outcome.
RESULTS: Out of 1084 patients analysed, 81 (7%) received critical care and 157 (14%) received critical care or unplanned additional treatment. Baseline PEFR (p=0.017), baseline heart rate (p<0.001), other serious illness (p=0.019), PEFR change (p=0.015) and heart rate change (p<0.001) predicted need for critical care. Baseline PEFR (p=0.010), baseline heart rate (p<0.001), baseline respiratory rate (p=0.017), other serious illness (p=0.023), PEFR change (p=0.003) and heart rate change (p=0.001) predicted critical care or additional unplanned treatment. Models based on these characteristics had c-statistics of 0.77 and 0.69 respectively.
 

Emerg Med J. 2013 Oct;30(10):872-3. doi: 10.1136/emermed-2013-203113.15.