日本呼吸器学会雑誌第44巻第11号
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- きよあつ かみこ
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2 Table1 CharacteristicsofthepatientshospitalizedforacuteexacerbationsofCOPD Totalnumberofepisodes 131(n= 99) Mean(SD)orn(%) BodyMassIndex,kg/m 2 Male 79(60.3) Age,yr 77.9(7.3) FEV1,L(n= 95) 0.97(0.43) FEV1,%pred(n= 95) 42.7(17.5) 50% 30(31.6) 35-49% 34(35.8) <35% 31(32.6) 19.2(3.7) 6Minuteswalkingdistance,m (n= 97) (93.9) Numberofhospitalizations: 1 40(36.6) 2 26(19.4) >3 65(44.0) Smokingstatus: Currentsmokers 29(25.1) Ex-smokers 70(74.9) Priortreatmentofhospitalization:yes 105(80.2) Anticholinergics,inhaled 70(54.7) β-agonist,inhaled 73(56.6) Corticosteroid,inhaled 58(45) Systemicsteroid,oral 12(9.3) LTOT 68(53.1) NPPV 2(1.6) Pulmonaryrehabilitation 4(3.1) Co-morbidity: Numberofco-morbidityindex 0.83(0.85) Diabetesmelitus 9(9.1) Hypertension 30(30.3) Cerebro-vasculardisease 12(12.1) Ischemicheartdisease 9(9.1) Malignancy 13(13.1) Osteoarthritisdiseases 17(17.2) Physiologicstatusathospitalization BasicADL:Priorhospitalization(n= 98) Athospitalization(n= 111) ABGs:PaO2,Torr PaO2/FiO2,Torr PaCO2,Torr Mean(SD) 17.4(4.5) 14.2(6.6) 73.0(27.5) 266.9(100.4) 51.0(21.2) Median(IQR) 20.0(16-20) 16.0(9-20) 68.5( ) 267.8( ) 43.7( ) Definitionofabbreviations:FEV1= forcedexpiratoryvolumeinonesecond,6mwd= 6minutes walkdistance,ltot= longterm oxygentherapy,nppv= noninvasivepositivepressureventilation,adl= activitiesofdailyliving,abgs=arterialbloodgas,fio2=fractionofinspiredoxygen,iqr= interquartilerange(25th-75thpercentiles) β
3 Table2 Directmedicalcostsfor131episodes Meancostperpatient(SD), Mediancostperpatient(IQR), Meandailycostperpatient(SD), 690,713 (371,337) 612,900 (232,633-1,148,793) 28,900 (15,537) Breakdownofmedicalcosts, Medications Injections Oxygentherapy Laboratory/Diagnostictest Ventilator Administrations mean(sd) 34,548(27,067) 46,256(57,012) 22,217(21,047) 89,659(66,209) 3,168(15,595) 494,865(245,016) % overtotalcosts Definitionofabbreviations:IQR= interquartilerange(25th-75thpercentiles)
4 Table3 Resultsofunivariateanalysisforthetotalmedicalcostofhospitalization foracuteexacerbationin131caseswithcopd Variables Subgroups(n) Totalcost( ) mean(sd) pvalue Age,yr: 78 (76) 755,310(414,497) < 78 (55) 601,451(281,692) Gender: male (79) 672,468(328,686) 0.26 female (20) 764,396(510,458) COPD: StageI (26) 568,142(242,452) StageI (31) 675,283(306,598) Stage I (28) 703,315(358,812) Numberofexacerbations: 3 (101) 713,585(391,148) < 3 (30) 683,919(366,996) BodyMassIndex: < 19 (64) 735,987(379,799) (64) 627,877(324,965) Hypoxia:PaO2/FiO2 < 268 (59) 813,603(389,332) < (56) 551,252(247,098) Hypercapnea:PaCO2 > 43.7 (57) 758,281(399,237) (58) 614,666(284,342) Systemicsteroiduse: yes (77) 774,124(423,321) no (52) 575,846(239,015) ADLscore: low (< 16) (52) 812,686(394,151) normal( 16) (59) 552,446(253,952) Co-morbidity: 1 (23) 690,020(409,161) <1 (101) 676,571(346,974) Inthecaseofcontinuousvariables,themedianwasusedtocreatetwoequalesubgroups. Table4 VariablesintheModelforHighDirectMedicalCost(> 612,000perpatientperepisode) Variables Oldage Low ADL Hypoxia Hypercapnea Systemicsteroiduse OR(95%C.I.) 1.94( ) 2.76( ) 4.13( ) 1.06( ) 3.14( ) pvalue Definitionofvariables;Oldage:over78y/o,Low ADL:Basic ADLscore<16 Hypoxia:PO2/FiO2< 268,Hypercapnea:PCO2> 43.7.A l variablesweredividedbymedianvalue. OR:oddsratio,CI:confidenceinterval,ADL:activitiesof dailyliving
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