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SCI 5 July 2019 Discriminative Accuracy of FEV1: FVC Thresholds for COPD-Related Hospitalization and Mortality
IMPORTANCE 重要性 According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1: FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial. 目前众多的指南指出，诊断慢性阻塞性肺疾病(COPD)需要第一秒用力呼气量与用力肺活量(FEV1: FVC)的比值小于0.70，但这个固定的诊断阈值仅基于专家意见，仍然存在争议。 OBJECTIVE 目标 To determine the discriminative accuracy of various FEV1: FVC fixed thresholds for predicting COPD-related hospitalization and mortality. 确定根据各种FEV1: FVC固定阈值来预测COPD相关住院和死亡率的诊断准确性。 DESIGN, SETTING, AND PARTICIPANTS 设计，设置及参与者 The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population–based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016. 美国国家心肺血液研究所(NHLBI)整合了来自美国4个普通人群队列的数据(社区动脉粥样硬化风险研究;心血管健康研究;健康、衰老和身体成分研究;动脉粥样硬化的多种族研究)。1987年到2000年间的45岁到102岁的参与者被纳入研究，并在2016年进行了纵向随访。 EXPOSURES 暴露 Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN). 存在气流阻塞，定义为基线FEV1:FVC小于固定阈值范围(0.75 ~ 0.65)或小于Global Lung Initiative reference equation (LLN)定义的正常值下限。 MAIN OUTCOMES AND MEASURES 主要结果及措施 The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach. 主要结果是COPD住院和COPD相关死亡率的综合，由裁定或管理标准定义。最优固定FEV1:FVC阈值是通过对这些COPD相关事件的最佳识别来定义的，使用未调整Cox比例风险模型的Harrell C统计量作为索引。使用非参数方法比较C统计量与小于0.70和小于LLN阈值的差异。 RESULTS 结果 Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. 整合队列中的24207名成年人(注册时的平均[SD]年龄为63[10.5]岁;12990名[54%]女性;16794名(69%)非西班牙裔白人;15181例(63%)曾经吸烟)，15年间随访11077例(77%)。在15年的中位随访中，3925名参与者在340 757人年的随访中发生了COPD相关事件(发病率密度为11.5 / 1000人年)，包括3563例与COPD相关的住院和447例与COPD相关的死亡。 With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95%CI, −0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models. 对于COPD相关事件的诊断，最佳固定阈值 (0.71;C最优固定阈值统计量，0.696) 与0.70阈值无显著性差异(差值0.001 [95%CI， - 0.002 ~ 0.004])，但比LLN阈值更为准确(差值为0.034 [95%CI, 0.028 ~ 0.041])。0.70的阈值为有吸烟史者的亚组分析和调整后的模型提供了最佳的诊断力。 CONCLUSIONS AND RELEVANCE 结论和意义 Defining airflow obstruction as FEV1: FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD. 将气流阻塞定义为FEV1: FVC小于0.70，可作为 COPD相关的住院和死亡率的诊断，与其他固定阈值和LLN相比差异不显著甚至更准确。这些结果支持使用FEV1:FVC小于0.70来鉴别临床具有显著COPD风险的个体。 喜欢SCI天天读的理由 陪您一起学习SCI医学论文 每天5分钟，让自己的英语牛逼起来 特殊福利让您惊喜连连 |
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