重症哮喘患者报告的结局指标的临床重要性：U-BIOPRED结果

IF 3.2 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES Health and Quality of Life Outcomes Pub Date : 2024-12-20 DOI:10.1186/s12955-024-02321-3

Roy Meys, Frits M E Franssen, Alex J Van 't Hul, Per S Bakke, Massimo Caruso, Barbro Dahlén, Stephen J Fowler, Thomas Geiser, Peter H Howarth, Ildikó Horváth, Norbert Krug, Annelie F Behndig, Florian Singer, Jacek Musial, Dominick E Shaw, Paolo Montuschi, Anke H Maitland-van der Zee, Peter J Sterk, Graham Roberts, Nazanin Z Kermani, Raffaele A Incalzi, Renaud Louis, Lars I Andersson, Scott S Wagers, Sven-Erik Dahlén, Kian Fan Chung, Ian M Adcock, Martijn A Spruit

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引用次数: 0

摘要

理由：关于重症哮喘患者报告结果测量（PROMs）的临床重要性的知识是有限的。目的：评估哮喘恶化是否以及在多大程度上随时间影响PROMS的变化，以及哮喘特异性PROMS可以预测常规护理中成年严重哮喘患者的恶化。方法：421例重症哮喘患者资料(女性62%；平均年龄51.9±13.4岁；平均FEV1（67.5±21.3%pred）。纳入的问题包括：哮喘控制问卷（ACQ5）；哮喘生活质量问卷（AQLQ）；医院焦虑抑郁量表；爱普沃斯嗜睡量表；药物依从性报告量表（MARS）；鼻结果试验（SNOT20）。参与者在基线和12-18个月的常规护理后进行评估。结果：PROMs与年龄、体重指数、FEV1、FeNO、嗜酸性细胞计数等临床特征呈极弱至弱相关。随访期间未出现急性加重的患者在所有PROMs （MARS除外）中均有统计学显著改善，而出现>2加重的患者则出现了恶化。基线ACQ5是急性加重的预测因子，AUC为0.590 （95%CI 0.514-0.666）。结论：重症哮喘患者PROMs与临床指标的相关性较差。此外，PROMs在日常护理中容易发生变化，病情恶化起着关键作用。需要系统地评估重度哮喘患者的PROMs，以根据患者的具体需求改善临床护理。

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Clinical importance of patient-reported outcome measures in severe asthma: results from U-BIOPRED.

Rationale: Knowledge about the clinical importance of patient-reported outcome measures (PROMs) in severe asthma is limited.

Objectives: To assess whether and to what extent asthma exacerbations affect changes in PROMS over time and asthma-specific PROMs can predict exacerbations in adult patients with severe asthma in usual care.

Methods: Data of 421 patients with severe asthma (62% female; mean age 51.9 ± 13.4 years; mean FEV₁ 67.5 ± 21.3%pred) from the U-BIOPRED cohort were analyzed. The included PROMs were: Asthma Control Questionnaire (ACQ5); Asthma Quality of Life Questionnaire (AQLQ); Hospital Anxiety and Depression scale (HADS); Epworth Sleepiness Scale (ESS); Medication Adherence Report Scale (MARS); Sino-Nasal Outcomes Test (SNOT20). Participants were assessed at baseline and after 12-18 months of usual care.

Results: PROMs showed very weak to weak correlations with clinical characteristics such as age, body mass index, FEV₁, FeNO and eosinophilic cell count. Patients presenting no exacerbations during follow-up showed a statistically significant improvement in all PROMs (except for MARS), whereas individuals experiencing > 2 exacerbations showed a deterioration. Baseline ACQ5 was a predictor of exacerbations with an AUC of 0.590 (95%CI 0.514-0.666).

Conclusions: The association of PROMs with clinical measures was poor in severe asthmatics. Moreover, PROMs were prone to changes in usual care, with exacerbations playing a key role. PROMs need to be systematically evaluated in severe asthma to improve clinical care based on specific patient's needs.

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来源期刊

Health and Quality of Life Outcomes 医学-卫生保健

CiteScore

7.30

自引率

2.80%

发文量

154

审稿时长

3-8 weeks

期刊介绍： Health and Quality of Life Outcomes is an open access, peer-reviewed, journal offering high quality articles, rapid publication and wide diffusion in the public domain. Health and Quality of Life Outcomes considers original manuscripts on the Health-Related Quality of Life (HRQOL) assessment for evaluation of medical and psychosocial interventions. It also considers approaches and studies on psychometric properties of HRQOL and patient reported outcome measures, including cultural validation of instruments if they provide information about the impact of interventions. The journal publishes study protocols and reviews summarising the present state of knowledge concerning a particular aspect of HRQOL and patient reported outcome measures. Reviews should generally follow systematic review methodology. Comments on articles and letters to the editor are welcome.