背景：慢性阻塞性肺病（chronic obstructive pulmonary disease, COPD）患者在生命末期一年中，明顯比肺癌患者經歷到更多身心社會方面的負荷，緩和醫療照護之介入可促進末期患者與家屬之生活品質。存活期的預估是COPD患者緩和醫療介入的重要評估依據，目前存活期預測指標皆以歐美國家為研究對象，無亞洲國家相關研究，亦缺乏各預測指標對台灣COPD病患之預測力驗證與臨床適用性評價。
研究目的：檢測現階段常用預測指標於台灣COPD患者一年存活期之預測力，並藉由檢測COPD患者存活期之重要預測因子，建構符合台灣COPD患者特性及適用於臨床之存活期預測指標。
研究方法：屬描述相關及推論性研究，採次級資料分析，資料來源為台灣某醫學中心於2006年開始建立之「COPD個案管理」資料庫，選取登記有案且追蹤一年以上之中至極重度COPD患者共294位。資料以描述性統計、獨立t檢定、卡方檢定、存活分析和ROC curve analysis進行分析。
研究結果：現存已發展之預測指標，以CPI、ADO和BODEx對本研究對象具有約75-76%之預測力。本研究建構之新預測指標COQ（共病症、血氧濃度和生活品質）為中至極重度COPD患者一年存活率之最佳預測指標，其預測力為94%，比現存已發展預測指標之預測力（59-76%）佳。
結論：針對末期一年存活期之預估，以新建構之COQ指標可準確預測，建議未來可應用於中至極重度COPD患者，以評估其疾病階段，促使緩和醫療照護提前介入，減輕病程痛苦，提昇末期生命之生活品質。

Background: Advanced chronic obstructive pulmonary disease (COPD) patients experience significantly more bio-psycho-social stress than patients with lung cancer. Palliative care can improve the quality of life of end stage COPD patients. Predicting the life expectancy is crucial to initiate the palliative care. While current studies of prognostic indexes for life expectancy are mainly based on European and American population, there is few study addressed the same issue among Asian population. Furthermore, the predicative power and clinical applicability of the prognostic indexes for one-year survival rate have not been evaluated for COPD patients in Taiwan.
Objectives: Purposes of this study were: (1) to identify the most important predicting factors of one-year survival rate, and (2) to construct a prognosis index of one-year survival rate for Taiwan COPD patients.
Methods: A descriptive and correlational research design. Data was collected from “COPD case management” program started in 2006 in a medical center in southern Taiwan. A total of 294 patients with moderate to very severe COPD who had been followed up for one-year were selected in this study. Descriptive statistics, t test, χ2 test, survival analysis and ROC curve analysis were performed by SPSS 17.0 for Windows.
Results: Three currently developed indexes, CPI, ADO and BODEx, were more appropriate to predict one-year survival rate of this study subjects with the predictive power about 75-76%. Co-morbidities (measured by Charlson Index), arterial oxygen saturation (SaO2) and the quality of life were three significant predictors for one-year survival rate in this study. Using the point system in the Cox proportional hazards regression model, a new prognostic index, COQ, was developed for predicting one-year survival rate among moderate to very severe COPD patients. Its predictive power was 94%.
Conclusions: The newly constructed prognostic index COQ predicts one-year survival rate accurately. It could help health care professionals identify palliative care needs earlier among patients with moderate to very severe COPD in order to alleviate symptoms and increase quality of life.

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