Chest
Volume 121, Issue 5, May 2002, Pages 1441-1448
Journal home page for Chest

Clinical Investigations
Copd
Mortality After Hospitalization for COPD

https://doi.org/10.1378/chest.121.5.1441Get rights and content

Objectives

To identify variables associated with mortality in patients admitted to the hospital for acute exacerbation of COPD.

Setting

Acute-care hospital in Barcelona (Spain).

Patients

One hundred thirty-five consecutive patients hospitalized for acute exacerbation of COPD, between October 1996 and May 1997.

Measurements and results

Clinical, spirometric, and gasometric variables were evaluated at the time of inclusion in the study. Socioeconomic characteristics, comorbidity, dyspnea, functional status, depression, and quality of life were analyzed. Mortality at 180 days, 1 year, and 2 years was 13.4%, 22%, and 35.6%, respectively. Sixty-four patients (47.4%) were dead at the end of the study (median follow-up duration, 838 days). Greater mortality was observed in the bivariate analysis among the oldest patients (p < 0.0001), women (p < 0.01), and unmarried patients (p < 0.002). Hospital admission during the previous year (p < 0.001), functional dependence (Katz index) [p < 0.0004], greater comorbidity (Charlson index) [p < 0.0006], depression (Yesavage Scale) [p < 0.00001]), quality of life (St. George's Respiratory Questionnaire [SGRQ]) [p < 0.01], and Pco2 at discharge (p < 0.03) were also among the significant predictors of mortality. In the multivariate analysis, the activity SGRQ subscale (p < 0.001; odds ratio [OR], 2.62; confidence interval [CI], 1.43 to 4.78), comorbidity (p < 0.005; OR, 2.2; CI, 1.26 to 3.84), depression (p < 0.004; OR, 3.6; CI, 1.5 to 8.65), hospital readmission (p < 0.03; OR, 1.85; CI, 1.26 to 3.84), and marital status (p < 0.0002; OR, 3.12; CI, 1.73 to 5.63) were independent predictors of mortality.

Conclusions

Quality of life, marital status, depressive symptoms, comorbidity, and prior hospital admission provide relevant information of prognosis in this group of COPD patients.

Section snippets

Subjects

Between October 1996 and May 1997, we recruited all consecutive patients admitted with COPD exacerbation to any medical ward of Hospital Mútua de Terrassa, a 520-bed, acute-care teaching referral center, in the province of Barcelona, Spain. Inclusion criteria were a clinical diagnosis of COPD, and forced spirometry at discharge showing FEV1 < 70% of the reference value and FEV1/FVC < 70%. Exacerbation was defined as breathlessness, respiratory failure (Po2 < 60 mm Hg and/or Pco2 > 50 mm Hg), or

Results

Of the 141 patients originally evaluated during hospital admission, follow-up information was available for 135 patients (96%; 124 men and 11 women). Six patients (4%) were unavailable for follow-up and were excluded from analysis. Mean age of the population studied was 72.2 ± 9.25 years. The women were older than the men: 79.36 ± 8.96 years vs 71.62 ± 9.03 years (p < 0.007). Mean length of stay was 13.47 ± 9.6 days (range, 2 to 76 days). Seventy patients (58.5%) were in respiratory failure (Po2

Discussion

The purpose of this study was to evaluate mortality predictors after discharge of patients hospitalized for acute exacerbation of COPD. This population consists of aging patients with associated chronic diseases and a high rate of functional dependence. We can expect that the factors predictive of mortality in such patients would be likely to differ from those reported for COPD patients overall. Our study confirms the importance of other factors, namely comorbidity, hospital readmission, the

ACKNOWLEDGMENT

We thank Dr. Pau Sanchez for critical review of the article, and Ms. Mary Ellen Kerans for assistance in writing the article.

References (35)

  • DS Postma et al.

    Assessment of ventilatory variables in survival prediction of patients with chronic airflow obstruction: the importance of reversibility

    Eur Respir J

    (1985)
  • NR Anthonisen et al.

    Prognosis in chronic obstructive pulmonary disease

    Am Rev Respir Dis

    (1986)
  • Y Sukumalchantra et al.

    Prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute ventilatory failure: a three year follow-up study

    Am Rev Respir Dis

    (1966)
  • HJ Sluiter et al.

    Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease

    Am Rev Respir Dis

    (1972)
  • T Asmundsson et al.

    Survival after acute respiratory failure

    Ann Intern Med

    (1974)
  • MG Seneff et al.

    Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease

    JAMA

    (1995)
  • AF Connors et al.

    Outcomes following acute exacerbation of severe chronic obstructive lung disease

    Am J Respir Crit Care Med

    (1996)
  • Cited by (522)

    View all citing articles on Scopus
    View full text