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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to assess the causes of death and risk factors for mortality in a cohort of patients with severe chronic obstructive pulmonary disease &#40;COPD&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We studied 203 patients with severe COPD &#40;forced expiratory volume in 1 second &#91;FEV<span class="elsevierStyleInf">1</span>&#93; &#60;50&#37;&#41;&#44; who were attended in our respiratory department day hospital &#40;2001-2006&#41;&#46; Clinical variables were recorded on inclusion&#44; and clinical course and causes of death were retrospectively reviewed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The mean &#40;SD&#41; age of patients was 69 &#40;8&#41; years and the mean FEV<span class="elsevierStyleInf">1</span> was 30&#46;8&#37; &#40;8&#46;2&#37;&#41;&#46; One-hundred and nine patients died &#40;53&#46;7&#37;&#41;&#59; death was attributed to respiratory causes in 72 &#40;80&#46;9&#37;&#41;&#44; with COPD exacerbation being the most frequent specific cause within this category &#40;48&#46;3&#37;&#41;&#46; During follow-up&#44; 18&#46;7&#37; required admission to the intensive care unit &#40;ICU&#41;&#46; Survival at 1&#44; 3&#44; and 5 years was 80&#37;&#44; 53&#37;&#44; and 26&#37;&#44; respectively&#46; The multivariate analysis showed that mortality was associated with age&#44; stage IV classification according to the Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41;&#44; cor pulmonale&#44; and hospital admission during the year prior to inclusion&#46; Need for admission to the ICU during follow-up was a factor independently associated with higher mortality&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Mortality in patients with severe COPD was high and exacerbation of the disease was one of the most frequent causes of death&#46; Age&#44; GOLD stage&#44; cor pulmonale&#44; prior admission to hospital&#44; and need for admission to the ICU during follow-up were independent predictors of mortality&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio es evaluar las causas de muerte y los factores pron&#243;sticos de mortalidad en una cohorte de pacientes con enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; grave&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 203 pacientes con EPOC grave &#40;volumen espiratorio forzado en el primer segundo &#60; 50&#37;&#41; controlados en el Hospital de D&#237;a de Neumolog&#237;a &#40;2001-2006&#41;&#46; Se registraron diversas variables cl&#237;nicas en el momento de la inclusi&#243;n&#44; y se revisaron retrospectivamente la evoluci&#243;n y las causas de muerte&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La edad media &#40;&#177; desviaci&#243;n est&#225;ndar&#41; de los pacientes fue de 69 &#177; 8 a&#241;os&#44; y el volumen espiratorio forzado en el primer segundo del 30&#44;8 &#177; 8&#44;2&#37;&#46; Fallecieron 109 pacientes &#40;53&#44;7&#37;&#41;&#46; De &#233;stos&#44; 72 murieron de causas respiratorias &#40;80&#44;9&#37;&#41;&#44; de las cuales la exacerbaci&#243;n de la EPOC fue la m&#225;s frecuente &#40;48&#44;3&#37;&#41;&#46; Durante el seguimiento&#44; el 18&#44;7&#37; precis&#243; ingreso en la Unidad de Cuidados Intensivos &#40;UCI&#41;&#46; La supervivencia al a&#241;o&#44; a los 3 y 5 a&#241;os fue del 80&#44; el 53 y el 26&#37;&#44; respectivamente&#46; El an&#225;lisis multivariante mostr&#243; que la mortalidad se asociaba a la edad&#44; al estadio IV de la clasificaci&#243;n de la Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41;&#44; al cor pulmonale y a la estancia hospitalaria durante el a&#241;o previo a la inclusi&#243;n&#46; La necesidad de ingreso en la UCI durante el seguimiento constituy&#243; un factor independiente asociado a mayor mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La mortalidad en la EPOC grave es elevada y la exacerbaci&#243;n de la enfermedad constituye la causa m&#225;s frecuente&#46; La edad&#44; el estadio GOLD&#44; el cor pulmonale&#44; los ingresos hospitalarios previos y la necesidad de ingreso en la UCI durante el seguimiento son factores pron&#243;sticos independientes de mortalidad&#46;</p>"
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Vol. 45. Issue 4.
Pages 181-185 (April 2009)
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Vol. 45. Issue 4.
Pages 181-185 (April 2009)
Original article
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Causes of Death and Risk Factors for Mortality in Patients With Severe Chronic Obstructive Pulmonary Disease
Causas de muerte en pacientes con EPOC grave. Factores pronósticos
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Amalia Morenoa, Concepción Montóna,
Corresponding author
cmonton@tauli.cat

Corresponding author.
, Yolanda Belmontea, Miguel Gallegoa, Xavier Pomaresa, Jordi Realb
a Servicio de Neumología, Hospital de Sabadell, Corporació Parc Taulí, Sabadell, Barcelona, Spain
b Servicio de Epidemiología, Unitat de Suport a la Recerca (USR) Lleida, IDIAP Jordi Gol, Lleida, Spain
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Abstract
Objective

The objective of this study was to assess the causes of death and risk factors for mortality in a cohort of patients with severe chronic obstructive pulmonary disease (COPD).

Patients and methods

We studied 203 patients with severe COPD (forced expiratory volume in 1 second [FEV1] <50%), who were attended in our respiratory department day hospital (2001-2006). Clinical variables were recorded on inclusion, and clinical course and causes of death were retrospectively reviewed.

Results

The mean (SD) age of patients was 69 (8) years and the mean FEV1 was 30.8% (8.2%). One-hundred and nine patients died (53.7%); death was attributed to respiratory causes in 72 (80.9%), with COPD exacerbation being the most frequent specific cause within this category (48.3%). During follow-up, 18.7% required admission to the intensive care unit (ICU). Survival at 1, 3, and 5 years was 80%, 53%, and 26%, respectively. The multivariate analysis showed that mortality was associated with age, stage IV classification according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), cor pulmonale, and hospital admission during the year prior to inclusion. Need for admission to the ICU during follow-up was a factor independently associated with higher mortality.

Conclusions

Mortality in patients with severe COPD was high and exacerbation of the disease was one of the most frequent causes of death. Age, GOLD stage, cor pulmonale, prior admission to hospital, and need for admission to the ICU during follow-up were independent predictors of mortality.

Keywords:
Chronic obstructive pulmonary disease
Mortality
Survival
Resumen
Objetivo

El objetivo del estudio es evaluar las causas de muerte y los factores pronósticos de mortalidad en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) grave.

Pacientes y métodos

Se incluyó a 203 pacientes con EPOC grave (volumen espiratorio forzado en el primer segundo < 50%) controlados en el Hospital de Día de Neumología (2001-2006). Se registraron diversas variables clínicas en el momento de la inclusión, y se revisaron retrospectivamente la evolución y las causas de muerte.

Resultados

La edad media (± desviación estándar) de los pacientes fue de 69 ± 8 años, y el volumen espiratorio forzado en el primer segundo del 30,8 ± 8,2%. Fallecieron 109 pacientes (53,7%). De éstos, 72 murieron de causas respiratorias (80,9%), de las cuales la exacerbación de la EPOC fue la más frecuente (48,3%). Durante el seguimiento, el 18,7% precisó ingreso en la Unidad de Cuidados Intensivos (UCI). La supervivencia al año, a los 3 y 5 años fue del 80, el 53 y el 26%, respectivamente. El análisis multivariante mostró que la mortalidad se asociaba a la edad, al estadio IV de la clasificación de la Global Initiative for Chronic Obstructive Lung Disease (GOLD), al cor pulmonale y a la estancia hospitalaria durante el año previo a la inclusión. La necesidad de ingreso en la UCI durante el seguimiento constituyó un factor independiente asociado a mayor mortalidad.

Conclusiones

La mortalidad en la EPOC grave es elevada y la exacerbación de la enfermedad constituye la causa más frecuente. La edad, el estadio GOLD, el cor pulmonale, los ingresos hospitalarios previos y la necesidad de ingreso en la UCI durante el seguimiento son factores pronósticos independientes de mortalidad.

Palabras clave:
EPOC
Mortalidad
Supervivencia
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
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