Original ContributionMortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features
Introduction
The prevalence of chronic obstructive pulmonary disease (COPD) follows an upward trend and involves high mortality and morbidity [1]. It is one of the few diseases whose incidence continues to rise [2]. Hospitalization for acute exacerbation represents the higher component of socioeconomic burden related to COPD. Yet, little is known about factors associated with mortality [3]. Previous studies have estimated in-hospital mortality for acute exacerbation of COPD to range from 4% to 30% [4], [5], [6], [7]. Several studies have investigated predictive factors related to in-hospital mortality after acute exacerbation of COPD. Some characteristics reported as risk factors are Pao2, oxygen saturation [3], older age [4], [8], cardiac factors [4], [8], [9], other comorbidities [8], low body mass index, severity of illness, serum albumin level, and functional status [9].
The present study was designed to assess mortality rates and potential determinants of in-hospital mortality for patients admitted for acute exacerbation of COPD. To do so, we conducted a retrospective cohort study by obtaining the information from the discharge reports.
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Materials and methods
We included all patients with COPD according to Global Initiative for Obstructive Lung Disease (GOLD) criteria [10] admitted to a large university hospital through our emergency department (ED) from January 1, 2004, until December 31, 2004. Each patient was registered in the hospital patient administration system according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and was classified considering diagnosis at discharge. Patients with a 491.21
Patient characteristics
The study population was composed of 763 patients that generated 972 admissions (Table 2). Most patients were men (80.7%) and elderly (average age, 75.5 ± 9.34 years). Annual income ranged from $8767 to $25,728. Fifty-five percent were classified as having severe COPD. Only 4.8% had been previously admitted to the ICU. A spirometry was performed in 153 patients during admission, showing a mean forced expiratory volume in 1 second (FEV1) of 46.9%. Two thirds (n = 658) had a moderate to severe
Discussion
This study highlights 3 relevant findings: first, in-hospital mortality of patients for acute exacerbation with COPD is relatively high; second, clinical features are the most reliable factors to predict this outcome; and third, when a patient has acute exacerbation of mild COPD according to classic Anthonisen criteria and is admitted to hospital, mortality tends to zero. These criteria show the most robust association with in-hospital mortality after comparing them with several demographic,
Conclusion
We conclude that the risk of mortality can be predicted through assessment of the clinical situation of the acute exacerbation of patients with COPD at the ED. This is the most powerful variable of the model, complemented by 4 other variables: age older than 75 years, severe chronic COPD, abnormal blood gas values, and onset of complications during admission. These are all aspects easily and usually registered at the ED. Taking into account our main conclusion, the initial management of these
Acknowledgment
The authors are grateful to “Fundación para la investigación Biomédica” del Hospital General Universitario “Gregorio Marañón” for the human support received.
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