Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features.Am J Emerg Med 2007; 25(5):515-22AJ
There is limited information about factors associated with mortality of patients with chronic obstructive pulmonary disease (COPD) admitted to hospital because of an acute exacerbation.
A retrospective cohort study including all patients admitted to hospital through our emergency department (ED) was conducted. A total of 972 electronic discharge reports were reviewed. Patient baseline features, aspects concerning acute exacerbation, as well as demographic, cardiac ultrasound, and microbiological data were collected.
In-hospital mortality rate was 6.4%. Of 315 patients with mild exacerbation according to Anthonisen criteria, only 1 died. In the univariate analysis, moderate to severe acute exacerbation of COPD, age older than 75 years, severe COPD, abnormal blood gas values, onset of complications during hospital stay, radiologic consolidation, a positive result in a microbiological respiratory sample, home oxygenotherapy, admission to the intensive care unit, left ventricular ejection fraction, and department of admission were statistically significant (P < .05). The multivariate analysis showed that moderate to severe COPD acute exacerbation (odds ratio [OR] 7.3; 95% confidence interval [CI], 3.6-17.7), age older than 75 years (OR 4.9; 95% CI, 2.3-10.8), severe COPD (OR 4.6; 95% CI, 2.1-10), abnormal blood gas values (OR 4.7; 95% CI, 1.1-19.8), and complication during hospital stay (OR 2.8; 95% CI 1.4-5.4) were independently related to mortality.
We found that clinical aspect appears the most relevant of all potential determinants of in-hospital mortality for patients admitted for acute exacerbation of COPD. Thus, the clinical assessment and therapeutic decision taken in this first moment at the ED are the key that predict the prognosis of this patients. These data suggest that the risk of mortality after the admission to hospital of patients with COPD because of an acute exacerbation can be successfully predicted by making a clinical assessment at the ED.