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Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation.
J Am Geriatr Soc 2008; 56(5):909-13JA

Abstract

OBJECTIVES

To identify clinical outcomes and variables associated with 6-month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

DESIGN

Prospective cohort study.

SETTING

General medicine acute care ward.

PARTICIPANTS

Two hundred forty-four elderly patients with COPD (mean age+/-standard deviation 82+/-7, 55.7% female) admitted to the hospital because of non-acidotic AECOPD.

MEASUREMENTS

Cognitive and mood status and physiological variables were measured. Self-reported comorbidities were assessed using the Charlson Comorbidity Index. In-hospital and long-term mortality and clinical outcomes were recorded.

RESULTS

At admission, this elderly population with AECOPD had low cognitive performance (mean Mini-Mental State Examination score 21+/-5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4+/-3), good nutritional status (body mass index (BMI) 25.1+/-5.5), moderate comorbidity (Charlson Comorbidity Index 4.0+/-1.9), high functional disability (Barthel Index (BI) 52+/-34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7+/-4.2). Two hundred twenty-five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6-month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI (beta=-0.16; 95% confidence interval (CI)=0.73-0.99), higher APACHE II score (beta=0,17; 95% CI=1.03-1.36), and lower BI at discharge (beta=-0.02; 95% CI=0.96-0.99) were independently associated with 6-month mortality.

CONCLUSION

Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6-month mortality of elderly patients admitted for nonacidotic AECOPD.

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    Authors+Show Affiliations

    Ranieri P
    Department of Internal Medicine, Istituto Clinico S. Anna, Brescia, Italy. piera.ranieri@grupposandonato.it
    Bianchetti A
    No affiliation info available
    Margiotta A
    No affiliation info available
    Virgillo A
    No affiliation info available
    Clini EM
    No affiliation info available
    Trabucchi M
    No affiliation info available

    MeSH

    APACHEAcute DiseaseAgedAged, 80 and overComorbidityDisability EvaluationDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansItalyMalePatient DischargeProspective StudiesPulmonary Disease, Chronic ObstructiveRespiratory InsufficiencyRisk AssessmentSurvival RateTreatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18384582

    Citation

    Ranieri, Piera, et al. "Predictors of 6-month Mortality in Elderly Patients With Mild Chronic Obstructive Pulmonary Disease Discharged From a Medical Ward After Acute Nonacidotic Exacerbation." Journal of the American Geriatrics Society, vol. 56, no. 5, 2008, pp. 909-13.
    Ranieri P, Bianchetti A, Margiotta A, et al. Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. J Am Geriatr Soc. 2008;56(5):909-13.
    Ranieri, P., Bianchetti, A., Margiotta, A., Virgillo, A., Clini, E. M., & Trabucchi, M. (2008). Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. Journal of the American Geriatrics Society, 56(5), pp. 909-13. doi:10.1111/j.1532-5415.2008.01683.x.
    Ranieri P, et al. Predictors of 6-month Mortality in Elderly Patients With Mild Chronic Obstructive Pulmonary Disease Discharged From a Medical Ward After Acute Nonacidotic Exacerbation. J Am Geriatr Soc. 2008;56(5):909-13. PubMed PMID: 18384582.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. AU - Ranieri,Piera, AU - Bianchetti,Angelo, AU - Margiotta,Alessandro, AU - Virgillo,Adriana, AU - Clini,Enrico M, AU - Trabucchi,Marco, Y1 - 2008/04/01/ PY - 2008/4/4/pubmed PY - 2008/5/22/medline PY - 2008/4/4/entrez SP - 909 EP - 13 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 56 IS - 5 N2 - OBJECTIVES: To identify clinical outcomes and variables associated with 6-month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN: Prospective cohort study. SETTING: General medicine acute care ward. PARTICIPANTS: Two hundred forty-four elderly patients with COPD (mean age+/-standard deviation 82+/-7, 55.7% female) admitted to the hospital because of non-acidotic AECOPD. MEASUREMENTS: Cognitive and mood status and physiological variables were measured. Self-reported comorbidities were assessed using the Charlson Comorbidity Index. In-hospital and long-term mortality and clinical outcomes were recorded. RESULTS: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini-Mental State Examination score 21+/-5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4+/-3), good nutritional status (body mass index (BMI) 25.1+/-5.5), moderate comorbidity (Charlson Comorbidity Index 4.0+/-1.9), high functional disability (Barthel Index (BI) 52+/-34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7+/-4.2). Two hundred twenty-five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6-month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI (beta=-0.16; 95% confidence interval (CI)=0.73-0.99), higher APACHE II score (beta=0,17; 95% CI=1.03-1.36), and lower BI at discharge (beta=-0.02; 95% CI=0.96-0.99) were independently associated with 6-month mortality. CONCLUSION: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6-month mortality of elderly patients admitted for nonacidotic AECOPD. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/18384582/Predictors_of_6_month_mortality_in_elderly_patients_with_mild_chronic_obstructive_pulmonary_disease_discharged_from_a_medical_ward_after_acute_nonacidotic_exacerbation_ L2 - https://doi.org/10.1111/j.1532-5415.2008.01683.x DB - PRIME DP - Unbound Medicine ER -