Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD

doi:10.1378/chest.124.2.459

Chest

Volume 124, Issue 2, August 2003, Pages 459-467

https://doi.org/10.1378/chest.124.2.459 Get rights and content

Background

Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported.

Study objective

The aim of this study was to investigate prospectively the outcome for all patients admitted to the hospital with acute exacerbations of COPD during hospital admission and after 1-year of follow-up. Furthermore, patient characteristics related to increased mortality rate were analyzed.

Design

We investigated prospectively the 1-year mortality rate and potential determinants of mortality for all patients admitted to the hospital with an acute exacerbation between January 1 and December 31, 1999.

Results

A total of 171 patients were included in the study. The mortality rate during hospital stay was 8%, increasing to 23% after 1 year of follow-up. Despite a comparable in-hospital mortality rate (6%), the 1-year mortality rate was significantly higher for patients admitted to the ICU for respiratory failure (35%). The multivariate Cox proportional hazards model was used to determine independent predictors of survival. Variables included in the regression model were age, sex, FEV₁, Pao₂, Paco₂, body mass index, long-term use of oral corticosteroids, comorbidity index, and hospital readmissions. The maintenance use of oral glucocorticosteroids (relative risk [RR], 5.07; 95% confidence interval [CI], 2.03 to 12.64), Paco₂ (RR, 1.17; 95% CI, 1.01 to 1.38), and age (RR, 1.07; 95% CI, 1.01 to 1.12) were independently related to mortality.

Conclusion

We conclude that the prognosis for patients who have been admitted to the hospital for acute exacerbation of COPD is poor. Long-term use of oral corticosteroids, higher Paco₂, and older age could be identified as risk factors associated with higher mortality.

Section snippets

Materials and Methods

We prospectively included in the study all patients who had been admitted for an acute exacerbation of COPD to the pulmonology ward of the University Hospital Maastricht between January 1 and December 31, 1999. Besides its academic function, the University Hospital of Maastricht has an important function as a regional hospital, therefore this patient population is representative of general pulmonary practices.

Patients were included if the following criteria were met: diagnosis of COPD,

Patient Characteristics

Between January 1, 1999, and January 1, 2000, 171 patients were admitted to the pulmonology ward of the University Hospital Maastricht with an acute exacerbation of COPD. Patient characteristics are listed in Table 1.

Most patients were elderly, and comorbid illnesses were common. About 30% of the patients even had two or more comorbid conditions. Hypoxia was a common condition on hospital admission as well as hypercapnia (Pao₂ ≤ 8.7 kPa, 85% of patients; Paco₂ ≥ 5.9 kPa, 55% of patients).

Discussion

The present study confirms previous data about mortality after acute exacerbations of COPD. Mortality during hospital admission for an acute exacerbation of COPD was high and continued to increase after hospital discharge.

For patients requiring ICU admission during their hospital stay, mortality was even higher. Besides Paco₂ and age, which were previously established as predictors of mortality, the long-term use of oral corticosteroids was found to be an important independent risk factor for

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: This study was supported by a research grant from Astra-Zeneca BV, the Netherlands.

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Chest

Clinical InvestigationsCOPDMortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD*

Background

Study objective

Design

Results

Conclusion

Section snippets

Materials and Methods

Patient Characteristics

Discussion

Chest

Chest

Respir Med

Am J Med

J Chronic Dis

Chest

Respir Med

Chest

Outcomes following acute exacerbation of severe chronic obstructive lung disease: the SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) [erratum published in Am J Respir Crit Care Med 1997; 155:386]

Am J Respir Crit Care Med

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

JAMA

Prediction of survival in patients with chronic airway obstruction

Am Rev Respir Dis

Predictors of mortality in chronic obstructive pulmonary disease: a 15-year follow-up study

Am Rev Respir Dis

Prognosis in chronic obstructive pulmonary disease

Am Rev Respir Dis

Nutritional status and mortality in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Asthma attacks with eosinophilia predict mortality from chronic obstructive pulmonary disease in a general population sample

Am J Respir Crit Care Med

Prognostic value of nutritional status in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Clinical Investigations
COPD
Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD^*