Predictors of Long-term Mortality after Hospitalization for Acute Exacerbation of COPD

Hae-Sun Jung; Jin Hwa Lee; Eun Mi Chun; Jin Wook Moon; Jung Hyun Chang

doi:10.4046/trd.2006.60.2.205

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Jung, Lee, Chun, Moon, and Chang: Predictors of Long-term Mortality after Hospitalization for Acute Exacerbation of COPD

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(2): 205-214.

Published online: 28 February 2006

DOI: https://doi.org/10.4046/trd.2006.60.2.205

Predictors of Long-term Mortality after Hospitalization for Acute Exacerbation of COPD

Hae-Sun Jung, M.D., Jin Hwa Lee, M.D., Eun Mi Chun, M.D., Jin Wook Moon, M.D., Jung Hyun Chang, M.D.

Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

Address for correspondence: Jin Hwa Lee, M.D. Department of Internal Medicine, Ewha Womans University, College of Medicine, 911-1 Mok-dong, Yancheon-gu, Seoul 158-710, Korea. Phone: +82-2-2650-6007, Fax: +82-2-2655-2076, jinhwalee@ewha.ac.kr

Received 22 November 2005 Accepted 1 February 2006

Abstract

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. The aim of this study was to determine predictors of long-term mortality after hospitalization for acute exacerbation of COPD.

Methods

We performed a retrospective cohort study of consecutive patients admitted to the hospital for COPD exacerbation between 2000 through 2004. Patients who had died in hospital or within 6-months after discharge, had tuberculosis scar, pleural thickening or bronchiectasis by chest radiography or had been diagnosed with malignancy during follow-up periods were excluded.

Results

Mean age of patients was 69.5 years, mean follow-up duration was 49 months, and mean FEV₁ was 1.00L (46% of predicted). Mortality was 35% (17/48). In the multivariate Cox regression analysis, heart rate of 100/min or more (p=0.003; relative risk [RR], 11.99; 95% confidence interval [CI], 2.34-61.44) and right ventricular systolic pressure (RVSP) of 35mmHg or more (p=0.019; RR, 6.85; 95% CI, 1.38-34.02) were independent predictors of mortality.

Conclusion

Heart rate and RVSP in stable state may be useful in predicting long-term mortality for COPD patients admitted to hospital with acute exacerbation.

Keywords: COPD, Mortality determinants, Heart rate, Right ventricular systolic pressure

Figures and Tables

Figure 1

Study design. EWUH, Ewha Womans University Hospital.

Figure 2

Survival curve during follow-up for the presence or absence of tachycardia in stable state of COPD.

Figure 3

Survival curve during follow-up for different levels of right ventricular systolic pressure (RVSP) measured using echocardiography.

Table 1

Baseline characteristics in survivors and non-survivors with COPD^*

NS, not significant.

^*Data are no. (%) or mean±SD.

^†Data came from ever-smokers.

Table 2

Clinical characteristics in survivors and non-survivors with COPD during follow-up period^*

NS, not significant.

^*Data are no. (%) or mean±SD.

^†Discharge after emergency care without admission.

^‡Data came from patients who admitted again after discharge.

Table 3

Baseline characteristics in survivors and non-survivors with COPD at admission^*

NS, not significant; APACHE II, acute physiology and chronic health examination II.

^*Data are mean±SD.

Table 4

Laboratory characteristics in survivors and non-survivors with COPD at the admission^*

NS, not significant; D(A-a)O₂, alveolar-arterial oxygen difference; WBC, white blood cell counts; ESR, erythrocyte sedimentation rate.

^*Data are no. (%) or mean±SD.

Table 5

Lung function in survivors and non-survivors with COPD in stable state^*

NS, not significant; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

^*Data are number (%) or mean±SD.

^†Global initiative for chronic Obstructive Lung Disease (GOLD) criteria as follows: mild, FEV₁≥80% of predicted; moderate, 50%≤FEV₁<80%; severe, 30%≤ FEV₁< 50%; very severe, FEV₁<30%

Table 6

Echocardiographic variables in survivors and non-survivors with COPD in stable state^*

LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; %FS, LV percent fractional shortening; RVSP, right ventricular systolic pressure; E, peak E velocity; A, peak A velocity; PHT, pressure half time.

^*Data are number (%) or mean±SD.

Table 7

Predictors of long-term mortality in patients with COPD: univariate analysis

BMI, body mass index; ICU, intensive care unit; FEV₁, forced expiratory volume in 1 second; RVSP, right ventricular systolic pressure.

Table 8

Multivariate analysis based on Cox regression model for predictors of long-term mortality in patients with COPD

RVSP, right ventricular systolic pressure.

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