Journal List > Tuberc Respir Dis > v.60(2) > 1000910

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

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.

Figures and Tables

Figure 1
Study design. EWUH, Ewha Womans University Hospital.
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Figure 2
Survival curve during follow-up for the presence or absence of tachycardia in stable state of COPD.
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Figure 3
Survival curve during follow-up for different levels of right ventricular systolic pressure (RVSP) measured using echocardiography.
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Table 1
Baseline characteristics in survivors and non-survivors with COPD*
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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*
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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*
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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*
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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*
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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*
trd-60-205-i006

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
trd-60-205-i007

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
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RVSP, right ventricular systolic pressure.

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