Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.

Thorax. 2005 Jul 29; Soler JJ, Martinez-Garcia MA, Roman P, Salcedo E, Navarro M, Ochando R. Hospital de Requena, Spain.

Background: Patients with COPD often present severe acute exacerbations requiring hospital treatment (AECOPD). However, little is known about the prognostic consequences of these exacerbations. The present study investigates whether severe AECOPD exerts a direct effect upon mortality.

Methods: A prospective cohort of COPD patients followed-up on for 5 years is studied. Multivariate techniques are used to analyze the prognostic influence of AECOPD episodes treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, comorbidity, long-term oxygen therapy, forced spirometry and arterial blood gases.

Results: The study comprised 304 male patients with an average age of 71+/-9 years and a FEV1 (%) of 46+/-17%. In the multivariate study, only older age (hazard ratio [HR]: 5.28, 95%CI: 1.75 - 15.93), PaCO2 (HR: 1.07, 95%CI: 1.02 - 1.12) and AECOPD were found to be independent indicators of poor prognosis. The patients with the greatest mortality risk were those with 3 or more AECOPD (HR: 4.13, 95%CI: 1.80 - 9.41).

Conclusion: The present study shows, for the first time, that severe AECOPD have an independent negative impact upon patient prognosis. Mortality is seen to increase with the frequency of severe exacerbations, particularly if these require hospitalization.




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