Mortalidad posthospitalaria en pacientes reingresadores por EPOC. Utilidad del índice BODE

Abstract

BackgroundThe BODE index can accurately predict mortality in ambulatory patients with COPD, although its utility in hospitalized patients is unknown. Material and methodsWe prospectively evaluated all patients hospitalized during one year for acute exacerbation of COPD with one or more admissions in the previous year. On discharge, previous functional dependence, comorbidity, depression and quality of life, among other variables, were evaluated. Body mass index, 6-minute walking test, dyspnea scale and spirometry with a post-bronchodilator test were performed on the last day of hospitalization and the BODE index was calculated using these data. ResultsA total of 66 patients were included, with a mean age of 71.6 ± 8.9 years. Of these patients, 42 (63.6%) died before the end of the study (median follow-up 1,490 days). A higher mortality was observed among the oldest patients (p < 0.004), those with more comorbidities (p < 0.05), worse score on the BODE index (p < 0.006; OR 1.3; CI 95%: 1.07-1.54) and the dyspnea scale (p < 0.008). Functional dependence (p < 0.02), and pCO2 > 45 mmHg at discharge (p < 0.001) were also significant predictors of mortality. In the multivariate analysis, only hypercapnia (p < 0.004; OR 3.48; CI 95% 1.49-8.14) and the BODE index (p < 0.0005; OR 1.47; CI 95%: 1.18-1.82) were independent predictors of mortality. ConclusionsThe BODE index measured at hospital discharge is an accurate and reliable predictor of mortality in patients who require several admissions for acute exacerbations of COPD.