Mortality predictors in acute exacerbation of COPD: A prospective study in Western India

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality world-wide. In 2016, COPD was the third leading cause of death. Thus prevention, early detection and prompt treatment of exacerbations may have an impact on the clinical progression and the risk of hospitalization. Material and Methods: This is a prospective study of 94 patients admitted for acute exacerbation of COPD in a tertiary care hospital over a period of 18 months. After a detailed medical history and physical examination, patients’ blood was sent for Arterial Blood Gas (ABG) analysis, a complete hemogram, blood sugar levels, serum albumin levels, blood urea nitrogen levels (BUN), serum creatinine levels, SGPT, SGOT, serum sodium and potassium levels. We have then compared these parameters in the patients who have died with those who have survived to determine mortality predictors. Result: A statistically significant corelation was observed between male gender, smoking (odd ratio of 1.5), duration of smoking (p=0.0014), history of prior admission (odd ratio of 2), longer duration of illness (p=0.045), elevated blood sugar levels (p=0.035), hypolabuminemia (0.001), hypopnatremia (0.001), respiratory acidosis (0.003), elevated partial pressure of CO2 (0.001) and mortality. Conclusion: We found a male preponderance of increased mortality. Increase in mortality was also there with the increase in the duration of smoking. Longer duration of illness was also an important predictor of mortality. Respiratory acidosis, hyponatremia, elevated blood sugar levels and hypoalbuminemia at the time of presentation are other important predictors of mortality in patients hospitalized for acute exacerbation of COPD. Keywords: Acute exacerbation; Chronic obstructive pulmonary disease (COPD); Predictors; Mortality.