Abstract
BackgroundHospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Identifying factors related to mortality 1 year after hospitalization could help determine interventions to reduce mortality.MethodsIn a prospective, observational, multicentre study, we evaluated data from two cohorts: the Spanish audit of hospital COPD exacerbation care (our derivation sample) and the Spanish cohort of the European audit of COPD exacerbation care (our validation sample). The endpoint was all-cause mortality. Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain.ResultsIn the multivariate analysis, factors independently related to an increase in mortality were older age, cardio-cerebro-vascular and/or dementia comorbidities, PaCO2 > 55 mmHg measured at emergency department arrival, hospitalizations for COPD exacerbations in the previous year, and hospital characteristics. The area under the receiver-operating curve for this model was 0.75 in the derivation cohort and 0.76 in the validation cohort.ConclusionOne-year mortality following the index hospitalization for an exacerbation of COPD was related to clinical characteristics of the patient and of the index event, previous events of similar severity, and characteristics of the hospital where the patient was treated.
Highlights
Hospitalization for a severe exacerbation of Chronic obstructive pulmonary disease (COPD) is an important event in the natural history of COPD
Mean patient age was 73 years, 89% were men, 24.6% were current smokers, 43% had a Charlson Comorbidity Index higher than 3, and 74.6% had previously been admitted for an exacerbation of COPD (eCOPD) (Table 1)
Factors of the index event Several variables were registered from the hospitalization, our study showed that only hypercapnia at the Mortality 1 year p-value
Summary
Hospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Hospitalization for a severe exacerbation of chronic obstructive pulmonary disease (eCOPD) is an important event in the natural history of this disease. Identifying factors associated with mid-term mortality (1 year) after hospitalization for an eCOPD could provide tools for more targeted evaluation of these patients and interventions to prevent premature death. Several studies designed for that purpose have yielded variable or conflicting results [2, 3]. The aim of this study was to determine predictors of one-year mortality in patients hospitalized for an eCOPD following discharge for the index event These divergent results can largely be attributed to study methodology, such as the patient population (recruited from the medical ward or from intermediate or intensive care), source of the data
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