Predictors of Outcome Among Adults With Acute Exacerbation of COPD: A Retrospective Cohort Study

Abstract

SESSION TITLE: Airways 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: With each COPD exacerbation, there is an associated decrease in lung function, quality of life and increased in morbidity and mortality. The identification of specific factors may affect the prognosis, management and outcome of each exacerbation. Though several scoring systems have been proposed for COPD exacerbation, some of the factors remain subjective and difficult to evaluate. Furthermore, some clinical and laboratory markers, deemed important in certain studies, were not included in these scoring systems. By consolidating previous studies, the aim of the study is to determine the factors affecting the outcome of an acute exacerbation of COPD. METHODS: Subjects admitted due to an acute exacerbation of COPD aged 40 years old and above from 2012-2015 were included in the study. Patients’ charts were retrieved and pre-determined prognostic factors were recorded and outcomes such as in-hospital mortality, need for mechanical ventilation and ICU admission were recorded as well. Logistic regression analysis was used to determine the significant predictors of in-hospital mortality, need for invasive mechanical ventilation and need for ICU admission. RESULTS: A total of 513 patients were included in the study. It showed that age of >70 years old [OR=7.56, p=0.001], BMI of <18.5kg/m2 [OR=36.49, p=<0.001], MRC dyspnea score of 5 [OR=40.12, p=<0.001], serum albumin of <35g/L [OR=16.09, p=<0.001], serum urea of >7mmol/L [OR=8.14, p=<0.001], hemoglobin level of <10.5g/dL [OR=1.92, p=0.021] and arterial pH of <7.20 [OR=4.89, p=<0.001] were associated with increased in-hospital mortality during an acute exacerbation of COPD. These were also observed as to the need for invasive mechanical ventilation and need for ICU admission. In addition, MRC dyspnea score of 4 was found to be significant for the need for invasive mechanical ventilation [OR=23.91, p=<0.001] and need for ICU admission [OR=26.84, p=<0.001]. However, the presence of diabetes mellitus [OR=0.37, p=<0.001] was found to be a protective factor for in-hospital mortality. CONCLUSIONS: Prognostic factors such as older age, malnutrition, severe MRC dyspnea score, hypoalbuminemia, elevated urea, anemia and severe acidosis significantly increases in-hospital mortality, need for invasive mechanical ventilation and ICU admission during an acute exacerbation of COPD. On the other hand, a controlled diabetes mellitus has shown to lower risk for in-hospital mortality. CLINICAL IMPLICATIONS: Prompt identification of identified prognostic factors during an acute exacerbation of COPD will guide the management in order to prevent delay in instituting possible life-saving interventions. Also, identification and controlling a concomitant diabetes mellitus in COPD patients proves to be important and protective. DISCLOSURE: The following authors have nothing to disclose: George Paul Habacon, Teresita DeGuia No Product/Research Disclosure Information