BACKGROUND An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that result in additional therapy. COPD is currently the fourth leading cause of death in the world. There is a need for prospective trials in COPD based on hard clinical outcomes such as death to bring improvements in clinical managements. Chronic obstructive pulmonary disease (COPD) ranks fourth as a cause of death in the United States, behind heart disease, cancer, and stroke. COPD is a costly disease with both direct costs (value of health care resource devoted to diagnosis and management) and indirect costs (monetary consequences of disability, missed work, premature mortality and caregiver or family costs resulting from the illness 1). Diagnostics test for COPD is spirometry FEV1/FVC. Spirometry is costly and is not readily available in rural settings and the technique to perform spirometry involves a lot of patient's conscious effort. Whereas ECG is easily available, affordable, does not require patient's conscious effort. We wanted to predict the electrocardiographic findings predicting mortality in acute exacerbation of COPD. METHODS This is an observational study including 101 patients with COPD acute exacerbations admitted in our institution for a period of 1 year. Selected patients were evaluated with a detailed clinical history and a 12 lead ECG is taken. Data was collected and tabulated. Statistical analysis was done using SPSS Software Version 12.0 and Epi Info Version 3.4.1. Univariate analysis comparing various variables in survivors and non survivors was done using Chi Square test and p value and Odds ratio were calculated. Then multivariate analysis was done using linear regression analysis to find out the most important independent predictors of mortality in COPD acute exacerbations. Study was approved by institutional ethics committee. RESULTS In this study, all the patients were males. 34 patients died during treatment. In the study, mean age of patients was 62.33 years. Of the patients who died, 10 (29.41%) were beedi smokers, and 24 patients were cigarette smokers. More patients belonged to the group with heavy smoking score, i.e.; >400. Presence of p pulmonale and RVH in ECG was found to be a predictor of poor outcome in case of a COPD acute exacerbation (p value <0.05). CONCLUSIONS In this study, majority of the patients belonged to the age group 60-70 years. Dyspnoea was the predominant symptom of our patients. Mortality rate of COPD acute exacerbations was 33.66% in this observational study. Electrocardiographic findings of p pulmonale and right ventricular hypertrophy were found to be predictors of mortality in COPD acute exacerbations by univariate analysis and multivariate analysis. In this study, electrocardiographic findings of p pulmonale and right ventricular hypertrophy were found to be important predictors of mortality in COPD acute exacerbations.
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