Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach

Abstract

The aim of our study was to estimate the case fatality of a severe exacerbation from long-term survival data presented in the literature.A literature search identified studies reporting o1.5 yr survival after a severe chronic obstructive pulmonary disease (COPD) exacerbation resulting in hospitalisation. The survival curve of each study was divided into a critical and a stable period. Mortality during the stable period was then estimated by extrapolating the survival curve during the stable period back to the time of exacerbation onset. Case fatality was defined as the excess mortality that results from an exacerbation and was calculated as 1 minus the (backwardly) extrapolated survival during the stable period at the time of exacerbation onset. The 95% confidence intervals (CI) of the estimated case fatalities were obtained by bootstrapping. A random effect model was used to combine all estimates into a weighted average with 95% CI.The meta-analysis based on six studies that fulfilled the inclusion criteria resulted in a weighted average case-fatality rate of 15.6% (95% CI 10.9-20.3), ranging from 11.4% to 19.0% for the individual studies.A severe COPD exacerbation requiring hospitalisation not only results in higher mortality risks during hospitalisation, but also in the time-period after discharge and contributes substantially to total COPD mortality.

Roflumilast with long-acting 2-agonists for COPD: influence of exacerbation history

“…These factors include continued smoking, the presence of chronic bronchitis, airway hyperresponsiveness, severity of disease and conditions that increase the risk of COPD exacerbations [23]. Indeed, frequent exacerbations are associated with accelerated loss of lung function, decline in health status and increased mortality, and may be a genuine marker of disease severity [1,24,25]. Thus, current guidelines for the management of COPD recommend escalation of maintenance treatment with increasing severity of disease, beginning with the addition of one or more long-acting bronchodilators.…”

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…COPD was the sixth leading cause of death in the world in 1990 and fourth in 2000, and is estimated to reach third place by 2020 3 . Estimated odds of death following hospitalization due to an exacerbation of COPD are 51% 7 .…”

High-risk patients following hospitalisation for an acute exacerbation of COPD

“…According to these studies, in-hospital mortality ranges from 2.5% to 30% [2][3][4][5][6][7][8][9][10][11]. In a meta-analysis including six European, American and Australian cohort studies with a follow-up period 1.5 years and providing either mortality rates at three time-points after hospital admission or survival curves, 2-and 5-year mortality rates were 43% and 51% [12]. Excess fatality that results from exacerbations after the critical period has been estimated to be [12].…”