Factors associated with mortality in patients with exacerbation of chronic obstructive pulmonary disease hospitalized in General Medicine departments

Abstract

We aim to improve knowledge on risk factors that relate to mortality in subjects with exacerbation of chronic obstructive pulmonary disease (COPD) who are hospitalized in General Medicine departments. In a cross-sectional multicenter study, by means of a logistic regression analysis, we assessed the possible association of death during hospitalization with the following groups of variables of participating patients: sociodemographic features, treatment received prior to admission and during hospitalization, COPD-related clinical features recorded prior to admission, comorbidity diagnosed prior to admission, clinical data recorded during hospitalization, laboratory results recorded during hospitalization, and electrocardiographic findings recorded during hospitalization. A total of 398 patients was included; 353 (88.7%) were male, and the median age of the patients was 75 years. Of these patients, 21 (5.3%) died during hospitalization. Only 270 (67.8%) received inhaled β(2) agonists during hospitalization, while 162 (40.7%) received angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The median of predicted FEV(1) prior to admission was 42%. A total of 350 patients (87.9%) had been diagnosed with two or more comorbid conditions prior to admission. An association was found between increased risk of death during hospitalization and the previous diagnoses of pneumonia, coronary heart disease, and stroke. In conclusion, comorbidity is an important contributor to mortality among patients hospitalized in General Medicine departments because of COPD exacerbation.

Clinical Audit of Patients Hospitalized due to COPD Exacerbation. MAG-1 Study

“…The role of the comorbidity must be carefully considered when analyzing factors related with mortality. 33 Clinical audits are a good method for benchmarking healthcare organizations. However, they sometimes yield little information on essential interventions to improve the care process.…”

Risk factors associated with chronic obstructive pulmonary disease early readmission

“…COPD exacerbations with a chest X-ray consistent with pneumonia are associated with worse outcomes, including inpatient mortality, 90 day mortality, and frequent readmissions 14,16,37,38 . Nantsupawat and coworkers demonstrated that a chest X-ray with pulmonary infiltrates was a risk factor for COPD early readmission 14 .…”

Características clínicas y tratamiento de los pacientes ancianos hospitalizados por descompensación de enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna españoles. Estudio ECCO

“…La mortalidad global observada durante el ingreso fue del 4% (16 pacientes) y se relacionó con el FEV 1 (media de 35,6 [10,2] frente a 43,6 [12,5] %; p < 0,005; intervalo de confianza del 95% [IC 95%] 0,88-0,97), aunque no con la edad (media de 73,6 [8,9] añ os frente a 77,1 [6,1] añ os; p = 0,09), el sexo (mujeres 12,5% [IC 95% 3,5-36,0] frente a un 11,3% [IC 95% 8,1-14,4]; p = 0,90) ni el nú mero de ingresos previos (6,3 [4,6] frente a 4,5 [3,9]; p = 0,07). Al alta, los pacientes ancianos fueron citados para seguir controles a asistencia primaria de forma predominante (49,5%; p < 0,001), mientras que los pacientes má s jó venes lo eran a la consulta especializada (Medicina Interna un 36,2% y Neumología un 34,5%).…”

“…EA-EPOC: exacerbació n aguda de la enfermedad pulmonar obstructiva cró nica; PCR: proteína C reactiva. (29,4) 87 (29,9) 30 (28,1) 0,770 Arritmia 108 (27,1) 72 (24,7) 36 (33,6) 0,010 Enfermedad coronaria 68 (17,1) 51 (17,5) 17 (15,9) 0,700 Arteriopatía perifé rica 50 (12,6) 32 (11) 18 (16,8) 0,120 Enfermedad cerebrovascular 38 (9,5) 24 (8,2) 14 (13,1) 0,140 Osteoporosis 37 (9,3) 26 (8,9) 11 (10,3) 0,680 Alcoholismo 56 (14,1) 50 (17,2) 6 (5,6) 0,003 Tromboembolia 13 (3,3) 12 (4,1) 1 (0,9) 0,110 Demencia 15 (3,8) 10 (3,4) 5 (4,7) 0,570 Edemas 132 (33,2) 96 (33) 36 (33,6) 0,900 Insuficiencia cardiaca 107 (26,9) 75 (25,8) 32 (29,…”

“…Ha demostrado una alta comorbilidad de los pacientes con EPOC ingresados en los servicios de Medicina Interna 10 , siendo esta distinta segú n el sexo de los pacientes 11 . Igualmente se ha demostrado una mayor mortalidad intrahospitalaria en los pacientes con diagnó stico de neumonía, enfermedad coronaria o cerebrovascular 12 .…”