Mortality After Hospitalization for COPD

Almagro, Pedro; Calbo, Esther; Echagüen, Anna Ochoa de; Barreiro, Bienvenido; Quintana, Salvador; Heredia, J.L. Pérez de; Garau, Javier

doi:10.1378/chest.121.5.1441

Cited by 574 publications

(465 citation statements)

References 28 publications

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“…5,8,11,24 The relatively low mortality rate is likely due to the fact that patients were recruited from outpatient clinics, not from hospitals settings 25 where mortality rates can be up to 49% at 2 years. 26 FEV 1% had the strongest association with mortality in our study, a relationship that has been observed in other studies.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Mortality in Patients with Stable COPD

et al. 2008

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OBJECTIVES:To determine which easily available clinical factors are associated with mortality in patients with stable COPD and if health-related quality of life (HRQoL) provides additional information. DESIGN:Five-year prospective cohort study. SETTING:Five outpatient clinics of a teaching hospital.PARTICIPANTS: Six hundred stable COPD patients recruited consecutively. MEASUREMENTS:The variables were age, FEV 1% , dyspnea, previous hospital admissions and emergency department visits for COPD, pack-years of smoking, comorbidities, body mass index, and HRQoL measured by Saint George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and ShortForm 36 (SF-36). Logistic and Cox regression models were used to assess the influence of these variables on mortality and survival.RESULTS: FEV 1% (OR: 0.62, 95% CI 0.5 to 0.75), dyspnea (OR 1.92, 95% CI 1.2 to 3), age (OR 2.41, 95% CI 1.6 to 3.6), previous hospitalization due to COPD exacerbations (OR 1.53, 1.2 to 2) and lifetime pack-years (OR 1.15, 95% CI 1.1 to 1.2) were independently related to respiratory mortality. Similarly, these factors were independently related to all-cause mortality with dyspnea having the strongest association (OR 1.54, 95% CI 1.1 to 2.2). HRQoL was an independent predictor of respiratory and all-cause mortality only when dyspnea was excluded from the models, except scores on the SGRQ were associated with all-cause mortality with dyspnea in the model. CONCLUSIONS:Among patients with stable COPD, FEV 1% was the main predictor of respiratory mortality and dyspnea of all-cause mortality. In general, HRQoL was not related to mortality when dyspnea was taken into account, and CRQ and SGRQ behaved in similar ways regarding mortality.KEY WORDS: chronic obstructive pulmonary disease; mortality; healthrelated quality of life.

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Section: Discussionmentioning

confidence: 99%

“…Our results are congruent with recently published studies. 7,24,27,28 Whether co-morbidities are predictors of mortality among patients with COPD remains controversial. We did not observe an association between number of comorbidities, much as Domingo-Salvany et al found.…”

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Predictors of Mortality in Patients with Stable COPD

et al. 2008

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“…4,5 Hence, prevention of exacerbations is an important treatment goal. 6 Hospitalisation of COPD patients due to an exacerbation is of particular relevance, since patients with a severe exacerbation requiring hospitalisation are at an increased risk of death 4,5,7 and hospital stays are a major driver of healthcare costs. 8,9 Tiotropium (Spiriva ® ) has been previously demonstrated to reduce the risk of exacerbations and associated hospitalisations in individual trials as secondary outcomes, [10][11][12][13][14] and more recently as a primary outcome.…”

Section: Introductionmentioning

confidence: 99%

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Halpin

Menjoge

Viel

2009

Primary Care Respiratory Journal

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Aim: To assess the effect of tiotropium 18mcg once daily on chronic obstructive pulmonary disease (COPD) exacerbations and exacerbation-related hospitalisations using a patient-level pooled analysis.Methods: All completed randomised, placebo-controlled, parallel-group tiotropium trials with a duration of >24 weeks were included (n=9). An exacerbation was defined in each study as >2 respiratory symptoms lasting >3 days, and requiring treatment with antibiotics and/or systemic steroids and/or hospitalisation.Results: Compared with placebo (2,862 patients), tiotropium (3,309 patients) significantly reduced by 21% both the risk of COPD exacerbation (95% confidence interval [CI] 0.73-0.86; p<0.0001) and the risk of exacerbation-associated hospitalisation (95% CI 0.65-0.96; p=0.015). Time to first exacerbation and first associated hospitalisation were increased. The protective effect of tiotropium was consistent regardless of age, gender, inhaled corticosteroid use and disease severity. Conclusion:This analysis provides further confirmatory evidence that tiotropium reduces the risk of exacerbation and associated hospitalisation.

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confidence: 99%

“…Previous studies focused on risk factors for admission in stable COPD patients, 2,3 external factors (e.g., air pollution) and admission, 4 or prognostic factors for in-hospital mortality. [5][6][7] However, these studies did not address the decision making for admission among patients presenting to the ED with COPD exacerbations. In addition, current guidelines recommend several consensus-based indications for hospitalization for COPD exacerbations [8][9][10][11] ; however, the degree of concordance with these guidelines in clinical practice is unknown.…”

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Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Tsai

Clark

Cydulka

et al. 2007

Academic Emergency Medicine

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Objectives: To determine the patient factors associated with hospital admission among adults who present to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease (COPD) and to determine whether admissions were concordant with recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Methods:The authors performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. By using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Predictors of admission were determined by multivariate logistic regression.Results: Of 384 patients, 233 (61%; 95% confidence interval = 56% to 66%) were admitted. Multivariate analysis showed that a higher likelihood of admission was associated with older age, female gender, more pack-years of smoking, recent use of inhaled corticosteroid, self-reported activity limitation in the past 24 hours, higher respiratory rate at ED presentation, and a concomitant diagnosis of pneumonia. Patients who reported the ED as their usual site for problem COPD care, or who had mixed COPD and asthma, were less likely to be admitted. The authors confirmed five of the seven testable indications for hospital admission in the GOLD guidelines.Conclusions: Several patient factors were independently associated with hospital admission among ED patients with COPD exacerbations. Overall, concordance with admission recommendations in the GOLD guidelines was high. The authors also identified a few novel predictors of admission (female gender, ED as the usual site for problem COPD care, mixed diagnosis of COPD and asthma, recent use of inhaled corticosteroid) that require replication in future studies. ACADEMIC EMERGENCY MEDICINE 2007; 14:6-15 ª 2007 by the Society for Academic Emergency MedicineKeywords: chronic obstructive pulmonary disease, exacerbation, admission, emergency department C hronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD is the third most common cause of hospitalization in the United States, with an estimated 726,000 hospitalizations in 2000. 1 Chronic obstructive pulmonary disease exacerbation also accounts for approximately 1.5 million emergency department (ED) visits per year. 1 Despite the tremendous burden of hospital admissions and ED visits caused by COPD exacerbations, little is known regarding factors associated with hospital admission from the ED. Previous studies focused on risk factors for admission in stable COPD patients, 2,3 external factors (e.g., air pollution) and admission, 4 or prognostic factors for in-hospital mortality. [5][6][7] However, these studies did not address the decision making for admission among patients presenting to the ED

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Mortality After Hospitalization for COPD

Cited by 574 publications

References 28 publications

Predictors of Mortality in Patients with Stable COPD

Predictors of Mortality in Patients with Stable COPD

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

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