Predictive Factors of Hospitalization for Acute Exacerbation in a Series of 64 Patients with Chronic Obstructive Pulmonary Disease

Abstract

Hospitalizations for acute exacerbation in patients with chronic obstructive pulmonary disease (COPD) have a great impact on health care expenditure. The aim of this study was to look at predictive factors of hospitalization for acute exacerbation in a group of patients with moderate to severe COPD. During the year 1994, we included 64 patients with COPD in this study. At inclusion, the patients being in a stable state, we performed a complete evaluation of their clinical, spirometric, gasometric, and pulmonary hemodynamic characteristics. All patients were followed during a period of at least 2.5 yr. We recorded the intervals free of hospitalization for exacerbation and realized an analysis of the proportional hazards not to be hospitalized using the Kaplan-Meier method. Univariate analysis using the log-rank test showed that the risk of being hospitalized was significantly increased in patients with COPD with a low body mass index (BMI <= 20 kg/m2, p = 0.015) and in patients with a limited 6-min walk distance (<= 367 m, p = 0. 045). But above all, the risk of hospitalization for acute exacerbation was significantly increased by gas exchange impairment and pulmonary hemodynamic worsening: PaO2 <= 65 mm Hg versus PaO2 > 65 mm Hg, p = 0.005; PaCO2 > 44 mm Hg versus PaCO2 <= 44 mm Hg, p = 0.005; and mean pulmonary artery pressure ( Ppa) at rest > 18 mm Hg versus Ppa <= 18 mm Hg, p = 0.0008. Neither age, nor the association of one or more comorbidities with COPD, nor the smoking habits had a significant impact on the risk of hospitalization in our study. Multivariate analysis showed that only PaCO2 and Ppa were independently related to the risk of hospitalization for acute exacerbation of COPD. We conclude that chronic hypercapnic respiratory insufficiency and pulmonary hypertension are predictive factors of hospitalization for acute exacerbation in COPD patients.

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

“…The prevalence of current smoking was 26%, slightly lower than the 33% [6] or 34% [26] reported by other studies on COPD patients hospitalized for exacerbation, but it is still a high proportion considering the consequences. Stopping smoking is the main treatment for COPD [1,22], and the patients that do not succeed will see their FEV1 decreasing at a faster rate [12].…”

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Consequently, the PaCO2 is regarded to be a poor prognostic indicator in general and has been demonstrated to be associated with the development of COPD-AE (1,7,(24)(25)(26)(27)(28)(29)(30). However, the majority of studies have focused on severely hypoxemic patients requiring NIV or patients who had previously experienced COPD-AE.…”

“…Therefore, NIV is currently widely used as a first line treatment in patients with severe COPD-AE. The clinical features demonstrated to have an association with the development of COPD-AE include a history of prior COPD-AE, hypercapnia, a lower forced expiratory volume in one second (FEV1) % predicted, the BODE (body mass index (BMI), airflow obstruction, dyspnea and exercise capacity) index, an impaired health status, hypoxemia, pulmonary hypertension and comorbidities (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although clinical predictors of the development of COPD-AE have been investigated in a number of previous studies, those affecting the need to initiate NIV in stable COPD outpatients who develop COPD-AE have not been sufficiently studied.…”

Guidelines for the diagnosis and treatment of pulmonary hypertension

“…In COPD, the presence of PH is associated with shorter survival [237] and frequent episodes of exacerbation [238]. PH is a poor prognostic factor in interstitial lung diseases and PAP is the most important predictor of mortality [37].…”