Predictors of All-Cause Mortality in Patients with Stable COPD: Medical Co-morbid Conditions or High Depressive Symptoms

Abstract

Co-morbid conditions are frequently found in patients with COPD. We evaluate the association of co-morbidities with mortality, in stable COPD. 224 patients, mean age 61.2 (± 10.00), 48.2% female, mean FEV1 1.1 (± 0.5) liters, median follow-up time 4.2 years, participated. Medical co-morbidities were scored according to the Charlson Co-morbidity Index (CCI). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist-90 (SCL-90). The Cox proportional hazard model was used for survival analyses. In our sample, 70% of all patients have a co-morbid medical condition or high depressive symptoms. During follow-up 51% of all patients died, and those with heart failure have the highest mortality rate (75%). Age, fat-free mass and exercise capacity were predictive factors, contrary to CCI-scores and high depressive symptoms. An unadjusted association between heart failure and survival was found. Although the presence of co-morbidities, using the CCI-score, is not related to survival, heart failure seems to have a detrimental effect on survival. Higher age and lower exercise capacity or fat-free mass predict mortality.

Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis

“…Only two studies explicitly identified HF phenotype using classification by ejection fraction measures [13,27]. Another two studies used medications as an indicator of HF diagnosis [29,52]. Two studies relied on questionnaires only for identification of HF [28,30], while Divo et al used a combination of questionnaires, clinical diagnosis, and medication [29].…”

“…Two studies relied on questionnaires only for identification of HF [28,30], while Divo et al used a combination of questionnaires, clinical diagnosis, and medication [29]. The majority of studies used electronic diagnostic coding [26,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][47][48][49][50][51] and/or clinical diagnosis [13,29,32,43,46,51,52] to identify HF.…”

“…Severity of airflow limitation varied greatly amongst studies. Baseline forced expiratory volume in 1 second [13] to 72.3% [52] of the study population being GOLD3-4. Boudestein et al included 40% of the study population having GPdiagnosed COPD, but not meeting GOLD criteria [13].…”

“…One study reported risk ratio and one study reported odds ratio for all-cause mortality of COPD patients with HF compared with those without HF (Fig. 5) [46], with five estimates failing to reach statistical significance [13,44,48,51,52]. Heterogeneity was considerable when considering all HR estimates (I 2 = 90.3%).…”

Serotonergic antidepressants in COPD: beneficial or harmful?

“…Severe lung function impairment [10] High partial pressure of carbon dioxide [10] Severe dyspnoea [19] Impaired quality of life [11] Physical disability [11,19] Depression [11,13,16,22] Long-term oxygen therapy [11,14] Anxiety [16] Chronic heart failure [14,21] Falls and history of falls [19] Reduced exercise capacity [11]…”