Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features

Bustamante‐Fermosel, Ana; Miguel‐Yanes, José M. de; Duffort‐Falcó, Mercedes; Muñoz, Javier

doi:10.1016/j.ajem.2006.09.014

Cited by 80 publications

(55 citation statements)

References 26 publications

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“…The mortality rate for these two groups, however, was not significantly different; perhaps because hospitalized COPD patients in both groups were elderly and had multiple comorbidities. Age and comorbidities have previously been identified as risk factors for in-hospital mortality [18][19][20]. Advanced age is an adverse prognostic factor, with age over 75 years giving rise to a relative risk of death of 4.9 (95% CI, 2.3-10.8) [19].…”

Section: Discussionmentioning

confidence: 99%

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Reechaipichitkul

2014

Asian Biomedicine

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Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function. Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined. Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010. Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000). Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.

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Section: Discussionmentioning

confidence: 99%

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Reechaipichitkul

2014

Asian Biomedicine

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“…Chronic obstructive pulmonary disease (COPD) exacerbation is common, and is associated with high in-hospital and post-discharge mortality, reported in the literature as varying from 2.5% to 30% depending upon subject characteristics and the setting of the investigation [1][2][3][4][5][6]. In a recent systematic review and meta-analysis, a number of characteristics of COPD patients as well as comorbidities were significantly associated with increased mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

et al. 2015

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Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes. @ERSpublications Hospital-admitted COPD exacerbation needs better risk stratification: spirometry and gas analysis improve outcomes http://ow.ly/RTbdk

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“…Moreover, general blood gas alterations [12,14,16,[18][19] , in particular hypercapnia [12,14,19] or hypoxaemia [18,19] , have been found to be strong predictors of mortality. Notably, a very recent study [12] demonstrates that the severity of respiratory acidosis in AECOPD increases progressively the risk of death during hospitalization (pH = 7.25-7.35 versus pH > 7.35 Odds Ratio-OR = 1.58 with a 95% Confidence Interval-CI 1.28-1.94; pH < 7.25 versus pH > 7.35 OR = 2.31, 95% CI 1.72-3.10).…”

Section: Introductionmentioning

confidence: 99%

“…Related to the severity of COPD, several factors have been defined as risk factors. In particular, is has been demonstrated that patients with chronic respiratory failure and previous need for longterm home oxygen therapy (LTOT) [16,18] or non-invasive mechanical ventilation [17] , patients with high values at admission of dyspnoea perception [13,15,17,18] , and patients with very severe airflow obstruction (forced expiratory volume in the 1st second, FEV1 ≤ 30 % of predicted) [16,18] have an increased risk of death related to AECOPD.…”

Section: Introductionmentioning

confidence: 99%

“…This aspect may in fact, be true especially when defining the prognosis of patients and then, adjusting levels of care and treatments, or optimizing timing of discharge and planning a followup visit. With regards to variables influencing survival and related to the general characteristics of patients, age at admission [9,[12][13][14][15][16][17] , particularly in older patients [9,13,16] , has been seen to be an important indicator of poor prognosis during hospitalization [9,[12][13][14][15][16][17] and in the post-discharge period [12,15] . Moreover, the presence of associated comorbidities to COPD [9,12,15,17] , may worsen the prognosis of AECOPD patients; in this context, cardiovascular disease plays a special role [15,16] .…”

Section: Introductionmentioning

confidence: 99%

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Clinical Factors Associated with an Increased Risk of Death at and During Hospitalization for an Acute Exacerbation of COPD (AECOPD) and for a Short Period after Discharge

Crisafulli

Alfieri

Torres³

et al. 2016

Journal of Respiratory Research

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Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features

Cited by 80 publications

References 26 publications

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

Clinical Factors Associated with an Increased Risk of Death at and During Hospitalization for an Acute Exacerbation of COPD (AECOPD) and for a Short Period after Discharge

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