Predictors of outcome in patients admitted with acute exacerbation of chronic obstructive pulmonary disease in a rural Tertiary Care Center

Abstract

Background:Chronic obstructive pulmonary disease (COPD) is associated with a high degree of mortality and morbidity around the world with the burden of the disease being more in the developing countries. In the Indian context data is limited. This study was carried out to determine the predictors of outcome in patients admitted with acute exacerbation of COPD in a rural Tertiary Care Center in the state of Kerala.Materials and Methods:This was a prospective cohort study. Patients admitted with acute exacerbation of COPD in the Intensive Care Unit between August 2013 and July 2014 was included in the study. Sociodemographic data, clinical variables, and investigations were collected. Mortality with respect to relevant risk factors was compared using Kaplan–Meier method and Cox proportional hazard model.Results:Seventy patients were enrolled in the study of whom 58 (82.9%) were above the age of 60 years. Majority of the patients (87.1%) were males. Tobacco smoking was the main risk factor in them. All the females had a history of exposure to biomass fuel in the form of firewood; none of them were smokers. Majority of patients (80.0%) had a history of one or more co-existing illnesses. Anemia was found to be an independent risk factor for mortality (adjusted hazard ratio: 3.167, 95% confidence interval: 1.516–6.616). Risk factors for poor outcome in COPD patients reported from other centers in India were not found to be relevant in this study.Conclusions:Anemia could be an independent risk factor for mortality in COPD patients. India already has a high prevalence of iron deficiency anemia especially in the rural area and in the geriatric population. Henceforth, family practitioners and primary care physicians may remain vigilant regarding the development of anemia in their COPD patients and institute remedial measures without delay. Futhermore, the wide variation reported in the predictors of outcome of COPD along with the finding of this study calls for an urgent need for more studies.

Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study

“…21 Although the final multivariable analysis did not fulfil other prior hypotheses of those laboratory parameters, some of our observations were supported by past studies such as hypoalbuminemia, 16 39 hyponatremia, 39 hypochloremia, 40 eosinopenia 16 and anaemia. 41 Hyponatremia is a common predictive marker of mortality and morbidity of AECOPD patients, although the effect found in our study was modest and non-significant. 40 Generally, all admitted AECOPD patients are administered with systemic corticosteroids during their admission in our setting, both intravenous and oral route.…”

Role of CBC Parameters in COPD with Acute Exacerbation in a Tertiary Care Center

“…In contrast to our study, several other studies showed that AECOPD were more commonly seen in males. 1,2,[11][12][13][14] The gender difference was not significant in our study.…”

“…Studies have shown the coexisting illness like diabetes and hypertension in COPD as well as AECOPD patients. 1,11,13,14 Diabetes among COPD was seen in 3.1% patients in a study done by Jain et al 11 Ittyachen et al 14 also showed diabetes in 27.1% and hypertension in 28.6% of COPD patients. Koo et al 1 showed coexisting diabetes in 18.0% and hypertension in 52.6% of COPD cases.…”

“…11 Most of the patients were smokers (64.58%) in our study like in other studies. 11,12,14 Study has shown that smoking is a major factor in AECOPD and most smokers admitted for exacerbation of COPD were included in the severe COPD group. 16 Cor pulmonale was seen in 43.05% patients in our study.…”

Reply to a letter to the editor written by Phansalkar et al, regarding publication entitled “Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from The Role of Sodium in Heart Failure Outcomes Prediction (‘SHOUT-PREDICTION’) study. Indian Heart J. 2021;73(4):458–463. doi:10.1016/j.ihj.2021.06.007”

“… 3 Similarly, outcomes in patients admitted with acute exacerbation of COPD may differ due to the severity of respiratory disease itself. 4 Moreover, COPD is an independent predictor of mortality in various HF registries. 5…”