Risk Factors Predicting In-Hospital Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

Background:Patients with chronic obstructive pulmonary disease(COPD) often present with acute and severe exacerbations requiring hospital admission and treatment. However, the identification of the factors which may predict for in-hospital mortality of such patients are not clear up to days and early detection of risk factors for in-hospital mortality may help clinicians for reducing of the mortality rate in hospitals.Objective: The aim of this study was to identification of risk factors for in-hospital mortality in patients with acute exacerbations of COPD.Methods:We have analysed 598 patients with acute exacerbations of COPD who have been admitted to the pulmonary medicine department of university from October 2013 to November 2018 .Patient age,smoking,BMI,co-morbidity,long-term oxygen therapy,forced spirometric parameters,pulmonary arterial pressure,d-dimer test,and arterial blodd gas tensions have been assessed.The mean age (SD) of patients was 65(11) years and forced expiratory volume in one second was 49(21)%.Results:The in-hospital mortality (pulmonary medicine and ICU departments) was 11.5%(69 of 598).Frequent exacerbations(with three or more exacerbations during last year) was greatest in-hospital mortality for patients(p=0.005).Arterial carbon dioxide tension was independent risk factor for in-hospital mortality(p<0.001).Co-morbidity Charlson index >_2 although was associated with highest mortality rate compared to survival patients (OR 3.27[0.98-6.34),CI 95%;p<0.003).One of interesting findings was high d-dimer level (>_1.0mg/l) in patients which was significantly higher in non-survival compared to survival(OR 7.54[2.65-12.35];p=0.0001) and the presence of Cor pulmonale and high pulmonary arterial pressure(PAP>_ 35mmHg) was independent risk factor increased risk of in-hospital mortality(OR 6.34(1.96-10-49);p<0.001).Conclusions:Several risk factors have been assessed as risk factors for in-hospital mortality in acute exacerbations of COPD .However ,most important of them were high level of arterial blood carbon tension ,frequent exacerbations of the disease ,co-morbidity ,high d-dimer level ,and presence of Cor pulmonale and pulmonary arterial hypertension which were associated with highest in-hospital mortality rate. Early recognition and identification of risk factors for in-hospital mortality may help for their preventing and modifying and reducing mortality in patients with acute exacerbations of COPD.