Results from a French study suggest that a number of clinical factors may help identify patients at increased risk for death after an acute exacerbation of chronic obstructive pulmonary disease (COPD).
In a 4-year follow-up of 1750 patients hospitalized for an acute COPD exacerbation in 2006-2007, the team found that some clinical signs of severity, such as lower-limb edema at admission and long-term oxygen therapy at discharge, as well as non-respiratory factors, such as older age and cardiovascular comorbidities, were significantly associated with an increased risk for death.
"Since these prognostic factors were identified in a high number of patients who were prospectively followed during a long period of time… the results can be considered as robust, at least in the considered population," say Nicolas Roche (Hôtel Dieu hospital, Paris) and colleagues.
Overall, 45% (n=787) of the patients died during the follow-up period, the researchers note in the European Respiratory Journal.
In multivariate analysis, the team found that increased age was significantly associated with an increased risk for death during follow up, at relative risks (RR) of 1.73 and 2.99 for patients aged 60-80 years and 80 years or older, respectively, versus those aged less than 60 years.
An increased number of hospital admissions for acute exacerbations within the previous year was also associated with an increased risk for death, at RRs of 1.28, 1.45, 1.76, and 1.91 for one, two, three, and four or more exacerbations, respectively, versus no exacerbations.
In addition, the presence of lung cancer (RR=2.08), cardiovascular comorbidity (RR=1.35), use of accessory respiratory muscles at admission (RR=1.19), lower-limb edema (RR=1.74) at admission, and oxygen therapy at discharge (RR=2.09) were significant risk factors for death during follow up.
Conversely, the presence of gastro-esophageal reflux disease and increased body mass index was associated with a reduced risk for death during follow up.
Surprisingly, the severity of airflow obstruction (forced expiratory volume in 1 second) at admission was not associated with mortality.
Roche et al conclude: "Hospital admission should provide an opportunity for clinicians to identify at-risk patients and provide them with closer follow-up and the best available preventive pharmacological and nonpharmacological treatments."
Mark Cowen, Senior medwireNews Reporter
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