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Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease
ARTICLE IN PRESS 104
Literature Review
COPD: exacerbations and mortality Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease Thorax 2005;60:925–31
Division of Respiratory and Critical Care Medicine, Department of General Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
J.J. Soler-Cataluna, M.A. Martinez-Garcia, P. Roman Sanchez, E. Salcedo, M. Navarro, R. Ochando
E-mail address: [email protected] (C. Ai-Ping).
Unidad de Neumologia, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casablanca s/n 46340, Requena (Valencia), Spain E-mail address: [email protected] (J.J. Soler-Cataluna).
Background: Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. Methods: Multivariate techniques were used to analyse the prognostic influence of acute exacerbations of COPD treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, co-morbidity, long-term oxygen therapy, forced spirometric parameters, and arterial blood gas tensions in a prospective cohort of 304 men with COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and forced expiratory volume in 1 s was 46 (17)%. Results: Only older age (hazard ratio (HR) 5.28, 95% CI 1.75–15.93), arterial carbon dioxide tension (HR 1.07, 95% CI 1.02–1.12), and acute exacerbations of COPD were found to be independent indicators of a poor prognosis. The patients with the greatest mortality risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80–9.41). Conclusions: This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital. Reproduced with permission from the BMJ Publishing Group. doi: 10.1016/j.rmedu.2006.01.020
In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: A retrospective study Chest 2005;128:518–24 C. Ai-Ping, K.H. Lee, T.K. Lim
Study objectives: The prognosis of patients with COPD requiring admission to the ICU is generally believed to be poor. There is a paucity of long-term survival data. We undertook a study to examine both the in-hospital and 5-year mortality rates and to identify the clinical predictors of these outcomes. Design: We conducted a retrospective cohort study of 57 patients admitted to the ICU between January 1999 and December 2000 for acute respiratory failure attributable to COPD. Results: The mean (7SD) age of the study population was 7078 years. More than 90% of patients required intubation, and the mean duration of mechanical ventilation (MV) was 2.372.2 days. The in-hospital mortality rate for the entire cohort was 24.5%. The mortality rates at 6 months and 1, 3, and 5 years were 39.0%, 42.7%, 61.2%, and 75.9%, respectively, following admission to the ICU. The median survival time for all patients was 26 months. The mortality rate at 5 years was 69.6% for patients who were discharged alive from the hospital. Using multivariate analysis, hospital mortality correlated positively with age, previous history of MV, long-term use of oral corticosteroids, ICU admission albumin level, APACHE (acute physiology and chronic health evaluation) II score, and duration of hospitalization. No factors predictive of mortality at 5 years were identified. Conclusions: We support previous findings of good early survival and significant but acceptable long-term mortality rates in patients who have been admitted to the ICU for acute exacerbation of COPD. Increased age, previous history of MV, poor nutritional status, and higher APACHE II score on ICU admission could be identified as risk factors associated with increased mortality rates. Long-term survival of patients with COPD who required MV for an acute exacerbation of their disease cannot be predicted simply from data available at the time of intubation. Physicians should incorporate these factors in their decision-making process. & 2005 American College of Chest Physicians doi: 10.1016/j.rmedu.2006.01.021
Literature Review
COPD: exacerbations and mortality Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease Thorax 2005;60:925–31
Division of Respiratory and Critical Care Medicine, Department of General Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
J.J. Soler-Cataluna, M.A. Martinez-Garcia, P. Roman Sanchez, E. Salcedo, M. Navarro, R. Ochando
E-mail address: [email protected] (C. Ai-Ping).
Unidad de Neumologia, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casablanca s/n 46340, Requena (Valencia), Spain E-mail address: [email protected] (J.J. Soler-Cataluna).
Background: Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. Methods: Multivariate techniques were used to analyse the prognostic influence of acute exacerbations of COPD treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, co-morbidity, long-term oxygen therapy, forced spirometric parameters, and arterial blood gas tensions in a prospective cohort of 304 men with COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and forced expiratory volume in 1 s was 46 (17)%. Results: Only older age (hazard ratio (HR) 5.28, 95% CI 1.75–15.93), arterial carbon dioxide tension (HR 1.07, 95% CI 1.02–1.12), and acute exacerbations of COPD were found to be independent indicators of a poor prognosis. The patients with the greatest mortality risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80–9.41). Conclusions: This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital. Reproduced with permission from the BMJ Publishing Group. doi: 10.1016/j.rmedu.2006.01.020
In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: A retrospective study Chest 2005;128:518–24 C. Ai-Ping, K.H. Lee, T.K. Lim
Study objectives: The prognosis of patients with COPD requiring admission to the ICU is generally believed to be poor. There is a paucity of long-term survival data. We undertook a study to examine both the in-hospital and 5-year mortality rates and to identify the clinical predictors of these outcomes. Design: We conducted a retrospective cohort study of 57 patients admitted to the ICU between January 1999 and December 2000 for acute respiratory failure attributable to COPD. Results: The mean (7SD) age of the study population was 7078 years. More than 90% of patients required intubation, and the mean duration of mechanical ventilation (MV) was 2.372.2 days. The in-hospital mortality rate for the entire cohort was 24.5%. The mortality rates at 6 months and 1, 3, and 5 years were 39.0%, 42.7%, 61.2%, and 75.9%, respectively, following admission to the ICU. The median survival time for all patients was 26 months. The mortality rate at 5 years was 69.6% for patients who were discharged alive from the hospital. Using multivariate analysis, hospital mortality correlated positively with age, previous history of MV, long-term use of oral corticosteroids, ICU admission albumin level, APACHE (acute physiology and chronic health evaluation) II score, and duration of hospitalization. No factors predictive of mortality at 5 years were identified. Conclusions: We support previous findings of good early survival and significant but acceptable long-term mortality rates in patients who have been admitted to the ICU for acute exacerbation of COPD. Increased age, previous history of MV, poor nutritional status, and higher APACHE II score on ICU admission could be identified as risk factors associated with increased mortality rates. Long-term survival of patients with COPD who required MV for an acute exacerbation of their disease cannot be predicted simply from data available at the time of intubation. Physicians should incorporate these factors in their decision-making process. & 2005 American College of Chest Physicians doi: 10.1016/j.rmedu.2006.01.021