BACKGROUND: It is crucial to identify risk factors for poor evolution of patients admitted to hospital with chronic obstructive pulmonary disease (COPD) in order to provide adequate intensive therapy and closer follow-up. OBJECTIVES: To identify predictors of adverse outcomes in patients hospitalised for exacerbation of COPD. METHODS: A prospective, observational study was conducted in patients admitted for exacerbation of COPD. Demographic and clinical parameters were evaluated, including different multidimensional prognostic scores. Adverse outcomes included the following: death during hospitalisation or 1-month follow-up, intensive care unit admission, invasive or non-invasive mechanical ventilation, prolonged hospitalisation (>11 days) and COPD-related emergency visit or readmission within 1 month after discharge. Univariate and multivariate analysis were performed. RESULTS: Of 155 patients included, an adverse outcome occurred in 69 (45%). Patients with an adverse outcome had lower forced expiratory volume in 1 s (p = 0.004) and more frequent exacerbations (p = 0.011), more frequently used oxygen at home (p = 0.042) and presented with lower pH (p < 0.001), lower ratio of arterial oxygen pressure to the fraction of inspired oxygen (p = 0.006), higher arterial carbon dioxide pressure (p < 0.001) and a worse score on several prognostic indices at admission. Independent predictors of adverse outcome were exacerbation of COPD in the previous year [odds ratio 3.9, 95% confidence interval (CI) 1.6-9.9; p = 0.004], hypercapnia (odds ratio 9.4, 95% CI 3.7-23.6; p < 0.001) and hypoxaemia (odds ratio 4.3, 95% CI 1.5-12.6; p = 0.008). In the presence of all three characteristics, the probability of an adverse outcome was 95%, while hypercapnia was the strongest prognostic factor with a risk of 54%. CONCLUSIONS: Patients with previous exacerbation of COPD, hypercapnia and hypoxaemia had the highest risk of an unfavourable evolution. The calculation of prognostic indices did not provide additional discriminative power.
BACKGROUND: It is crucial to identify risk factors for poor evolution of patients admitted to hospital with chronic obstructive pulmonary disease (COPD) in order to provide adequate intensive therapy and closer follow-up. OBJECTIVES: To identify predictors of adverse outcomes in patients hospitalised for exacerbation of COPD. METHODS: A prospective, observational study was conducted in patients admitted for exacerbation of COPD. Demographic and clinical parameters were evaluated, including different multidimensional prognostic scores. Adverse outcomes included the following: death during hospitalisation or 1-month follow-up, intensive care unit admission, invasive or non-invasive mechanical ventilation, prolonged hospitalisation (>11 days) and COPD-related emergency visit or readmission within 1 month after discharge. Univariate and multivariate analysis were performed. RESULTS: Of 155 patients included, an adverse outcome occurred in 69 (45%). Patients with an adverse outcome had lower forced expiratory volume in 1 s (p = 0.004) and more frequent exacerbations (p = 0.011), more frequently used oxygen at home (p = 0.042) and presented with lower pH (p < 0.001), lower ratio of arterial oxygen pressure to the fraction of inspired oxygen (p = 0.006), higher arterial carbon dioxide pressure (p < 0.001) and a worse score on several prognostic indices at admission. Independent predictors of adverse outcome were exacerbation of COPD in the previous year [odds ratio 3.9, 95% confidence interval (CI) 1.6-9.9; p = 0.004], hypercapnia (odds ratio 9.4, 95% CI 3.7-23.6; p < 0.001) and hypoxaemia (odds ratio 4.3, 95% CI 1.5-12.6; p = 0.008). In the presence of all three characteristics, the probability of an adverse outcome was 95%, while hypercapnia was the strongest prognostic factor with a risk of 54%. CONCLUSIONS:Patients with previous exacerbation of COPD, hypercapnia and hypoxaemia had the highest risk of an unfavourable evolution. The calculation of prognostic indices did not provide additional discriminative power.
Authors: Ian G Stiell; Jeffrey J Perry; Catherine M Clement; Robert J Brison; Brian H Rowe; Shawn D Aaron; Andrew D McRae; Bjug Borgundvaag; Lisa A Calder; Alan J Forster; Jennifer Brinkhurst; George A Wells Journal: CMAJ Date: 2018-12-03 Impact factor: 8.262
Authors: M-T García-Sanz; J-C Cánive-Gómez; N García-Couceiro; L Senín-Rial; S Alonso-Acuña; A Barreiro-García; E López-Val; L Valdés; F-J González-Barcala Journal: Ir J Med Sci Date: 2016-03-18 Impact factor: 1.568
Authors: Ian G Stiell; Catherine M Clement; Shawn D Aaron; Brian H Rowe; Jeffrey J Perry; Robert J Brison; Lisa A Calder; Eddy Lang; Bjug Borgundvaag; Alan J Forster; George A Wells Journal: CMAJ Date: 2014-02-18 Impact factor: 8.262
Authors: Jared Chiarchiaro; Natalie C Ernecoff; Praewpannarai Buddadhumaruk; Kimberly J Rak; Robert M Arnold; Douglas B White Journal: J Crit Care Date: 2015-09-03 Impact factor: 3.425
Authors: Timothy B Depp; Kathleen A McGinnis; Kevin Kraemer; Kathleen M Akgün; E Jennifer Edelman; David A Fiellin; Adeel A Butt; Stephen Crystal; Adam J Gordon; Matthew Freiberg; Cynthia L Gibert; David Rimland; Kendall J Bryant; Kristina Crothers Journal: AIDS Date: 2016-01-28 Impact factor: 4.177