Cohort Study of Factors Contributing to Mortality Two Months after Exacerbation of COPD According to Patient Destination from Emergency Department
Marisa Baré *
Clinical Epidemiology, Parc Taulí Sabadell University Hospital, Sabadell, Catalonia, Spain and Health Services Research on Chronic Diseases Network- REDISSEC, Spain and Obstetrics, Gynecology and Preventive Medicine Department, Autonomous University of Barcelona-UAB, Bellaterra, Catalonia, Spain
Concepción Montón
Health Services Research on Chronic Diseases Network- REDISSEC, Spain and Pulmonology Service, Parc Taulí Sabadell- University Hospital, Spain
Xavier Pomares
Pulmonology Service, Parc Taulí Sabadell- University Hospital, Spain
Juli Font
Internal Medicine, Emergency Department, Parc Taulí Sabadell-University Hospital, Sabadell. Catalonia, Spain
Núria Torà
Clinical Epidemiology, Parc Taulí Sabadell University Hospital, Sabadell, Catalonia, Spain and Health Services Research on Chronic Diseases Network- REDISSEC, Spain
Cristina Estirado
Pulmonology Department, Hospital del Mar – IMIM, CIBERES, ISCiii, CEXS, University Pompeu Fabra, Barcelona, Catalonia, Spain
José Maria Quintana
Health Services Research on Chronic Diseases Network- REDISSEC, Spain and Research Unit, Galdakao Hospital, Bilbao, Spain
Ana Santiago
Pulmonology Service, Hospital La Paz, Madrid, Spain
Silvia Vidal
Research Unit, Hospital Costa del Sol, Marbella, Spain
The IRYSS-COPD Appropriateness Study Group
*Author to whom correspondence should be addressed.
Abstract
Background: We aimed to determine the mortality two months after exacerbation of chronic obstructive pulmonary disease (eCOPD) and to identify factors associated with mortality, comparing patients admitted to wards and those discharged to home from the emergency department.
Methods: This prospective multicentre study included all consecutive patients presenting with eCOPD at emergency departments in 16 public hospitals in Spain. Clinical variables were recorded from a standardized questionnaire. Independent predictors of mortality were modelled by logistic regression analysis. The calibration and discriminative power of the models for the two groups (discharged and admitted) were estimated by the Hosmer-Lemeshow test and the area under the curve (AUC), respectively. Bootstrap methods were applied for internal validation.
Results: 2487 patients were included; 1537 (62%) of these were admitted to wards. A total of 155 (6.2%; 95% CI: 5.2% - 7.1%) patients had died at 2 months: mortality was four times higher in patients admitted than in patients discharged. Age ≥ 80 years, Charlson score >2, and pronounced dyspnoea were independent factors for mortality in both groups; in admitted patients, Glasgow scale, baseline treatments for COPD, previous heart disease, complications during hospitalization, and corticoids at discharge were also independent factors.
Conclusions: In eCOPD, age, comorbidities, and dyspnoea are important for short-term prognosis in both patients admitted to wards and those discharged to home. In patients admitted to wards, the severity of baseline disease and eCOPD and corticoid treatment affect the short-term prognosis.
Keywords: Fatal prognosis, dyspnoea, comorbidity, destination