Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

Background and Aim Exacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs?particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients. Methods This was a retrospective population-based cohort study.We selected 900 patients with confirmed COPD aged 35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission.We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1?4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year. Results Of the patients, 16.4%had 1 severe exacerbations, varying from 9.3%in mild GOLD grade 1 to 44%in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95%confidence interval [CI], 3.53?12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41?17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated. Conclusions Hospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality

Factores predictivos de morbimortalidad al año en pacientes con EPOC

RESUMEN: A pesar de la importancia de las Agudizaciones en la Enfermedad Pulmonar Obstructiva Crónica(AEPOC), sabemos poco de sus determinantes. OBJETIVOS Analizar la existencia de un ‘Fenotipo Agudizador’(FA) y estimar la existencia de predictores de AEPOC. Evaluar la capacidad predictiva de un índice de gravedad propio(IGP). METODOLOGÍA Estudio de cohortes retrospectivo. Identificándose 900 pacientes con EPOC en Cantabria a 31/12/2011, en bases de datos poblacionales. Se clasificó a cada paciente como ‘FA’, o como ‘Fenotipo No Agudizador’(FNA), en 2012. La frecuencia de agudizaciones graves y la mortalidad global fueron también tratadas como variables dependientes. RESULTADO-CONCLUSIONES El principal predictor independiente de ser ‘FA’ fue el antecedente de agudizaciones el año previo, apoyando la existencia de un ‘FA’ estable. El IGP obtuvo una buena capacidad predictiva de ser ‘FA’, hospitalización por AEPOC y mortalidad al año. El añadir las comorbilidades, aumentó esta capacidad. La vacunación antigripal, disminuyó el riesgo de hospitalización por AEPOC.ABSTRACT: Despite the importance of exacerbations of chronic obstructive pulmonary disease(COPD), we know relatively little about their determinants. OBJECTIVES To analyze whether there is or not a ‘Frequent-Exacerbation’(FE) phenotype of COPD and to discover exacerbation predictors.To estimate the predictive accuracy of an own index of severity. METHODS Retrospective population-based cohort study. 900 patients with confirmed COPD ≥ 35 years, were selected in Cantabria at 31 December 2011. We defined ‘FE’ and ‘Infrequent Exacerbator’(IE) phenotype in 2012. Frequency of severe exacerbations, and overall mortality were also treated as dependent variables. RESULTS-CONCLUSIONS The main predictor of ‘FE’ was a history of frequent exacerbations the previous year, and it supports a ‘FE’ phenotype of COPD. Our composite score obtained a high predictive accuracy of being ‘FE’, COPD hospitalization and overall mortality next year. Adding comorbidities increased this predictive accuracy. Influenza vaccination diminished the risk of hospitalization by exacerbation the following year

Crude and adjusted odds ratios (ORs) according to previous exacerbations for the risk of hospitalized exacerbations and mortality the following year.

<p>Crude and adjusted odds ratios (ORs) according to previous exacerbations for the risk of hospitalized exacerbations and mortality the following year.</p

Crude and adjusted odds ratios (ORs) according to comorbidities for the risk of hospitalized exacerbations and mortality the following year.

<p>Crude and adjusted odds ratios (ORs) according to comorbidities for the risk of hospitalized exacerbations and mortality the following year.</p

Crude and adjusted odds ratios (ORs) according to sociodemographic and lifestyle characteristics for the risk of hospitalized exacerbations and mortality the following year.

<p>Crude and adjusted odds ratios (ORs) according to sociodemographic and lifestyle characteristics for the risk of hospitalized exacerbations and mortality the following year.</p

Baseline sociodemographic, lifestyle, and clinical characteristics of the patients.

<p>Baseline sociodemographic, lifestyle, and clinical characteristics of the patients.</p