Chest
Volume 142, Issue 5, November 2012, Pages 1126-1133
Journal home page for Chest

Original Research
COPD
Comorbidities and Short-term Prognosis in Patients Hospitalized for Acute Exacerbation of COPD: The EPOC en Servicios de Medicina Interna (ESMI) Study

https://doi.org/10.1378/chest.11-2413Get rights and content

Background

Comorbidities are frequent in patients hospitalized for COPD exacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge.

Methods

A longitudinal, observational, multicenter study of patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge.

Results

We studied 606 patients, 594 men (89.9%), with a mean (SD) age of 72.6 (9.9) years and a postbronchodilator FEV1 of 43.2% (21.2). The mean Charlson index score was 3.1 (2.0). On admission, 63.4% of patients had arterial hypertension, 35.8% diabetes mellitus, 32.8% chronic heart failure, 20.8% ischemic heart disease, 19.3% anemia, and 34% dyslipemia. Twenty-seven patients (4.5%) died within 3 months. The Charlson index was an independent predictor of mortality (P < .003; OR,1.23; 95% CI, 1.07-1.40), even after adjustment for age, FEV1, and functional status measured with the Katz index. Comorbidity was also related with the need for hospitalization from the ED, length of stay, and hospital readmissions for COPD or other causes.

Conclusions

Comorbidities are common in patients hospitalized for a COPD exacerbation, and they are related to short-term prognosis.

Section snippets

Materials and Methods

The EPOC en Servicios de Medicina Interna (ESMI) study (ie, COPD in Internal Medicine Services study) is a longitudinal, observational, multicenter study, conducted in 70 ED and internal medicine services in Spain, that included the first 10 consecutive patients seen for a COPD exacerbation during a 1-year period (October 2009-October 2010). Exacerbation was defined as a change in the symptoms of patients, beyond daily variations and requiring a change in regular medication.9 Inclusion criteria

Results

Overall, 679 patients were screened, and 606 were included. Fifteen patients were excluded for having an incomplete minimum data set, and another 58 cases were unable to perform spirometry or did not fulfill spirometric criteria for COPD. In 48 cases, spirometry was not available within the 6-month period before admission and could not be performed between discharge and follow-up visit, but a prior diagnosis of COPD with spirometric confirmation was available. These patients were included in

Discussion

Our study confirms the high prevalence of comorbidity in patients hospitalized for exacerbation of COPD and its importance in relation to short-term prognosis in this population, namely to the need for a readmission or mortality within 3 months after hospital discharge. Although previous studies have shown the relationship between comorbidity and posthospital mortality, these studies have usually been based on long-term follow-up.7, 12, 13 Other significant predictors of mortality such as age,

Acknowledgments

Author contributions: Dr Almagro had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Almagro: contributed to study design, analysis and interpretation of the data, and writing of the manuscript

Dr Cabrera: contributed to data collection and review of the manuscript.

Dr Diez: contributed to data collection and review of the manuscript.

Dr Boixeda: contributed to data collection and review of the manuscript.

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    Funding/Support: This work was supported by Chiesi España.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    *

    A complete list of study investigators is provided in e-Appendix 1.

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