Predictors of 6-Month Mortality in Elderly Patients with Mild Chronic Obstructive Pulmonary Disease Discharged from a Medical Ward After Acute Nonacidotic Exacerbation.
Ranieri, Piera MD *,+; Bianchetti, Angelo MD *,+; Margiotta, Alessandro MD *,+; Virgillo, Adriana MD *,+; Clini, Enrico M. MD ++; Trabucchi, Marco MD +
Journal of the American Geriatrics Society.
56(5):909-913, May 2008.
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OBJECTIVES: To identify clinical outcomes and variables associated with 6-month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
DESIGN: Prospective cohort study.
SETTING: General medicine acute care ward.
PARTICIPANTS: Two hundred forty-four elderly patients with COPD (mean age /-standard deviation 82 /-7, 55.7% female) admitted to the hospital because of non-acidotic AECOPD.
MEASUREMENTS: Cognitive and mood status and physiological variables were measured. Self-reported comorbidities were assessed using the Charlson Comorbidity Index. In-hospital and long-term mortality and clinical outcomes were recorded.
RESULTS: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini-Mental State Examination score 21 /-5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4 /-3), good nutritional status (body mass index (BMI) 25.1 /-5.5), moderate comorbidity (Charlson Comorbidity Index 4.0 /-1.9), high functional disability (Barthel Index (BI) 52 /-34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7 /-4.2). Two hundred twenty-five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6-month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI ([beta]=-0.16; 95% confidence interval (CI)=0.73-0.99), higher APACHE II score ([beta]=0,17; 95% CI=1.03-1.36), and lower BI at discharge ([beta]=-0.02; 95% CI=0.96-0.99) were independently associated with 6-month mortality.
CONCLUSION: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6-month mortality of elderly patients admitted for nonacidotic AECOPD.
(C) 2008 by the American Geriatrics Society