Publication:

Acute exacerbation of chronic obstructive pulmonary disease: predictors of outcome: single center prospective study from India

Background Acute exacerbations are associated with high rates of morbidity and mortality and hospital readmissions. With the rise in the rate of COPD and increased rate of mortality, this study was performed to predict the outcome of acute exacerbations in chronic obstructive pulmonary disease.

Methods 124 patients were admitted with exacerbations of chronic obstructive pulmonary disease presented in the Emergency Department in our hospital were included into the study. Apart from the regular demographic details, blood tests and X rays, spirometric analysis was done for all patients. The patients were asked to describe the level of dyspnoea before the onset of exacerbation and their MRC score was noted. Record of previous hospitalization before the present episode of exacerbations was noted and the length of the hospital stay was also recorded. Partial pressure of arterial oxygen and carbon dioxide (PaO2, PaCO2) and pH were measured on arterial blood sample taken before the oxygen therapy.

Results The mean age of the patients was 66.9 ± 7.3, and the predominant MRC score of the patients was 2. Mortality rate of the patients was 14.5% most of whom were during the in-hospital stay. The PaO2 was 63 on average but in all the patients who died, the PaO2 level was below 60mmHg and the PaCO2 levels were above 46mmHg. Comorbidities include diabetes, hypertension, pneumonia, among others.

Conclusions Age is an independent predictor for the outcome of AECOPD apart from PaO2 and PaCO2 levels. Other predictors for mortality whether in-hospital or after discharge are smoking, both active and ex, low FEV1 comorbidities like diabetes, hypertension, pneumonia, tuberculosis, renal failure etc.