Risk indexes for exacerbations and hospitalizations due to COPD.
OBJECTIVE
The ability to predict exacerbations in patients with COPD might permit more rational use of preventive interventions. Our objective was to develop risk indexes for exacerbations and hospitalizations due to exacerbations that might be applied to the individual patient.


METHODS
Spirometry, demographics, and medical history were obtained at baseline in 1,829 patients with moderate-to-very severe COPD who entered a trial of inhaled tiotropium. Information about exacerbations and hospitalizations due to exacerbation was collected during the 6-month follow-up period. Analyses of first outcomes were modeled using univariable and multivariable Cox proportional hazards regressions.


RESULTS
During follow-up, 551 patients had at least one exacerbation and 151 patients had at least one hospitalization due to exacerbation. In the multivariable model for exacerbation, older age, percentage of predicted FEV(1), duration of COPD, a productive cough, antibiotic or systemic corticosteroid use for COPD in the prior year, hospitalization for COPD in the prior year, and theophylline use at baseline predicted a higher risk. In the multivariable model for hospitalization, older age, percentage of predicted FEV(1), unscheduled clinic/emergency department visits for COPD in the prior year, any cardiovascular comorbidity, and prednisone use at baseline were associated with greater risk. Both the exacerbation and the hospitalization models provided moderately good discrimination, the validated concordance indexes being 0.66 and 0.73, respectively. Methods for calculating risk in individual patients are provided.


CONCLUSIONS
Spirometry along with a few questions directed to the patient are strongly predictive of exacerbations and related hospitalizations over the ensuing 6 months.
Niewoehner
Dennis E
DE
Department of Medicine at Veterans Affairs Medical Centers in Minneapolis, MN 55417, USA. niewo001@umn.edu
Lokhnygina
Yuliya
Y
Rice
Kathryn
K
Kuschner
Ware G
WG
Sharafkhaneh
Amir
A
Sarosi
George A
GA
Krumpe
Peter
P
Pieper
Karen
K
Kesten
Steven
S
D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D013147:Spirometry; D000069447:Tiotropium Bromide; D014481:United States
D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide