title: Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  General medicine acute care ward.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Istituto Clinico S. Anna, Brescia, Italy. piera.ranieri@grupposandonato.it
authors.forename: Piera
authors.initials: P
authors.lastname: Ranieri
authors.forename: Angelo
authors.initials: A
authors.lastname: Bianchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Margiotta
authors.forename: Adriana
authors.initials: A
authors.lastname: Virgillo
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Clini
authors.forename: Marco
authors.initials: M
authors.lastname: Trabucchi
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome