Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.
OBJECTIVE
There is a paucity of survival data regarding the prognosis of elderly patients following acute exacerbations of COPD (AECOPD). We undertook a study to examine long-term mortality rates and to identify clinical and laboratory predictors of these outcomes.


METHODS
A retrospective cohort study was conducted of 786 consecutive elderly (>65 years) patients admitted to general medicine acute-care wards for AECOPD. Factors determining short- and long-term mortality were analysed.


RESULTS
The mean (+/-SD) age of the study population was 75.8 +/- 7.3 years (range 65-100 years). The in-hospital mortality rate for the entire cohort was 7.25%. The risk of mortality at 1, 3 and 5 years was 28%, 47% and 54%, respectively. In univariate analysis age (hazard ratio 1.52; 95% confidence interval: 1.23-1.91), FEV(1) (1.45; 1.73-2.35), active cancer (1.23; 1.64-2.32), current smoking (1.74; 1.35-2.11), ischaemic heart disease (1.58; 1.28-2.02), congestive heart failure (1.55; 1.23-2.26) and maintenance use of oral glucocorticosteroids (1.58; 1.11-2.79) were significantly associated with mortality. In multivariate analysis, only current smoking (1.89; 1.18-1.93), ischaemic heart disease (1.41; 1.07-1.68), PaCO(2) on admission (1.49; 1.03-1.60), hospital readmission (2.23; 1.40-2.18) and FEV(1) (1.41; 1.12-1.54) were independent predictors of mortality.


CONCLUSIONS
This study provides new insights into the predictive factors associated with long-term prognosis in elderly patients admitted for acute exacerbations of COPD, which differ from those previously identified for younger patients.
Fruchter
Oren
O
Pulmonary Division, Rambam Health Care Campus and The Bruce Rappaport School of Medicine, Haifa, Israel. o_fruchter@rambam.health.gov.il
Yigla
Mordechai
M
D000368:Aged; D000369:Aged, 80 and over; D018568:Crown-Rump Length; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis