A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation.
BACKGROUND
Mortality from COPD is increasing worldwide, but detailed causes of death are rarely assessed, particularly in low-income countries.


METHODS
In a retrospective study, we reviewed the autopsy reports and medical records of deceased patients admitted to the hospital for severe exacerbation of COPD, from January 2005 to December 2007, at the Institute for Pulmonary Diseases of Vojvodina, Serbia.


RESULTS
Forty-three patients with a hospital admission diagnosis of COPD exacerbation underwent autopsy; all had died within 24 h of admission to the hospital. Twenty-three patients (54%) had a long COPD history (> 10 years), and 19 patients (44%) had more than one hospitalization in the last year of life. The median age at death was 70 years (interquartile range, 65 to 75 years), and male sex was predominant (n = 31; 72%). The main (primary) causes of death were reported as cardiac failure (n = 16; 37.2%), pneumonia (n = 12; 27.9%), and pulmonary thromboembolism (PTE) (n = 9; 20.9%). Respiratory failure due to a progression of COPD was the primary cause of death in six patients (14%). Most patients had more then one comorbid disease (n = 33; 77%), and the most frequent comorbid disease was chronic heart failure (n = 25; 58%).


CONCLUSIONS
Autopsy results suggest that common contributing causes of early death in patients hospitalized with severe COPD exacerbation are concomitant complications, as follows: cardiac failure, pneumonia, and PTE. Quality improvement interventions should focus on recognizing and treating these conditions at the time of hospital admission.
Zvezdin
Biljana
B
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. Electronic address: biljanazvezdin@yahoo.com.
Milutinov
Senka
S
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Kojicic
Marija
M
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Hadnadjev
Mirjana
M
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Hromis
Sanja
S
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Markovic
Marica
M
Nijmegen Center of Molecular Life Science, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Gajic
Ognjen
O
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.