title: A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation.
abstract: 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.
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. Electronic address: biljanazvezdin@yahoo.com.
authors.forename: Biljana
authors.initials: B
authors.lastname: Zvezdin
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Senka
authors.initials: S
authors.lastname: Milutinov
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Marija
authors.initials: M
authors.lastname: Kojicic
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Hadnadjev
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Hromis
authors.affiliation: Nijmegen Center of Molecular Life Science, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Marica
authors.initials: M
authors.lastname: Markovic
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic