Comorbidity, hospitalization, and mortality in COPD: results from a longitudinal study.
We evaluated comorbidity, hospitalization, and mortality in chronic obstructive pulmonary disease (COPD), with special attention to risk factors for frequent hospitalizations (more than three during the follow-up period), and prognostic factors for death. Two hundred eighty-eight consecutive COPD patients admitted to respiratory medicine wards in four hospitals for acute exacerbation were enrolled from 1999 to 2000 in a prospective longitudinal study, and followed up until December 2007. The Charlson index without age was used to quantify comorbidity. Clinical and biochemical parameters and pulmonary function data were evaluated as potential predictive factors of mortality and hospitalization. FEV(1), RV, PaO(2), and PaCO(2) were used to develop an index of respiratory functional impairment (REFI index). Hypertension was the most common comorbidity (64.2%), followed by chronic renal failure (26.3%), diabetes mellitus (25.3%), and cardiac diseases (22.1%). Main causes of hospitalization were exacerbation of COPD (41.2%) and cardiovascular disease (34.4%). Most of the 56 deaths (19.4%) were due to cardiovascular disease (67.8%). Mortality risk depended on age, current smoking, FEV(1), PaO(2), the REFI index, the presence of cor pulmonale, ischemic heart disease, and lung cancer. Number and length of hospital admissions depended on the degree of dyspnea and REFI index. The correct management of respiratory disease and the implementation of aggressive strategies to prevent or treat comorbidities are necessary for better care of COPD patients.
Terzano
Claudio
C
Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Fondazione E. Lorillard Spencer Cenci, Via Casal de' Pazzi 16, 00156 Rome, Italy. cterzano@tin.it
Conti
Vittoria
V
Di Stefano
Fabio
F
Petroianni
Angelo
A
Ceccarelli
Daniela
D
Graziani
Elda
E
Mariotta
Salvatore
S
Ricci
Alberto
A
Vitarelli
Antonio
A
Puglisi
Giovanni
G
De Vito
Corrado
C
Villari
Paolo
P
Allegra
Luigi
L
D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005541:Forced Expiratory Volume; D006331:Heart Diseases / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality; D011660:Pulmonary Heart Disease / Q000453:epidemiology; D012123:Pulmonary Ventilation / Q000502:physiology*; D012115:Residual Volume; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
D002245:Carbon Dioxide; D010100:Oxygen