title: Comorbidity, hospitalization, and mortality in COPD: results from a longitudinal study.
abstract: 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.
authors.affiliation: 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
authors.forename: Claudio
authors.initials: C
authors.lastname: Terzano
authors.forename: Vittoria
authors.initials: V
authors.lastname: Conti
authors.forename: Fabio
authors.initials: F
authors.lastname: Di Stefano
authors.forename: Angelo
authors.initials: A
authors.lastname: Petroianni
authors.forename: Daniela
authors.initials: D
authors.lastname: Ceccarelli
authors.forename: Elda
authors.initials: E
authors.lastname: Graziani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mariotta
authors.forename: Alberto
authors.initials: A
authors.lastname: Ricci
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Puglisi
authors.forename: Corrado
authors.initials: C
authors.lastname: De Vito
authors.forename: Paolo
authors.initials: P
authors.lastname: Villari
authors.forename: Luigi
authors.initials: L
authors.lastname: Allegra
mesh_terms: 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
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen