title: The effect of airflow limitation on the cause of death in patients with COPD.
abstract: COPD is characterized by airflow limitation that is usually progressive. The present study investigated the cause of death and the effect of airflow limitation on all-cause mortality in COPD patients. A prospective cohort of 600 COPD patients were followed for 3 years. Patients in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 (32.7%), GOLD 3 (48.1%), or GOLD 4 (19.1%). Overall, 117 patients died (19.6%). Deaths were due to respiratory failure (29%), cardiovascular disease (25.6%), cancer (17.9%), infection (11%), gastrointestinal disease (9.4%), and other causes (6.7%). According to the Cox regression analysis, the following independent factors were related to mortality: age (years), hazards ratio (HR) 1.046 (confidence interval [CI] 95% 1.021, 1.072); current smoking status, HR 1.535 (CI 95% 1.003, 2.350); cancer, HR 7.172 (CI 95% 4.515, 11.395); cardiovascular disease, HR 2.623 (CI 95% 1.821, 3.778); severe airflow limitation (GOLD 4), HR 2.378 (CI 95% 1.605, 3.525); and highest quartile of acute exacerbations, HR 1.852 (CI 95% 1.236, 2.775). The present study shows that severe airflow limitation, current smoking status, the presence of cardiovascular disease, cancer, and a high frequency of acute exacerbations have an independent negative impact on the prognosis of COPD patients.
authors.affiliation: Department of Respiratory Medicine, Valme University Hospital, Seville, Spain. ialfageme@separ.es
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alfageme
authors.forename: Nuria
authors.initials: N
authors.lastname: Reyes
authors.forename: Mercedes
authors.initials: M
authors.lastname: Merino
authors.forename: Angela
authors.initials: A
authors.lastname: Reina
authors.forename: Javier
authors.initials: J
authors.lastname: Gallego
authors.forename: Jorge
authors.initials: J
authors.lastname: Lima
authors.forename: Zulema
authors.initials: Z
authors.lastname: Palacios
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000401:mortality; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology