title: The impact of depressive symptoms on recovery and outcome of hospitalised COPD exacerbations.
abstract: The impact of depressive symptoms on outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been thoroughly evaluated in prospective studies. We prospectively enrolled 230 consecutive patients hospitalised for AECOPD, without previous diagnosis of depression. Depressive symptoms were evaluated with Beck's depression inventory. Pulmonary function tests, arterial blood gases, COPD assessment test (CAT) and Borg dyspnoea scale were recorded on admission and on days 3, 10 and 40. Patients were evaluated monthly for 1 year. Patients with depressive symptoms required longer hospitalisation (mean ± sd 11.6 ± 3.7 versus 5.6 ± 4.1 days, p<0.001). Clinical variables improved during the course of AECOPD, but depressive symptoms on admission had a significant impact on dyspnoea (p<0.001) and CAT score (p = 0.012) improvement. Patients with depressive symptoms presented more AECOPD (p<0.001) and more hospitalisations for AECOPD (p<0.001) in 1 year. In multivariate analysis, depressive symptoms were an independent predictor of mortality (hazard ratio 3.568, 95% CI 1.302-9.780) and risk for AECOPD (incidence rate ratio (IRR) 2.221, 95% CI 1.573-3.135) and AECOPD hospitalisations (IRR 3.589, 95% CI 2.319-5.556) in 1 year. The presence of depressive symptoms in patients admitted for AECOPD has a significant impact on recovery and is related to worse survival and increased risk for subsequent COPD exacerbations and hospitalisations in 1 year.
authors.affiliation: Sismanogleion General Hospital, Athens, Greece.
authors.forename: Andriana I
authors.initials: AI
authors.lastname: Papaioannou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bartziokas
authors.forename: Stamatoula
authors.initials: S
authors.lastname: Tsikrika
authors.forename: Foteini
authors.initials: F
authors.lastname: Karakontaki
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Kastanakis
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Haniotou
authors.forename: Spyros
authors.initials: S
authors.lastname: Papiris
authors.forename: Stelios
authors.initials: S
authors.lastname: Loukides
authors.forename: Vlassis
authors.initials: V
authors.lastname: Polychronopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostikas
mesh_terms: D000368:Aged; D003863:Depression / Q000150:complications* / Q000503:physiopathology; D018450:Disease Progression; D004417:Dyspnea / Q000150:complications / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012907:Smoking; D016896:Treatment Outcome