Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries.
OBJECTIVE
Mortality rate is high in patients with chronic obstructive pulmonary disease (COPD). Our aim was to investigate long-term mortality and associated risk factors in COPD patients previously hospitalized for a COPD exacerbation.


METHODS
A total of 256 patients from the Nordic countries were followed for 8.7 ± 0.4 years after the index hospitalization in 2000-2001. Prior to discharge, the St George's Respiratory Questionnaire was administered and data on therapy and comorbidities were obtained. Information on long-term mortality was obtained from national registries in each of the Nordic countries.


RESULTS
In total, 202 patients (79%) died during the follow up period, whereas 54 (21%) were still alive. Primary cause of death was respiratory (n = 116), cardiovascular (n = 43), malignancy (n = 28), other (n = 10), or unknown (n = 5). Mortality was related to older age, with a hazard risk ratio (HRR) of 1.75 per 10 years, lower forced expiratory volume in 1 second (FEV(1)) (HRR 0.80), body mass index (BMI) <20 kg/m(2) (HRR 3.21), and diabetes (HRR 3.02). Older age, lower BMI, and diabetes were related to both respiratory and cardiovascular mortality. An association was also found between lower FEV(1) and respiratory mortality, whereas mortality was not significantly associated with therapy, anxiety, or depression.


CONCLUSIONS
Almost four out of five patients died within 9 years following an admission for COPD exacerbation. Increased mortality was associated with older age, lower lung function, low BMI, and diabetes, and these factors should be taken into account when making clinical decisions about patients who have been admitted to hospital for a COPD exacerbation.
Department of Respiratory Medicine, Allergy and Sleep, National University Hospital, Reykjavik, Iceland.
Gunnar
G
Gudmundsson
Charlotte Suppli
CS
Ulrik
Thorarinn
T
Gislason
Eva
E
Lindberg
Eva
E
Brøndum
Per
P
Bakke
Christer
C
Janson
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors