title: Factors affecting mortality following emergency admission for chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major cause of mortality worldwide. Patients with COPD frequently have systemic comorbidities that often require unscheduled hospitalization for exacerbation and deterioration of physical conditions, and can have a poor prognosis. We verified factors affecting patients' short-term mortality, using a national inpatient database in Japan.
  
  
  METHODS
  We retrospectively collected data for COPD patients (age: >40 years) with emergency admission between July 2010 and March 2013, using the Diagnosis Procedure Combination database. We performed multivariate logistic analyses fitted with a generalized estimating equation to assess factors associated with all-cause in-hospital mortality.
  
  
  RESULTS
  A total of 177,207 patients (mean age: 77.5 years; males: 72.9%) were identified. All-cause in-hospital death occurred in 23,614 patients (13.7%). Higher mortality was associated with older age, male sex, lower body mass index, more severe dyspnea, lower level of consciousness, and worse activities of daily life. Higher mortality was also associated with comorbid conditions, including bacterial pneumonia, aspiration pneumonia, interstitial pneumonitis, pulmonary embolism, respiratory failure, lung cancer, heart failure, cerebral infarction, liver cirrhosis, and chronic renal failure.
  
  
  CONCLUSIONS
  Our study demonstrated that all-cause in-hospital mortality in patients with COPD who required emergency hospitalization was associated with deteriorated general conditions and comorbidities at admission. Physicians should take into account these prognostic factors to choose better treatment options for COPD patients.
authors.forename: Wakae
authors.initials: W
authors.lastname: Hasegawa
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku 113-8655, Tokyo, Japan. YAMAUCHIY-INT@h.u-tokyo.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Sunohara
authors.forename: Taisuke
authors.initials: T
authors.lastname: Jo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Takami
authors.forename: Takahide
authors.initials: T
authors.lastname: Nagase
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D003244:Consciousness Disorders / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors