title: Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients.
abstract: BACKGROUND
  Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients.
  
  
  METHODS
  Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant'Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines.
  
  
  RESULTS
  229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01-16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52-8.83), belonging to moderate (HR = 3.50; 95% CI 1.01-12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35-28.85).
  
  
  CONCLUSIONS
  Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.
authors.affiliation: Department of Public Health, Local Health Authority of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pandolfi
authors.affiliation: Pneumology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zanasi
authors.affiliation: Department of Public Health, Local Health Authority of Bologna, Bologna, Italy.
authors.forename: Muriel Assunta
authors.initials: MA
authors.lastname: Musti
authors.affiliation: Department of Public Health, Local Health Authority of Bologna, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Stivanello
authors.affiliation: Department of Clinical, Integrated and Experimental Medicine, Respiratory and Clinical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Pisani
authors.affiliation: Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Angelini
authors.affiliation: Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Maffei
authors.affiliation: Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Hrelia
authors.affiliation: Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Angeloni
authors.affiliation: Department of Public Health, Local Health Authority of Bologna, Bologna, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Zenesini
authors.affiliation: Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Hrelia
mesh_terms: D000368:Aged; D000886:Anthropometry; D001835:Body Weight; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D013147:Spirometry