title: Mortality Predictive Factors in Subjects With COPD After a Pulmonary Rehabilitation Program: A 3-Year Study.
abstract: BACKGROUND
  COPD is a high-mortality disease and projected to become the third leading cause of death worldwide by 2030. Our aim was to evaluate predictors of 3-y mortality and factors associated with early (1 y) and late (second and third year) mortality in subjects with severe COPD who completed a pulmonary rehabilitation program.
  
  
  METHODS
  A historical cohort study was performed with subjects with COPD who were admitted to a day-hospital for chronic respiratory failure for a pulmonary rehabilitation program, from January 2008 to December 2010. The population was characterized based on sociodemographic factors, body mass index, smoking habits, lung function tests, respiratory failure, comorbidities, bacterial colonization, Modified Medical Research Council dyspnea index, 6-min walk test, mechanical ventilation, noninvasive ventilation, long-term oxygen therapy, hospital admissions, and mortality.
  
  
  RESULTS
  From 183 patients who completed a pulmonary rehabilitation program, 93 had COPD. Our cohort had 78 male and 15 female subjects. The mean age ± SD was 68.6 ± 8.9 y, ranging from 43 to 85 y. After the pulmonary rehabilitation program, there were fewer, although not statistically significantly different hospital admissions (2.1 vs 1.7, P = .17). Three years after the pulmonary rehabilitation program, 34 subjects died (36.6%). Hypercapnic respiratory failure (P = .02), noninvasive ventilation (P = .002), lung cancer (P = .001), shorter 6-min walk distance (P = .03), and higher number of previous hospital admissions (P < .001) were associated with a higher mortality rate.
  
  
  CONCLUSIONS
  There is a high mortality rate in late-stage patients with COPD. The most relevant factors associated with mortality were lung cancer, respiratory failure and noninvasive ventilation, severe exacerbations with hospitalization, and lower functional exercise capacity.
authors.affiliation: Department of Pulmonology, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal. catia_sss@msn.com.
authors.forename: Cátia
authors.initials: C
authors.lastname: Saraiva
authors.affiliation: Unidade de Reabilitação Respiratória, Serviço de Pneumologia II, CHLN-Hospital Pulido Valente, Lisbon, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Abreu
authors.affiliation: Department of Pulmonology, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Djamila
authors.initials: D
authors.lastname: Neves
authors.affiliation: Unidade de Reabilitação Respiratória, Serviço de Pneumologia II, CHLN-Hospital Pulido Valente, Lisbon, Portugal. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D010343:Patient Admission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology / Q000534:rehabilitation*; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D000070857:Walk Test
keywords: COPD; exacerbations; functional exercise capacity; lung cancer; mortality; noninvasive ventilation; pulmonary rehabilitation; respiratory failure