One-year Mortality in COPD After an Exacerbation: The Effect of Physical Activity Changes During the Event.
Mortality is one of the most important outcomes in patients with chronic obstructive pulmonary disease (COPD). Different predictors have been associated with mortality, including the patient's level of physical activity (PA). The objective of this work was to establish the relationship between changes in PA during a moderate-to-severe COPD exacerbation (eCOPD) and 1-year mortality after the index event. This was a prospective observational cohort study with recruitment of 2,484 patients with an eCOPD attending the emergency department (ED) of 16 participating hospitals. Variables recorded included clinical and sociodemographic data from medical records, dyspnea, health-related quality of life, and PA before the index eCOPD and 2 months after the hospital or ED discharge, as reported by the patient. In the multivariate analysis worsening changes in PA from baseline to 2 months after the ED index visit [odds ratio (ORs) from 2.78 to 6.31] was related to 1-year mortality, using the age-adjusted Charlson comorbidity index (OR: 1.22), and previous use of long-term domiciliary oxygen therapy or non-invasive mechanical ventilation at home (OR: 1.68). The same variables were also predictive in the validation sample. Areas under the receiver operating characteristic curve in the derivation and validation sample were 0.79 and 0.78, respectively. In conclusion, PA is the strongest predictor of dying in the following year, i.e., those with worsened PA from baseline to 2 months after an eCOPD or with very low PA levels have a higher risk.
a Servicio de Neumologia , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Cristóbal
C
Esteban
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Susana
S
Garcia-Gutierrez
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Maria J
MJ
Legarreta
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Ane
A
Anton-Ladislao
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Nerea
N
Gonzalez
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.
Iratxe
I
Lafuente
c Subdirección General de Tecnología e Innovación Sanitarias . Consejería de Sanidad de la Comunidad de Madrid , Madrid , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Nerea
N
Fernandez de Larrea
d Unidad de Calidad , Hospital Valme , Sevilla , Spain.
Silvia
S
Vidal
e Unidad de Epidemiología Clínica , Corporacio Parc Tauli , Barcelona , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
Marisa
M
Bare
b Unidad de Investigación , Hospital Galdakao-Usansolo , Galdakao , Spain.|f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC) , Galdakao , Spain.
José M
JM
Quintana
Iryss
I
-Copd Group
D019540:Area Under Curve; D015897:Comorbidity; D018450:Disease Progression; D015444:Exercise; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D063087:Noninvasive Ventilation; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology; D012372:ROC Curve; D011897:Random Allocation; D057566:Self Report; D012720:Severity of Illness Index; D013997:Time Factors
Chronic obstructive; cohort studies; mortality; physical activity; pulmonary disease