title: Predictors of outcome in patients admitted with acute exacerbation of chronic obstructive pulmonary disease in a rural Tertiary Care Center.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is associated with a high degree of mortality and morbidity around the world with the burden of the disease being more in the developing countries. In the Indian context data is limited. This study was carried out to determine the predictors of outcome in patients admitted with acute exacerbation of COPD in a rural Tertiary Care Center in the state of Kerala.
  
  
  METHODS
  This was a prospective cohort study. Patients admitted with acute exacerbation of COPD in the Intensive Care Unit between August 2013 and July 2014 was included in the study. Sociodemographic data, clinical variables, and investigations were collected. Mortality with respect to relevant risk factors was compared using Kaplan-Meier method and Cox proportional hazard model.
  
  
  RESULTS
  Seventy patients were enrolled in the study of whom 58 (82.9%) were above the age of 60 years. Majority of the patients (87.1%) were males. Tobacco smoking was the main risk factor in them. All the females had a history of exposure to biomass fuel in the form of firewood; none of them were smokers. Majority of patients (80.0%) had a history of one or more co-existing illnesses. Anemia was found to be an independent risk factor for mortality (adjusted hazard ratio: 3.167, 95% confidence interval: 1.516-6.616). Risk factors for poor outcome in COPD patients reported from other centers in India were not found to be relevant in this study.
  
  
  CONCLUSIONS
  Anemia could be an independent risk factor for mortality in COPD patients. India already has a high prevalence of iron deficiency anemia especially in the rural area and in the geriatric population. Henceforth, family practitioners and primary care physicians may remain vigilant regarding the development of anemia in their COPD patients and institute remedial measures without delay. Futhermore, the wide variation reported in the predictors of outcome of COPD along with the finding of this study calls for an urgent need for more studies.
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Ittyachen
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Smitha
authors.initials: S
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Community Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Arun N
authors.initials: AN
authors.lastname: Bhatt
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Shanavas
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Department of Pulmonary Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Jijo Oommen
authors.initials: JO
authors.lastname: Roy
authors.affiliation: Department of Pulmonary Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: M
authors.initials: M
authors.lastname: Sugathan
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ambadan
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala, India.
authors.forename: Jelty
authors.initials: J
authors.lastname: Kuriakose
keywords: Acute exacerbation; chronic obstructive pulmonary disease; predictors of outcome; rural area