title: One-year mortality after severe COPD exacerbation in Bulgaria.
abstract: BACKGROUND
  One-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined.
  
  
  OBJECTIVE
  To examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients' characteristics and comorbidities.
  
  
  METHODS
  A total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM), arterial hypertension (AH), and metabolic syndrome (MS). Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register.
  
  
  RESULTS
  One-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%,p= 0.107). There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%,p= 0.013). The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%,p= 0.009). There is a trend for increased mortality in the group with FEV1 < 50% (11.5 vs. 4.4%,p= 0.094). Cox regression shows 3.7% increase in mortality rate for 1% decrease in FEV1, 5.2% for 1% decrease in PEF, 7.8% for one year age increase and 8.1% for 1 CAT point increase (allp< 0.05).
  
  
  CONCLUSIONS
  This study finds relatively low one-year mortality in COPD patients after surviving severe exacerbation. Grade C and FEV1 > 80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.
authors.affiliation: Clinical Center for Pulmonary Diseases, Medical University-Sofia , Sofia , Bulgaria.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Mekov
authors.affiliation: Clinical Center for Pulmonary Diseases, Medical University-Sofia , Sofia , Bulgaria.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Slavova
authors.affiliation: Department of Clinical Laboratory and Clinical Immunology, Central Clinical Laboratory, Medical University-Sofia, University Hospital "Alexandrovska," Sofia , Bulgaria.
authors.forename: Adelina
authors.initials: A
authors.lastname: Tsakova
authors.affiliation: Department of Clinical Laboratory and Clinical Immunology, Central Clinical Laboratory, Medical University-Sofia, University Hospital "Alexandrovska," Sofia , Bulgaria.
authors.forename: Marianka P
authors.initials: MP
authors.lastname: Genova
authors.affiliation: Clinical Center for Pulmonary Diseases, Medical University-Sofia , Sofia , Bulgaria.
authors.forename: Dimitar T
authors.initials: DT
authors.lastname: Kostadinov
authors.affiliation: Clinical Center for Pulmonary Diseases, Medical University-Sofia , Sofia , Bulgaria.
authors.forename: Delcho
authors.initials: D
authors.lastname: Minchev
authors.affiliation: Clinical Center for Pulmonary Diseases, Medical University-Sofia , Sofia , Bulgaria.
authors.forename: Dora
authors.initials: D
authors.lastname: Marinova
authors.affiliation: Department of Internal Medicine, Clinic of Endocrinology and Metabolism, Medical University-Sofia, University Hospital "Alexandrovska," Sofia , Bulgaria.
authors.forename: Mihail A
authors.initials: MA
authors.lastname: Boyanov
keywords: COPD; Comorbidities; Exacerbation; Lung function; Mortality; Quality of life