title: Determining prognosis in acute exacerbation of COPD.
abstract: BACKGROUND
  Acute exacerbations are the leading causes of hospitalization and mortality in patients with COPD. Prognostic tools for patients with chronic COPD exist, but there are scarce data regarding acute exacerbations. We aimed to identify the prognostic factors of death and readmission after exacerbation of COPD.
  
  
  METHODS
  This was a retrospective study conducted in the Department of Internal Medicine of Geneva University Hospitals. All patients admitted to the hospital with a diagnosis of exacerbation of COPD between 2008 and 2011 were included. The studied variables included comorbidities, Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification, and biological and clinical parameters. The main outcome was death or readmission during a 5-year follow-up. The secondary outcome was death. Survival analysis was performed (log-rank and Cox).
  
  
  RESULTS
  We identified a total of 359 patients (195 men and 164 women, average age 72 years). During 5-year follow-up, 242 patients died or were hospitalized for the exacerbation of COPD. In multivariate analysis, age (hazard ratio [HR] 1.03, 95% CI 1.02-1.05;P<0.0001), severity of airflow obstruction (forced expiratory volume in 1 s <30%; HR 4.65, 95% CI 1.42-15.1;P=0.01), diabetes (HR 1.47, 95% CI 1.003-2.16;P=0.048), cancer (HR 2.79, 95% CI 1.68-4.64;P<0.0001), creatinine (HR 1.003, 95% CI 1.0004-1.006;P=0.02), and respiratory rate (HR 1.03, 95% CI 1.003-1.05;P=0.028) on admission were significantly associated with the primary outcome. Age, cancer, and procalcitonin were significantly associated with the secondary outcome.
  
  
  CONCLUSIONS
  COPD remains of ominous prognosis, especially after exacerbation requiring hospitalization. Baseline pulmonary function remains the strongest predictor of mortality and new admission. Demographic factors, such as age and comorbidities and notably diabetes and cancer, are closely associated with the outcome of the patient. Respiratory rate at admission appears to be the most prognostic clinical parameter. A prospective validation is, however, still required to enable the identification of patients at higher risk of death or readmission.
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva.
authors.forename: Yves
authors.initials: Y
authors.lastname: Flattet
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva; Service of Internal Medicine, Riviera Chablais Hospital, Monthey, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva.
authors.forename: Jacques
authors.initials: J
authors.lastname: Serratrice
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva.
authors.forename: Jérome
authors.initials: J
authors.lastname: Stirnemann
authors.affiliation: Department of Internal Medicine, Service of General Internal Medicine, Geneva University Hospitals, Geneva.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006785:Hospitals, University; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D056152:Respiratory Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors
keywords: COPD; exacerbation; prognosis