Predictors of poor outcomes in acute exacerbations of chronic obstructive pulmonary disease

The aim of this study was to identify predictors of poor outcomes in patients hospitalized for severe acute exacerbation of COPD (AECOPD).

Methods. This retrospective, observational cohort study was conducted in Pulmonology Department of a city hospital in 2015 – 2016 and involved patients  hospitalized for severe AECOPD. Patients were divided according to outcomes. Poor  outcomes included at least one of the followings: the need in invasive (IMV)  or non-invasive (NIV) ventilation, admission to ICU, in-hospital death and COPD- related readmission during 2 months. Demographic, clinical, laboratory  parameters, pulmonary function tests and blood gas analysis were analyzed;  different multidimensional prognostic scores were also evaluated and compared.

Results. Of 121 patients included, a poor outcome had occurred in 45 patients (37%). Among them, NIV was required in 21 (17%), IMV in 8 (6%), and admission to ICU in 16 patients (13%); death was registered in 6 patients (5%) and  readmission in 27 (22%) of the patients. Patients with poor outcomes were  admitted more frequently by ambulance (62% vs 40%; p = 0.003), more often  were admitted to a hospital for AECOPD in the previous year (69% vs 45%; p =  0.0006), and had lower pH (p = 0.001), lower PaO2 (p = 0.001), higher PaCO2 (p  = 0.001), and a worse score on several prognostic scales such as APACHE II (13.9  ± 5.4 vs 7.8 ± 3.6; p = 0.001), DECAF (2.4 ± 0.6 vs 1.5 ± 0.6; p = 0.001),  BODEx (5.6 ± 1.8 vs 3.9 ± 1.1; p = 0.001), DOSE (2.9 ± 1.5 vs 2.2 ± 1.2; p =  0.029), and ADO (4.9 ± 1.5 vs 4.3 ± 1.3; p = 0.015) at admission. They more  frequently received O2 therapy (87% vs 46%; p = 0.001) and had longer hospital  stay (19.2 ± 6.2 days vs 12.5 ± 1.8 days; p = 0.001). 

Conclusions. Hypercapnia, hypoxemia and worse prognostic scores on admission predicted poor outcome in patients hospitalized for AECOPD during the previous year.

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