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Predictors of 6‐Month Mortality in Elderly Patients with Mild Chronic Obstructive Pulmonary Disease Discharged from a Medical Ward After Acute Nonacidotic Exacerbation
Author(s) -
Ranieri Piera,
Bianchetti Angelo,
Margiotta Alessandro,
Virgillo Adriana,
Clini Enrico M.,
Trabucchi Marco
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2008.01683.x
Subject(s) - medicine , copd , comorbidity , exacerbation , body mass index , intensive care unit , geriatric depression scale , acute exacerbation of chronic obstructive pulmonary disease , cohort study , depression (economics) , cohort , prospective cohort study , physical therapy , anxiety , psychiatry , depressive symptoms , economics , macroeconomics
OBJECTIVES: To identify clinical outcomes and variables associated with 6‐month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN: Prospective cohort study. SETTING: General medicine acute care ward. PARTICIPANTS: Two hundred forty‐four elderly patients with COPD (mean age±standard deviation 82±7, 55.7% female) admitted to the hospital because of non‐acidotic AECOPD. MEASUREMENTS: Cognitive and mood status and physiological variables were measured. Self‐reported comorbidities were assessed using the Charlson Comorbidity Index. In‐hospital and long‐term mortality and clinical outcomes were recorded. RESULTS: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini‐Mental State Examination score 21±5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4±3), good nutritional status (body mass index (BMI) 25.1±5.5), moderate comorbidity (Charlson Comorbidity Index 4.0±1.9), high functional disability (Barthel Index (BI) 52±34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7±4.2). Two hundred twenty‐five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6‐month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI (β=−0.16; 95% confidence interval (CI)=0.73–0.99), higher APACHE II score (β=0,17; 95% CI=1.03–1.36), and lower BI at discharge (β=−0.02; 95% CI=0.96–0.99) were independently associated with 6‐month mortality. CONCLUSION: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6‐month mortality of elderly patients admitted for nonacidotic AECOPD.