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Original Research: COPD |

A Postmortem Analysis of Major Causes of Early Death in Patients Hospitalized With COPD Exacerbation

Biljana Zvezdin, MD, PhD; Senka Milutinov, MD; Marija Kojicic, MD; Mirjana Hadnadjev, MD; Sanja Hromis, MD; Marica Markovic, MSc; Ognjen Gajic, MD, MSc, FCCP
Author and Funding Information

From the Institute for Pulmonary Diseases of Vojvodina (Drs. Zvezdin, Milutinov, Kojicic, Hadnadjev, and Hromis), Sremska Kamenica, Serbia; the Division of Pulmonary and Critical Care Medicine (Drs. Kojicic and Gajic), Department of Internal Medicine, Mayo Clinic, Rochester, MN; and the Nijmegen Center of Molecular Life Science (Ms. Markovic), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.

Biljana Zvezdin, MD, PhD, Assistant Professor, Institute for Pulmonary Diseases of Vojvodina, Institutski put 4, 21 208 Sremska Kamenica, Serbia; e-mail: biljanazvezdin@yahoo.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

For editorial comment see page 329


© 2009 American College of Chest Physicians


Chest. 2009;136(2):376-380. doi:10.1378/chest.08-2918
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Background:  Mortality from COPD is increasing worldwide, but detailed causes of death are rarely assessed, particularly in low-income countries.

Methods:  In a retrospective study, we reviewed the autopsy reports and medical records of deceased patients admitted to the hospital for severe exacerbation of COPD, from January 2005 to December 2007, at the Institute for Pulmonary Diseases of Vojvodina, Serbia.

Results:  Forty-three patients with a hospital admission diagnosis of COPD exacerbation underwent autopsy; all had died within 24 h of admission to the hospital. Twenty-three patients (54%) had a long COPD history (> 10 years), and 19 patients (44%) had more than one hospitalization in the last year of life. The median age at death was 70 years (interquartile range, 65 to 75 years), and male sex was predominant (n = 31; 72%). The main (primary) causes of death were reported as cardiac failure (n = 16; 37.2%), pneumonia (n = 12; 27.9%), and pulmonary thromboembolism (PTE) (n = 9; 20.9%). Respiratory failure due to a progression of COPD was the primary cause of death in six patients (14%). Most patients had more then one comorbid disease (n = 33; 77%), and the most frequent comorbid disease was chronic heart failure (n = 25; 58%).

Conclusions:  Autopsy results suggest that common contributing causes of early death in patients hospitalized with severe COPD exacerbation are concomitant complications, as follows: cardiac failure, pneumonia, and PTE. Quality improvement interventions should focus on recognizing and treating these conditions at the time of hospital admission.


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