To identify risk factors related to Acute Exacerbation of Chronic Obstructive Pulmonary disease ( COPD ) in hospitalized patients as a retrospective nested case control study.
From Jan 2002 to June 2004, a total of 162 patients were admitted who satisfied the criteria for Acute Exacerbation of COPD. Of these, 26 patients died. They were compared with 136 discharged patients (controls)Acute Exacerbation of COPD was defined using the criteria of Anthonisen et al : increased dyspnoea /sputum volume & sputum purulence. Severity of lung disease was stratified based on FEV1 % predicted using GOLD guidelines (StageI:FEV1/ FVC < 70% with FEV1 > 80%, Stage IIa:FEV1 50-80% stage IIb:FEV1 30 –50% & stage III FEV1 <30%): Clinical outcomes were recorded in all patients.
Sixteen percent of deaths occurred in hospitalized patients due to acute exacerbation. The main risk factors with odds ratios (OR) were: use of ventilator OR = 3.46 ( 95% CI :1.22-9.28, P= 0.02), increased stage of severity OR = 4.35 (95% CI : 1.01-18.86, P= 0.05) prolonged length of stay in ICU OR 9.32 (95%,CI:4.27-87.3) (P=0.0001) prolonged length of stay in hospital OR =2.76 (95% CI : 1.02-7.51, P=0.04). Interestingly age, sex, type of respiratory failure, sputum culture /sensitivity and presence of one or more co-morbidities did not affect the ultimate outcome.
The results of our study suggest that use of ventilator, prolonged length of ICU stay, hospital stay,decreased FEV1 determine treatment outcomes. Prospective studies in appropriately stratified patients are needed to validate these findings in Indian setup loco regionally.
Treatment outcomes in acute exacerbations of COPD are determined by variable factors which need to be ascertained in each center.
Avanti Vigg, None.