PURPOSE: Acute exacerbation of COPD (AE COPD) is a common cause of emergency room (ER) visits and is a major cause of morbidity and mortality. Very little data is available from India regarding prognostic factors in these patients.
METHODS: The study was undertaken at Mediciti Hospital, Hyderabad, a tertiary care referral centre. All patients with AECOPD who presented to ER between October 2004 and September 2005 were included.
RESULTS: Of 48 patients studied, 42 were males, all of them were smokers (87.5%). Mean age was 66.02 ± 10.47 years. Mean duration of the disease was 8.06±6.65 years. All patients presented with cough, recent worsening of dyspnea and increased sputum purulence/volume. 56.25% patients had one or more associated co-morbid illnesses, majority had hypertension (33.33%). Of 32 patients with Respiratory failure on admission 20 (62.5%) patients had Type II and 12 (37.5%) had Type I failure. 29 patients received medical management, 13 patients required non-invasive ventilator support (NIV) and 6 patients required invasive mechanical ventilation (IMV). Overall mortality was 5 (10.41%). 30 variables were compared between survivors and non-survivors. Univariate sensitivity analysis revealed that presence of altered sensorium (P=0.019), Hypotension (P<0.001), cyanosis (P=0.0483), Hypoalbuminemia (P=0.0005), Severe Acidosis (P=0.0009), Hypercapnia (P=0.0304) and Hypoxia (P=0.075) at the time of admission and need for IMV (P<0.001) as predictors of mortality.
CONCLUSION: 67% of AECOPD presented with Respiratory failure, majority were type II. NIV had a successful outcome in 85%. Overall mortality was 10.4%Altered Sensorium, Cyanosis, hypotension, Hypoalbuminemia, severe acidosis, hypercapnia and hypoxia at the time of admission predict adverse outcome.Those who need IMV had high mortality. Survivors had less hospital stay.
CLINICAL IMPLICATIONS: Early assessment of these risk factors in patients with AECOPD and aggressive management would help to provide a better outcome.
DISCLOSURE: Ramakrishna Madakala, None.