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Original Research: COPD |

Comorbidities and Short-term Prognosis in Patients Hospitalized for Acute Exacerbation of COPDComorbidity and Prognosis in COPD Hospitalized Patients: The EPOC en Servicios de Medicina Interna (ESMI) Study

Pedro Almagro, MD; Francisco Javier Cabrera, MD; Jesus Diez, MD; Ramon Boixeda, MD; M. Belen Alonso Ortiz, MD; Cristina Murio, MD; Joan B. Soriano, MD; for the Working Group on, COPD, Spanish Society of Internal Medicine*
Author and Funding Information

From the Internal Medicine Service (Dr Almagro), Hospital Universitario Mutua De Terrassa, Barcelona; Internal Medicine Service (Dr Cabrera), Hospital General Universitario Gregorio Marañón, Madrid; Internal Medicine Service (Dr Diez), Hospital Royo Villanova, Zaragoza; Internal Medicine Service (Dr Boixeda), Hospital de Mataró, Barcelona; Internal Medicine Service (Dr Alonso Ortiz), Hospital Juan Negrín, Gran Canaria; Medical Departament (Dr Murio), Laboratorios Chiesi, Barcelona; and Programa de Epidemiología e Investigación Clínica (Dr Soriano), Fundación Caubet-Centro Internacional de Medicina Respiratoria Avanzada (CIMERA), Baleares, Spain.

Correspondence to: Pedro Almagro, MD, Hospital Mutua de Terrassa, Barcelona University, Plaza Dr Robert No. 5, 08221 Terrassa, Barcelona, Spain; e-mail: 19908pam@comb.cat

*

A complete list of study investigators is provided in e-Appendix 1.


Funding/Support: This work was supported by Chiesi España.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1126-1133. doi:10.1378/chest.11-2413
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Background:  Comorbidities are frequent in patients hospitalized for COPD exacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge.

Methods:  A longitudinal, observational, multicenter study of patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge.

Results:  We studied 606 patients, 594 men (89.9%), with a mean (SD) age of 72.6 (9.9) years and a postbronchodilator FEV1 of 43.2% (21.2). The mean Charlson index score was 3.1 (2.0). On admission, 63.4% of patients had arterial hypertension, 35.8% diabetes mellitus, 32.8% chronic heart failure, 20.8% ischemic heart disease, 19.3% anemia, and 34% dyslipemia. Twenty-seven patients (4.5%) died within 3 months. The Charlson index was an independent predictor of mortality (P < .003; OR,1.23; 95% CI, 1.07-1.40), even after adjustment for age, FEV1, and functional status measured with the Katz index. Comorbidity was also related with the need for hospitalization from the ED, length of stay, and hospital readmissions for COPD or other causes.

Conclusions:  Comorbidities are common in patients hospitalized for a COPD exacerbation, and they are related to short-term prognosis.

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