Abstract
Background: Mortality rates at 2 years following discharge among patients with exacerbation of COPD have ranged from 22% to 49%. No mortality data is available for such patients from India, especially Kashmir, where COPD is common.
Objective: To determine the post discharge mortality rate and its determinants among patients with COPD hospitalized for acute exacerbation, in a 650-bedded tertiary care facility in Srinagar, Kashmir (India).
Methods: One hundred and fifty-one patients admitted with a diagnosis of acute exacerbation of COPD from October 2008 to October 2010 & discharged after treatment were followed prospectively for a period of 2 years for any deaths and recurrences of exacerbations. The relationship of mortality with potential patient factors was analysed statistically by employing multiple logistic regression analysis, Kaplan- Meier survival analysis and Cox regression.
Results: During a followup of two years following discharge, 39.7% patients died with the majority (34.4%) of deaths occurring during the first year. Risk factors associated with increased mortality included lower health status at discharge (SGRQ score > 60, p value < 0.001), GOLD stage 4 (p < 0.001), BMI < 18 kgs/m2 (p value < 0.001), SaO2 ≤ 90% at discharge (p < 0.001) and 6MWT distance of < 150 metres (p < 0.001). Frequency of exacerbations increased with increasing GOLD stage (p < 0.001).
Conclusion: Mortality after discharge is high among north Indian patients admitted with acute exacerbation. Poor functional status at discharge and advanced lung disease are predictive of excessive mortality. Advanced stage of lung disease is associated with frequent exacerbations.
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