Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis

A. Singanayagam, S. Schembri, J. D. Chalmers

    Research output: Contribution to journalArticlepeer-review

    150 Citations (Scopus)

    Abstract

    Rationale: There is a need to identify clinically meaningful predictors of mortality following hospitalized COPD exacerbation. Objectives: The aim of this study was to systematically review the literature to identify clinically important factors that predict mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: Eligible studies considered adults admitted to hospital with COPD exacerbation. Two authors independently abstracted data. Odds ratios were then calculated by comparing the prevalence of each predictor in survivors versus nonsurvivors. For continuous variables, mean differences were pooled by the inverse of their variance, using a random effects model. Measurements and Main Results: Therewere 37 studies included (189,772 study subjects) with risk of death ranging from3.6% for studies considering short-termmortality, 31.0% for long-term mortality (up to 2 yr after hospitalization), and 29.0% for studies that considered solely intensive care unit (ICU)-admitted study subjects. Twelve prognostic factors (age, male sex, low bodymass index, cardiac failure, chronic renal failure, confusion, long-term oxygen therapy, lower limb edema, Global Initiative for Chronic Lung Disease criteria stage 4, cor pulmonale, acidemia, and elevated plasma troponin level) were significantly associated with increased short-term mortality. Nine prognostic factors (age, low body mass index, cardiac failure, diabetes mellitus, ischemic heart disease,malignancy, FEV , long-term oxygen therapy, and PaO on admission) were significantly associated with long-termmortality. Three factors (age, low Glasgow Coma Scale score, and pH) were significantly associated with increased risk of mortality in ICUadmitted study subjects. Conclusion: Different factors correlate with mortality from COPD exacerbation in the short term, long term, and after ICU admission. These parameters may be useful to develop tools for prediction of outcome in clinical practice.
    Original languageEnglish
    Pages (from-to)81-89
    Number of pages9
    JournalAnnals of the American Thoracic Society
    Volume10
    Issue number2
    DOIs
    Publication statusPublished - 2013

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