Predicting Mortality Factors in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

Abstract

Objectives: To predict mortality factors in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Methodology: A prospective cross-sectional validation study was performed in Jinnah Postgraduate Medical Center Karachi, Pakistan from 2019 to 2020 at the Chest Medicine department, a largest public tertiary care center in Karachi. All the patients with other inflammatory diseases such as malignancy, Arthritis, Inflammatory bowel diseases, connective tissue disorders, bronchiectasis (radiologically proven or history of phlegm expectoration >30 ml/day) or history of Tuberculosis were excluded. Patients with a recent history of use of antibiotic treatment or systemic steroids (prednisolone equivalent to >20 mg/day) in the preceding two months on medical record were also excluded from the study. Ethical Approval was taken from Institutional Research committee. All the patients who were presented to ER with Acute exacerbation of COPD was included in the study, AECOPD was defines Anthonisen criteria.  Data was entered into SPSS version 21 for statistical analysis of the data.

Results: Total 157 study participants were included into the study with predominance of male gender (n=106, 67.5%). The average age of study participants was 65.1 ± 11.41 years. Age was significantly higher among non-survivors than survivors (p=0.037). PH level at 4 hours was significantly lower in survivors (p=0.038). Heart rate (p=0.026) and respiratory rate (p=0.018) were significantly higher among non-survivors at 4 hours. Among NLR, PLR, PCO2, PO2 and HCO3, a higher sensitivity of 92.59% for NLR and lower specificity of 6.15% PCO2 was determined. None of these parameters had area under the curve significantly higher than 0.5. Multivariable logistic regression showed that age and PCO2 were independently predictors of mortality.

Conclusion: The present study found that increasing age and PCO2 were significant predictors of mortality in in patients with acute exacerbation of chronic obstructive pulmonary disease. NLR has high sensitivity and low specificity in determining the mortality