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Predictors of Mortality in Patients with Stable COPD

OBJECTIVES To determine which easily available clinical factors are associated with mortality in patients with stable COPD and if health-related quality of life (HRQoL) provides additional information. DESIGN Five-year prospective cohort study. SETTING Five outpatient clinics of a teaching hospital....

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Published in:Journal of general internal medicine : JGIM 2008-11, Vol.23 (11), p.1829-1834
Main Authors: Esteban, Cristóbal, Quintana, José M., Aburto, Myriam, Moraza, Javier, Egurrola, Mikel, España, Pedro Pablo, Pérez-Izquierdo, Julio, Capelastegui, Alberto
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Language:English
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Summary:OBJECTIVES To determine which easily available clinical factors are associated with mortality in patients with stable COPD and if health-related quality of life (HRQoL) provides additional information. DESIGN Five-year prospective cohort study. SETTING Five outpatient clinics of a teaching hospital. PARTICIPANTS Six hundred stable COPD patients recruited consecutively. MEASUREMENTS The variables were age, FEV 1% , dyspnea, previous hospital admissions and emergency department visits for COPD, pack-years of smoking, comorbidities, body mass index, and HRQoL measured by Saint George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Short-Form 36 (SF-36). Logistic and Cox regression models were used to assess the influence of these variables on mortality and survival. RESULTS FEV 1% (OR: 0.62, 95% CI 0.5 to 0.75), dyspnea (OR 1.92, 95% CI 1.2 to 3), age (OR 2.41, 95% CI 1.6 to 3.6), previous hospitalization due to COPD exacerbations (OR 1.53, 1.2 to 2) and lifetime pack-years (OR 1.15, 95% CI 1.1 to 1.2) were independently related to respiratory mortality. Similarly, these factors were independently related to all-cause mortality with dyspnea having the strongest association (OR 1.54, 95% CI 1.1 to 2.2). HRQoL was an independent predictor of respiratory and all-cause mortality only when dyspnea was excluded from the models, except scores on the SGRQ were associated with all-cause mortality with dyspnea in the model. CONCLUSIONS Among patients with stable COPD, FEV 1% was the main predictor of respiratory mortality and dyspnea of all-cause mortality. In general, HRQoL was not related to mortality when dyspnea was taken into account, and CRQ and SGRQ behaved in similar ways regarding mortality.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-008-0783-x