Two-Year Mortality Following a Severe COPD Exacerbation in Bulgarian Patients

Abstract

Abstract Two-year mortality in patients with COPD is expected to be between 10% and 49% depending on the investigated subgroup and specific patients’ characteristics. Aim: To assess the two-year mortality in COPD patients following hospitalization for severe exacerbation and to describe the prognostic value of comorbidities and specific patients’ characteristics. Materials and methods: We included 152 consecutive patients hospitalized for COPD exacerbation and signing informed consent. The Metabolic syndrome (MS), diabetes mellitus (DM), and hypovitaminosis D were diagnosed according to international guidelines. Demographic parameters (age, sex, smoking status, and the number of pack-years) were recorded. Quality of life was examined using CAT and mMRC questionnaires. The lung function was assessed by spirometry. Two-year mortality was determined according to data extracted from the national death register. Results: Two-year mortality rate was 11.8%. The investigated comorbidities – DM, MS, arterial hyper-tension (AH) and vitamin D status were no predictors of the two-year mortality. Mortality was increased in patients with mMRC ≥ 2 (17.2 vs. 1.9%, p = 0.005) and CAT score ≥ 10 (14.2 vs. 0%, p = 0.045). Severe exacerbation during the previous year was a risk factor for the registered two-year mortality (17.5% vs 5.6%, p = 0.021). The two-year mortality was increased in the group with FEV1 < 50%, compared to FEV1 > 50% (18.0 vs. 7.7%, p = 0.049). Cox regression analysis showed a 3.0% increase in the mortality rate for each 1% decrease in FEV1, 6.2% for each 1% decrease in PEF, 7.8% for one year of increasing age, 4% for 1% decrease in the FEV1/FVC ratio and 7.1% for each 1 point increase of CAT (all p-values < 0.05). Conclusions: The two-year mortality of COPD patients following a severe exacerbation was relatively low. Chronological age, FEV1, history for severe exacerbation during the previous year, reduced quality of life, and low BMI were all associated with increased mortality. Disease Grade C, mMRC < 2, and CAT score < 10 were associated with a favourable prognosis.