Predictors of Mortality in Patients with Stable COPD
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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.
Five-year prospective cohort study.
Five outpatient clinics of a teaching hospital.
Six hundred stable COPD patients recruited consecutively.
The variables were age, FEV1%, 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.
FEV1%(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.
Among patients with stable COPD, FEV1% 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.
- Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Summary. Am J Respir Crit Care Med. 2001;163:1256–76.
- American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995;152(suppl):S77–120.
- Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1986;133:14–20.
- Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. A 15 year follow up study. Am Rev Respir Dis. 1979;119:895–902.
- Nishimura K, Takateru I, Tsukino M, et al. Dyspnea is a better predictor of 5 year survival than airway obstruction in patients with COPD. Chest. 2002;121:1434–40. CrossRef
- Landbo C, Presscott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160:1856–61.
- Soler-Cataluña JJ, Martinez-Garcia MA, Román Sánchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925–31. CrossRef
- Oga T, Nishimura K, Tsukino M, et al. Analysis of the factors related to mortality in chronic obstructive pulmonary disease. Role of exercise capacity and health status. Am J Respir Crit Care Med. 2003;167:544–9. CrossRef
- Cote CG, Celli BR. Predictors of mortality in chronic obstructive pulmonary disease. Clin Chest Med. 2007;28:515–24. CrossRef
- Celli BC, Cote CG, Marín JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. NEJM. 2004;350:1005–12. CrossRef
- Domingo-Salvany A, Lamarca R, Ferrer M, et al. Health related quality of life and mortality in male patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166:680–5. CrossRef
- Oga T, Nishimura K, Tsukino M, et al. Health status measured with the CRQ does not predict mortality in COPD. Eur Respir J. 2002;20:1147–51. CrossRef
- Fletcher CM, Elmes PC, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. BMJ. 1959;2:257–66. CrossRef
- Medical Section of the American Lung Association. Standardization of spirometry: 1994 update. Am Rev Respir Dis. 1994;152:1107–36.
- Sanchis J. Normativa para la espirometría forzada: Grupo de trabajo de la SEPAR para la práctica de la espirometría clínica. Arch Bronconeumol. 1989;25:132–42.
- Quanjer PH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows. Report working party standardization of lung function test, European Community for Steel and Coal. Official statement of the European Respiratory Society. Eur Respir J. 1993;16:5–40.
- Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Summary. Am J Respir Crit Care Med. 2001;163:1256–76. (Updated 2006). Available at URL: www.goldcopd.com.
- Ware JE, Snow KK, Kosinsky M, et al. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute; 1993.
- Alonso J, Prieto L, Ferrer M, et al. Testing the measurement properties of the Spanish version of the SF-36 health survey among male patients with chronic obstructive pulmonary disease. J Clin Epidemiol. 1998;51:1087–94. CrossRef
- Jones PW, Quirk FH, Baveystock CM. The St George’s respiratory questionnaire. Respir Med. 1991;85(Suppl B):25–31. CrossRef
- Ferrer M, Alonso J, Prieto L, et al. Validity and reliability of the St George’s Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. Eur Respir J. 1996;9:1160–6. CrossRef
- Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42:773–8.
- Güell R, Casan P, Sangenís M, et al. Quality of life in patient with chronic respiratory disease: the Spanish version of the chronic respiratory questionnaire (CRQ). Eur Respir J. 1998;11:55–60. CrossRef
- Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest. 2002;121:1441–8. CrossRef
- Anthonisen NR, Connett JE, Enright PL, et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333–9. CrossRef
- Connors AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Respir Crit Care Med. 1996;154:959–7.
- Hersh CP, DeMeo DL, Al-Ansari E, et al. Predictors of survival in severe, early onset COPD. Chest. 2004;126:1443–51. CrossRef
- Goel A, Pinckney RG, Littenberg B. APACHE II predicts long-term survival in COPD patients admitted to a general medical ward. J Gen Intern Med. 2003;18:824–30. CrossRef
- Mahler DA, Mejia-Alfaro R, Ward J, et al. Continuous measurement of breathlessness during exercise: validity, reliability, and responsiveness. J Appl Physiol. 2001;90:2188–96.
- Fletcher C. Standardised questionnaire on respiratory symptoms: a statement prepared and approved by MRC committee on the aetiology of chronic bronchitis (MRC breathlessness score). BMJ. 1960;2:1665.
- Hajiro T, Nishimura K, Tsukino M, et al. A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD. Chest. 1999;116:1632–37. CrossRef
- Hajiro T, Nishimura K, Tsukino M, et al. Comparison of discriminative properties among disease specific questionnaires for measuring health related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:785–90.
- Hajiro T, Nishimura K, Tsukino M, et al. Stages of disease severity and factors that affect the health status of patients with chronic obstructive pulmonary disease. Respir Med. 2000;94:841–46. CrossRef
- Predictors of Mortality in Patients with Stable COPD
Journal of General Internal Medicine
Volume 23, Issue 11 , pp 1829-1834
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- chronic obstructive pulmonary disease
- health-related quality of life
- Industry Sectors
- Author Affiliations
- 1. Pneumology Department, Galdakao, Bizkaia, Spain
- 3. Servicio de Neumología, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, Spain
- 2. Research Unit, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Bizkaia, Spain