Chronic Obstructive Pulmonary Disease Exacerbations in an Internal Medicine Ward: Characterization and Outcome Predictors

Abstract

Introduction: In Portugal, chronic obstructive pulmonary disease (COPD) affects around 14.2% of those older than 40 years. Internal Medicine plays a role in the hospitalized CODP exacerbation patient care. Our objective was to characterize the COPD exacerbation patients admitted to an Internal Medicine ward focusing on adverse outcome predictors.
Methods: An observational retrospective study retrieved data from three consecutive years. A univariate and multivariate analysis was performed assuming the all-cause in-hospital death outcome.
Results: The sample comprised 280 cases. The mean age was 76.0 years and 53.6% were male. At admission, depressed mental status was evident in 21.8% and hypotension in 3.6%. Thirty six percent were acidemic and 64.3% were hypercapnic. A hemoglobin value below 10.0 g/dL was found in 4.6%, eosinopenia in 20.4%, and creatininemia above 2.0 mg/dL in 6.0%. Ten percent had atrial fibrillation. Twenty-nine patients died in the hospital (10.4%). We identified the following predictors: admission in the previous
90 days (OR 4.7; p = 0.006), atrial fibrillation (OR 5.0; p = 0.002), systolic blood pressure < 100 mm Hg (OR 3.7; p = 0.023), eosinopenia (OR 2.7; p = 0.034) and hemoglobin < 10 g/dL (OR 5.1; p = 0.026) and creatinine > 2.0 mg/dL (OR 3.8; p = 0.048). Absence of predictors at admission was linked to a low risk profile.
Conclusion: Compared to the overall COPD exacerbation patient, those admitted to an Internal Medicine tend to be older and to have higher degree of comorbidity. The identified predictors can be linked to the COPD exacerbation pathophysiology.