COPD: most patients with severe disease were dead within 4 years

Clinical bottom line (level 1b)

  1. Most patients with severe COPD were dead within 4 years.
  2. Patients with the following features were at increased risk of dying
    • ECG signs of RVH or overload
    • chronic renal failure
    • ECG signs of ischaemic heart disease
    • increasing age
Incalzi et al: European Respiratory Journal 1997; 10: 2794-2800
Expires November 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Italy

288 patients (aged mean 67, 85% male) discharged following an acute exacerbation of COPD (defined as an increase in dyspnoea and a reduction of physical fitness severe enough to require hospitalisation). Mean FEV1 34% predicted, FEV1/FVC 41% predicted, mean pO2 8.5 kPa, mean pCO2 6.0 kPa

Excluded if
  • discharged to outside town
  • near-terminal illness (life-expectancy less than 1 month)
  • major psychiatric disorder or dementia
  • participating in other medical trials
  • insufficient clinical records to diagnose co-morbid diseases
  • admitted for non-COPD reasons



    • Factors studied:
  • co-morbid disease, spirometry, ECG, arterial blood gases
  • ECG signs of RVH or overload
  • chronic renal failure
  • ECG signs of ischaemic heart disease signs of myocardial infarction, ST-T elevation or depression of at least 1.5 mm, or a negative T-Wave with drug or extracardiac conditions likely to cause it
  • increasing age (per year)




    • Multivariate regression analysis performed to adjust for confounding factors.

    94% followed for mean 3.4 years
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death mean 3.4 years 228/270 84%
    (80% to 89%)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    ECG signs of RVH or overload 3.4 years 228/270
    (84.4%)     		1.76
    (1.30 to 2.38)     		16
    (12 to 32)
    chronic renal failure 3.4 years 228/270
    (84.4%)     		1.79
    (1.05 to 3.02)     		16
    (10 to 160)
    ECG signs of ischaemic heart disease 3.4 years 228/270
    (84.4%)     		1.42
    (1.02 to 1.96)     		25
    (14 to 390)
    increasing age (per year) 3.4 years 228/270
    (84.4%)     		1.04
    (1.02 to 1.05)     		200
    (160 to 390)

    Comments

    1. 63% died from COPD, 16% from cardiovascular disease, and 5% from lung cancer.

    Citation

    1. Incalzi RA, Fuso L, De Rosa M, et al: co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. European Respiratory Journal 1997; 10: 2794-2800
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient severe COPD
    Intervention or Exposure clinical features, ECG
    Outcome death