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VOLUME 7 , ISSUE 2 ( July-December, 2018 ) > List of Articles

Original Article

Predictors of Mortality in Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Hemant Kumar, Satyadeo Choubey

Keywords : Acute exacerbation of chronic obstructive pulmonary disease, chronic obstructive pulmonary disease, predictors of mortality

Citation Information : Kumar H, Choubey S. Predictors of Mortality in Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study. Indian J Respir Care 2018; 7 (2):77-82.

DOI: 10.4103/ijrc.ijrc_21_17

License: CC BY-NC-SA 4.0

Published Online: 02-12-2022

Copyright Statement:  Copyright © 2018; Indian Journal of Respiratory Care.


Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in increased morbidity, mortality and tremendous socioeconomic burden. Predicting inhospital mortality may aid prognostication, planning for the site of care, i.e., ward versus intensive care units, and better individualization of treatment. Aim of Study: This study aims in predicting inhospital mortality in patients of AECOPD based on the parameters measured at the time of admission. Methods: Known COPD patients in acute exacerbations admitted in a tertiary care hospital were interrogated for clinical history and examination. All relevant laboratory tests including arterial blood gas analysis, complete blood count, liver and renal function tests, and random blood sugar were done. Based on outcome, patients were grouped into survivors and nonsurvivors. Parameters recorded were then subjected for univariate analysis to get their statistical significance. All significant variables on univariate analysis were then analyzed further with multivariate analysis. Results: Out of the total 140 patients included in the study, 24 (17%) died during their hospital stay. Of the various acute-phase parameters recorded at the time of the admission, only five qualified to be predictors of inhospital mortality based on univariate and multivariate analyses. These were partial pressure of carbon dioxide in arterial blood (PaCO2) (odds ratio [OR], 95% confidence interval [CI] =1.067, 0.993–1.146), pH (OR, 95% CI = 0.001, 0.001–0.584), serum glutamic pyruvate transaminase (SGPT) (OR, 95% CI = 1.032, 1.006–1.059), sodium (OR, 95% CI = 0.779, 0.689–0.881), and random blood sugar (OR, 95% CI = 1.018, 1.007–1.029). With these five factors combined, area under receiver operating characteristic (ROC) curve was 0.9684, sensitivity 79.18%, specificity 96.55%, positive predictive value 82.61%, negative predictive value 95.73%, and correctly classify acute exacerbation in 93.57%. Good survival can be expected if these parameters are within normal limits. Conclusion: pH, PaCO2, SGPT, serum sodium, and random blood sugar at the time of admission are independent predictors of mortality in patients of AECOPD. These can be helpful in developing a prediction tool of inhospital mortality in such patients.

  1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease;
  2. Available from: [Last accessed on 2018 Feb 19].
  3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
  4. Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J 2004;23:698-702.
  5. Kanner RE, Anthonisen NR, Connett JE; Lung Health Study Research Group. Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: Results from the lung health study. Am J Respir Crit Care Med 2001;164:358-64.
  6. Wouters EF. The burden of COPD in the Netherlands: Results from the confronting COPD survey. Respir Med 2003;97 Suppl C: S51-9.
  7. Connors AF Jr., Dawson NV, Thomas C, Harrell FE Jr., Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to understand prognoses and preferences for outcomes and risks of treatments) Am J Respir Crit Care Med 1996;154:959-67.
  8. Steer J, Norman EM, Afolabi OA, Gibson GJ, Bourke SC. Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD. Thorax 2012;67:117-21.
  9. Sangwan V, Chaudhry D, Malik R. Dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score and BAP-65 score, tools for prediction of mortality in acute exacerbations of chronic obstructive pulmonary disease: A comparative pilot study. Indian J Crit Care Med 2017;21:671-7.
  10. Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 2003;124:459-67.
  11. Hansen EF, Phanareth K, Laursen LC, Kok-Jensen A, Dirksen A. Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:1267-71.
  12. Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:961-6.
  13. Khilnani GC, Banga A, Sharma SK. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an Intensive Care Unit: A one year study. BMC Pulm Med 2004;4:12.
  14. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to Intensive Care Units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995;274:1852-7.
  15. Bhatt SP, Mohan A, Mohan C, Mohan C, Arora S, Guleria R. Predictors of in- hospital mortality and morbidity in patients with acute exacerbation of chronic obstructive pulmonary disease. Chest 2006;130:97-8.
  16. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-9.
  17. Yeh HC, Punjabi NM, Wang NY, Pankow JS, Duncan BB, Cox CE, et al. Cross-sectional and prospective study of lung function in adults with type 2 diabetes: The atherosclerosis risk in communities (ARIC) study. Diabetes Care 2008;31:741-6.
  18. Ittyachen AM, Krishnamoorthy S, Bhatt AN, Abdulla S, Roy JO, Sugathan M, et al. Predictors of outcome in patients admitted with acute exacerbation of chronic obstructive pulmonary disease in a rural Tertiary Care Center. J Family Med Prim Care 2016;5:411-5.
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