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Predicting outcomes following hospitalization for acute exacerbations of COPD

Lookup NU author(s): Dr John Steer, Emeritus Professor John Gibson, Professor Stephen Bourke

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Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of hospital admission and are associated with significant morbidity, mortality, high readmission rates and high resource utilization. More accurate prediction of survival and readmission in patients hospitalized with AECOPD should help to optimize clinical management and allocation of resources, including targeting of palliative care and strategies to reduce readmissions. We have reviewed the published retrospective and prospective studies in this field to identify the factors most likely to be of value in predicting in-hospital and post-discharge mortality, and readmission of patients hospitalized for AECOPD. The prognostic factors which appear most important vary with the particular outcome under consideration. In-hospital mortality is related most clearly to the patient's acute physiological state and to the development of acute comorbidity, while post-discharge mortality particularly reflects the severity of the underlying COPD, as well as specific comorbidities, especially cardiac disease. Important factors influencing the frequency of readmission include functional limitation and poor health-related quality of life. Large prospective studies which incorporate all the potentially relevant variables are required to refine prediction of the important outcomes of AECOPD and thus to inform clinical decision making, for example on escalation of care, facilitated discharge and provision of palliative care. © The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.


Publication metadata

Author(s): Steer J, Gibson G, Bourke S

Publication type: Review

Publication status: Published

Journal: QJM: An International Journal of Medicine

Year: 2010

Volume: 103

Issue: 11

Pages: 817-829

Print publication date: 26/07/2010

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

URL: http://dx.doi.org/10.1093/qjmed/hcq126

DOI: 10.1093/qjmed/hcq126


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