One-year Mortality in COPD After an Exacerbation: The Effect of Physical Activity Changes During the Event

ABSTRACT

Mortality is one of the most important outcomes in patients with chronic obstructive pulmonary disease (COPD). Different predictors have been associated with mortality, including the patient's level of physical activity (PA). The objective of this work was to establish the relationship between changes in PA during a moderate-to-severe COPD exacerbation (eCOPD) and 1-year mortality after the index event. This was a prospective observational cohort study with recruitment of 2,484 patients with an eCOPD attending the emergency department (ED) of 16 participating hospitals. Variables recorded included clinical and sociodemographic data from medical records, dyspnea, health-related quality of life, and PA before the index eCOPD and 2 months after the hospital or ED discharge, as reported by the patient. In the multivariate analysis worsening changes in PA from baseline to 2 months after the ED index visit [odds ratio (ORs) from 2.78 to 6.31] was related to 1-year mortality, using the age-adjusted Charlson comorbidity index (OR: 1.22), and previous use of long-term domiciliary oxygen therapy or non-invasive mechanical ventilation at home (OR: 1.68). The same variables were also predictive in the validation sample. Areas under the receiver operating characteristic curve in the derivation and validation sample were 0.79 and 0.78, respectively. In conclusion, PA is the strongest predictor of dying in the following year, i.e., those with worsened PA from baseline to 2 months after an eCOPD or with very low PA levels have a higher risk.

KEYWORDS:

• Chronic obstructive
• cohort studies
• mortality
• physical activity
• pulmonary disease

Acknowledgment

The authors are grateful for the support of the 16 participating hospitals, as well as the ED physicians, other clinicians, and staff members of the various clinical, research, quality, and medical records units of these hospitals. They also gratefully acknowledge the patients who participated in the study.

Declaration of interest statement

We disclose any financial, consulting, and personal relationships with other people or organizations that could influence (bias) the author's work.

Funding

This work was supported in part by grants from the Fondo de Investigación Sanitaria (PI 06/1010, PI06/1017, PI06/714, PI06/0326, PI06/0664); Department of Health of the Basque Government (2012111008), Department of Education, Language Policy and Culture of the Basque Government (IT620-13); and the thematic networks - REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas) - of the Instituto de Salud Carlos III.

The IRYSS-COPD group included the following co-investigators: Dr. Jesús Martínez-Tapias (Hospital Virgen de las Nieves, Granada); Alba Ruiz (Hospital de Motril, Granada); Dr. Eduardo Briones (Unidad de Epidemiología. Distrito Sanitario Sevilla); Dr. Silvia Vidal (Unidad de Investigación, Hospital Costa del Sol, Marbella); Dr. Emilio Perea-Milla, Francisco Rivas (Servicio de Epidemiología, Hospital Costa del Sol, Málaga – REDISSEC); Dr. Maximino Redondo (Servicio de Laboratorio, Hospital Costa del Sol, Málaga-REDISSEC); Javier Rodríguez Ruiz (Responsable de Enfermería del Área de Urgencias, Hospital Costa del Sol, Málaga); Dra. Marisa Baré (Epidemiología y Evaluación, Corporació Sanitaria Parc Taulí-CSPT, Sabadell REDISSEC), Dr. Manel Lujan, Dra. Concepción Montón (Servicio de Neumología, CSPT/REDISSEC); Dra. Amalia Moreno, Dra. Josune Ormaza, Dr. Javier Pomares (Servicio de Neumología, CSPT); Dr. Juli Font (Medicina, Servicio de Urgencias; CSPT), Dra. Cristina Estirado, Dr. Joaquín Gea (Servicio de Neumología, Hospital del Mar, Barcelona); Dra. Elena Andradas (subdirectora de Promoción de la Salud y Epidemiología del Ministerio de Sanidad, Servicios Sociales e Igualdad); Dr. Juan Antonio Blasco (Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid); Dra. Nerea Fernández de Larrea (Subdirección General de Tecnología e Innovación Sanitarias. Consejería de Sanidad de la Comunidad de Madrid/REDISSEC); María del Puerto Cano Aguirre (Hospital de Torrejón, Madrid); Dra. Esther Pulido (Servicio de Urgencias, Hospital Galdakao-Usansolo, Bizkaia); Dr. Jose Luis Lobo (Servicio de Neumología, Hospital Txagorritxu, Araba); Dr. Mikel Sánchez (Servicio de Urgencias, Hospital Galdakao-Usansolo); Dr. Luis Alberto Ruiz (Servicio de Respiratorio, Hospital de Cruces, Bizkaia); Dra. Ane Miren Gastaminza (Hospital San Eloy, Bizkaia); Dr. Ramon Agüero (Servicio de Neumología, Hospital Marques de Valdecilla, Santander); Dr. Eva Tabernero and Carmen M. Haro (Hospital de Santa Marina); Dr. Gabriel Gutiérrez (Servicio de Urgencias, Hospital Cruces, Bizkaia); Dra. Belén Elizalde (Dirección Territorial de Gipuzkoa); Dr. Felipe Aizpuru (Unidad de Investigación, Hospital Txagorritxu, Álava/REDISSEC); Dra. Inmaculada Arostegui, Irantzu Barrio (Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV/EHU-REDISSEC; Amaia Bilbao (Hospital Universitario Basurto/REDISSEC); Dr. Cristóbal Esteban (Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia/REDISSEC); Dra. Nerea González, Susana Garcia, Iratxe Lafuente, Urko Aguirre; and Miren Orive, Edurne Arteta, and Dr. Jose M. Quintana (Unidad de Investigación, Hospital Galdakao-Usansolo, Bizkaia/REDISSEC).