Mortality after an Emergency Department Visit for Exacerbation of Chronic Obstructive Pulmonary Disease

Figures & data

Figure 1. Estimated survival function of 482 emergency department patients with COPD exacerbation

Table 1. Baseline characteristics of 482 emergency department patients with COPD exacerbation

Age (years), mean ± SD	72 ± 9
Female (%)	56
Race/ethnicity (%)
White	94
Black	3
Hispanic	2
Asian	1
Other	< 1
Married (%)	38
Median household income, U.S. dollars, median (IQR)	47,119 (39,670–55,291)
Body mass index, kg/m^2, mean ± SD	27.7 ± 7.8
Co-morbid conditions (%) Myocardial infarction	23
Congestive heart disease	40
Peripheral vascular disease	15
Dementia	2
Chronic pulmonary disease	100
Rheumatologic disease	3
Peptic ulcer disease	5
Mild liver disease	2
Diabetes (mild to moderate)	23
Diabetes with chronic complication	4
Hemiplegia or paraplegia	< 1
Renal disease	6
Any malignancy, including lymphoma and leukemia	18
Moderate or severe liver disease	< 1
Metastatic solid tumor	5
Acquired Immune Deficiency Syndrome	0
Charlson index, median (IQR)	2 ([1], [2], [3], [4])
COPD-related ED visit or hospitalization during past year (%)	23
Hospitalization at the index visit (%)	62

SD denotes standard deviation; IQR, interquartile range; COPD, chronic obstructive pulmonary disease; GOLD, Global initiative for chronic obstructive lung disease.

*Baseline body mass index available for 103 patients with measured height and weight within 2 years before their index visit.

Table 2. Unadjusted risk factors for mortality in 482 emergency department patients with COPD exacerbation

	Hazard Ratio	95% CI
Age (per 5-year increase)	1.3	1.2–1.4
Female	1.0	0.8–1.4
Race/ethnicity
White	1.0	Reference
Black	0.6	0.2–1.6
Hispanic	0.3	0.1–1.4
Asian	0.3	0.04–1.9
Other	1.8	0.2–12.6
Marital status
Married	1.0	Reference
Single, divorced, widowed, separated	1.4	1.04–1.84
Median household income
< $44,999	1.0	Reference
$45,000–$54,999	0.9	0.7–1.3
$55,000 +	1.1	0.8–1.5
Body mass index (kg/m^2)
< 25.0	2.1	1.2–3.6
25.0–29.9	1.0	Reference
30.0 +	1.4	0.8–2.6
Co-morbid conditions
Myocardial infarction	1.2	0.9- 1.7
Congestive heart disease	1.8	1.4–2.4
Peripheral vascular disease	1.2	0.8–1.7
Dementia	1.9	0.9–4.3
Chronic pulmonary disease	N/A	N/A
Rheumatologic disease	0.4	0.1–1.3
Peptic ulcer disease	1.0	0.6–1.9
Mild liver disease	1.4	0.6–3.5
Diabetes (mild-to-moderate)	0.9	0.7–1.3
Diabetes with chronic complication	1.3	0.7–2.4
Hemiplegia or paraplegia	0.7	0.1–5.1
Renal disease	2.0	1.3–3.2
Any malignancy, including lymphoma and leukemia	1.5	1.1–2.0
Moderate or severe liver disease	1.2	0.2–8.4
Metastatic solid tumor	2.4	1.5–4.0
Charlson index	1.11	1.05–1.16
Hospital utilization for COPD exacerbation during past year
None	1.0	Reference
1+	2.0	1.5–2.6
Hospitalization at the index visit	1.33	1.00–1.77

CI denotes confidence interval; and COPD, chronic obstructive pulmonary disease.

Table 3. Pulmonary function test results and univariate analysis of mortality by pulmonary function

	Percentage	HR	95% CI
COPD stage per GOLD
0	27	1.0	Reference
1	1	0.9	0.5–1.8
2	15
3	30	1.3	0.8–2.0
4	27
Airway reversibility	12	0.6	0.3–1.3

HR denotes hazard ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease; and GOLD, Global initiative for chronic obstructive lung disease.

*COPD stage available for 117 patients in whom spirometry data were available within 2 years before their index visit. COPD stages 1 and 2 and stages 3 and 4 were each combined for the purposes of assessing the association with COPD stage and mortality.

^†Reversibility available for 102 patients in whom spirometry data were available within 2 years before their index visit.

Table 4. Multivariate models of overall and early mortality in 482 emergency department patients with COPD exacerbation

	Overall Mortality		Early Mortality &%
	HR	95% CI	OR	95% CI
Age (per 5-year increase)	1.3	1.2–1.4	1.3	1.1–1.6
Female	0.9	0.7–1.2	—	—
Single, divorced, widowed, separated	1.2	0.9–1.6	—	—
Congestive heart failure	1.6	1.2–2.1	1.4	0.7–2.8
Metastatic solid tumor	3.3	2.0–5.5	7.0	2.6–19.1
Hospital utilization for COPD exacerbation during past year	1.9	1.4–2.6	2.2	1.1–4.6
Hospitalization at the index visit	1.2	0.9–1.6	1.2	0.6–2.4

COPD denotes chronic obstructive pulmonary disease; HR, hazard ratio; CI, confidence interval; OR, odds ratio.

*The Cox regression model the proportional hazards assumption is valid. Univariate results are shown in Table 2.

^†Early mortality denotes death within 60 days of the index visit. The logistic regression model gave a good fit to the data (Hosmer-Lemeshow test, p = 0.51). The area under the receiver operator curve was 0.73.

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