Anemia is a Mortality Predictor in Hospitalized Patients for COPD Exacerbation

Figures & data

Table 1.  Characteristics of 117 patients with AECOPD

	Values*	SD
Gender, n male/female	109/8
Age, yr	72	9.1
BMI	25.8	5.4
Hospital stay, d	5.8	5.6
Dispnea MRC	2.29	1
LTOT, n (%)	54 (46.5)
Smokers current, n (%)	23 (19.7)
pCO2 mmHg	48.8	11.8
FEV1%	37.4	12.1
FVC%	51.9	13.9
FEV1/FVC,%	52.4	9.8
COPD severity according to GOLD
GOLD I (n = 0)	0%
GOLD II (n = 12)	10%
GOLD III (n = 38)	32.7%
GOLD IV (n = 67)	57.3%
Charlson index	4.9	1.6
SGRQA	74.4	21.5
SGRQI	54.2	15.6
SGRQS	63.6	17.4
SGRQG	62.5	14.3
Admissions previous yr	1.9	2.2
Emergency previous yr	1.6	2.4
Bursts corticoids pr yr	2.5	2.8

*Values given as mean ± SD, unless otherwise indicated. n = Number

SGRQA: Activity Subscale of SGRQ, SGRQI: Impact subscale of SGRQS, Symptoms subscale of SGRQ, General subscale of SGRQ.

Table 2.  Data relative to nutrition, hemoglobin, hematocrit and inflammatory parameters of 117 patients with AECOPD

	Mean values	SD
Hemoglobin g/dl	13.5	1.7
Hematocrit%	40.3	5.1
PCR mg/dl	42.3	53.5
Lean Mass%	65.2	6.8
Fat Mass%	34.9	6.8
Muscle Mass%	38.2	6.9
FFMI	16.4	4.7
Albumin mg/dl	35.9	5.4
Prealbumin g/dl	21.6	8

Table 3.  General characteristics comparing survivors and non-survivors

	Exitus* (n = 26)	Survivors* (n = 91)	P
Age, yr	74.8 ± 6.5	71.8 ± 9.5	0.095
BMI	24.9 ± 4.5	26.1 ± 5.6	0.550
Hospital stay, d	7.4 ± 8.8	5.4 ± 4.3	0.848
Dispnea MRC	2.58 ± 1.1	2.19 ± 1.1	0.063
pCO2 mmHg	49.5 ± 10	48.7 ± 12	0.558
FEV1%	36.13 ± 10.6	37.71 ± 12.7	0.589
FVC%	52.87 ± 11.3	52.12 ± 14.7	0.256
FEV1/FVC%	49.7 ± 9.3	53.2 ± 9.9	0.119
Charlson index	5.33 ± 1.8	4.79 ± 1.6	0.226
SGRQA	82.03 ± 19.6	72.19 ± 21.7	0.054
SGRQI	49.31 ± 13.4	55.63 ± 16.1	0.063
SGRQS	68.61 ± 15.9	62.87 ± 17.9	0.454
SGRQG	63.44 ± 11.3	62.5 ± 15.2	0.587
Admissions previous yr	3.54 ± 2.99	1.45 ± 1.6	0.000
Emergency previous yr	2.64 ± 2.7	1.27 ± 2.3	0.001
Bursts corticoids pr yr	3.9 ± 3.4	2.19 ± 2.5	0.019

*Values given as mean ± SD, unless otherwise indicated.

SGRQA: Activity Subscale of SGRQ, SGRQI: Impact subscale of SGRQS, Symptoms subscale of SGRQ, General subscale of SGRQ.

Table 4.  Data relative to nutrition, inflammatory and anemia parameters, comparing survivors and non-survivors

	Exitus* (n = 26)	Survivors* (n = 91)	P
Hemoglobin g/dl	12.41 ± 1.3	13.83 ± 1.7	0.000
Hematocrit%	37.61 ± 3.8	41.19 ± 5.1	0.000
PCR mg/dl	36.4 ± 36.6	44.4 ± 58.3	0.877
Lean Mass%	66.32 ± 6.2	64.82 ± 7	0.416
Fat Mass%	33.67 ± 6.2	35.37 ± 7	0.354
Muscle Mass%	35.12 ± 6.6	39.12 ± 6.7	0.010
FFMI	15.24 ± 2.8	16.61 ± 5.1	0.234
Albumin mg/dl	33.3 ± 4.4	36.8 ± 5.5	0.003
Prealbumin g/dl	22.63 ± 10.8	21.34 ± 7.1	0.986

*Values given as mean ± SD, unless otherwise indicated.

Table 5.  Univariate Cox proportional hazards model for factors associated with mortality

		95% CI for RR
	RR	Lower	Superior	P
Anemia	4.4	1.96	9.9	0.000
Albumin < 36mg/dl	3.1	1.2	7.9	0.017
SGRQ Activity > 79.5	2.8	1	7.6	0.049
Admissions/year > 1	4.5	1.79	11.4	0.001
Dispnea MRC > 3	1.7	0.49	5.58	0.41
Muscle mass (% <37.6)	2.8	0.98	7.8	0.052

Figure 1.  Survival plot of anemia influence using the Kaplan-Meier test (log rank test: p < 0.000).

Figure 2.  Survival plot regarding influence of admissions in previous year using the Kaplan-Meier test (log rank test: p < 0.000).

Table 6.  Multivariate Cox proportional hazards model for factors associated with mortality

		95% CI for RR
	RR	Lower	Superior	P
Anemia	5.939	1.86	18.98	0.003
Admissions/year > 1	5.879	1.30	26.52	0.021

Table 7.  Causes of death

Causes of Mortality	Number (%)
Respiratory insufficiency	11 (42.3)
Fissured thoracic aortic aneurysm	2 (7.7)
Pneumonia	1 (3.8)
Invasive pulmonary aspergillosis	1 (3.8)
Heart failure	1 (3.8)
Acute myocardial Infarction	1 (3.8)
Lower intestinal bleeding	1 (3.8)
Sudden death	1 (3.8)
Lung carcinoma	1 (3.8)
Squamous cell carcinoma rectum	1 (3.8)
Gastric carcinoma	1 (3.8)
Incarcerated hernia	1 (3.8)
Unknown causes	3 (11.5)