Factors associated with risk of death in hospitalized patients for exacerbation of chronic obstructive pulmonary disease: an updated scoping review

ABSTRACT

Introduction

The Exacerbation of Chronic Obstructive Pulmonary Disease (ECOPD), especially if leading to hospitalization, increases the risk of death. Our scoping review aims to identify updated mortality risk factors in both short- and long-term periods.

Areas covered

A comprehensive search, covering the period from January 2013 to February 2024, was performed to identify eligible studies that consider factors associated with death in hospitalized ECOPD. We considered short-term mortality, up to one year (including in-hospital mortality, IHM) and long-term mortality over one year, without time limits. We excluded studies concerning the intensive care area.

Expert opinion

We considered 38 studies, 32 and 8 reporting data about short- and long-term mortality, respectively. Two studies consider both periods. Several factors, some already known, others newly identified, have been evaluated and discussed. Some of these were related to the characteristics and severity of COPD (age, body mass index, lung impairment), and some considered the response to ECOPD. In this last context, we focused on the increasing role of biomarkers in predicting the mortality of patients, particularly IHM. Our factors associated with a worse prognosis may be helpful in the clinical practice to identify patients at risk and, subsequently, determine a personalized approach.

KEYWORDS:

• Age
• Biomarkers
• Exacerbations of chronic obstructive pulmonary disease
• Hospitalization
• Mortality
• Personalized approach
• Predictors
• Prognosis
• Severity

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Article highlights

• Which factors are associated with a worse prognosis in hospitalized COPD patients?

• In our updated scoping review, we report several factors, some already known and others newly identified.

• Regarding known factors, we confirm the negative role of the patient’s age, its association with comorbidities (predominantly heart failure), and the severity of COPD. Body weight continues to be a protective factor.

• Concerning factors related to the response to ECOPD, we highlight the biological aspects related to biomarkers.

• The predicted role of biomarkers appears to be clinically extensively applicable and cost-effective.

Abbreviations

ECOPD indicates exacerbation of chronic obstructive pulmonary; ICU, intensive care unit.

Declarations of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.