ABSTRACT
Prospective study has shown that severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospital management are independently associated with all-cause mortality and the patients at highest risk of dying are those presenting with more than three exacerbations, especially if these required inpatient care. Connors and colleagues (1) reported an in-hospital mortality rate of 11% in patients with acute hypercapnic respiratory failure, with subsequent mortality of 43% and 49% at one and two years, respectively. Seneff et al. (2) found an inpatient mortality of 24%, with this figure increasing to 59% at one year. In a more recent study (3) of patients receiving noninvasive ventilation (NIV) for an acute hypercapnic exacerbation, 73% survived the admission, but by one year after discharge, 80% had been readmitted, 63% had experienced another life-threatening event, and almost 50% had died. Survivors spent a median of 12% of the following year in hospital. A low body mass score predicted early readmission or death, and early death was more frequent in highly dyspneic patients [medical research council (MRC) score, p < 0.001]. Budweiser et al. (4) have also shown that nutritional status, base excess, and extent of hyperinflation (as index of physiological severity) are reliable predictors of mortality in keeping with the previously established bodymass, obstruction, dyspnea, and exercise capacity (BODE) index.
