Survival, quality of life and health resource use following hospitalisation for acute exacerbations of chronic obstructive pulmonary disease

Abstract

Background Hospital admissions with acute exacerbations of chronic obstructive pulmonary disease are common and associated with high mortality rates, frequent readmission and worse quality of life. An ability to identify patients at risk of subsequent poor outcome is lacking and the longitudinal change in quality of life following discharge is uncertain. Methods The study consisted of two parts: 1) Clinical data were collected on 920 consecutive patients hospitalised with exacerbations. The ability of a novel modification of the traditional MRC dyspnoea scale (the extended MRC dyspnoea scale, eMRCD) to identify patients at risk of poor outcome was assessed. Independent predictors of important clinical outcomes were recorded and clinical prediction tools derived. 2) A subgroup of 183 patients underwent longitudinal assessment of quality of life following hospital discharge and predictors of quality of life decline were identified. Results The study population was similar to that reported in UK national audits. 96 (10.4%) patients died in-hospital and 37.3% were readmitted to hospital, or died without being readmitted, within 90-days of discharge. The eMRCD was a better predictor of outcome than the traditional scale and, compared to all clinical variables, was the single strongest predictor of mortality and readmission Strong independent predictors of many important clinical outcomes were identified and, notably, the DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) predictive tool was derived and shown to be an excellent, and internally valid, mortality predictor (area under ROC curve = 0.858). Most patients who survived to discharge reported an improvement in respiratory symptoms and quality of life during follow-up. We defined a subgroup of patients who experienced poor post-discharge quality of life and identified robust, simple-to- measure predictors of poor quality of life. Conclusions Important patient outcomes can be accurately predicted in this population. Application of our results may reduce morbidity and mortality in this common and frequently fatal condition by improving clinical decision making regarding appropriate level of care, location of care and resource allocation.