Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

Background and objective: There is a paucity of survival data regarding the prognosis of elderly patients following acute exacerbations of COPD (AECOPD). We undertook a study to examine long‐term mortality rates and to identify clinical and laboratory predictors of these outcomes. Methods: A retrospective cohort study was conducted of 786 consecutive elderly (>65 years) patients admitted to general medicine acute‐care wards for AECOPD. Factors determining short‐ and long‐term mortality were analysed. Results: The mean (±SD) age of the study population was 75.8 ± 7.3 years (range 65–100 years). The in‐hospital mortality rate for the entire cohort was 7.25%. The risk of mortality at 1, 3 and 5 years was 28%, 47% and 54%, respectively. In univariate analysis age (hazard ratio 1.52; 95% confidence interval: 1.23–1.91), FEV₁ (1.45; 1.73–2.35), active cancer (1.23; 1.64–2.32), current smoking (1.74; 1.35–2.11), ischaemic heart disease (1.58; 1.28–2.02), congestive heart failure (1.55; 1.23–2.26) and maintenance use of oral glucocorticosteroids (1.58; 1.11–2.79) were significantly associated with mortality. In multivariate analysis, only current smoking (1.89; 1.18–1.93), ischaemic heart disease (1.41; 1.07–1.68), PaCO₂ on admission (1.49; 1.03–1.60), hospital readmission (2.23; 1.40–2.18) and FEV₁ (1.41; 1.12–1.54) were independent predictors of mortality. Conclusions: This study provides new insights into the predictive factors associated with long‐term prognosis in elderly patients admitted for acute exacerbations of COPD, which differ from those previously identified for younger patients.