Adequacy and prognostic impact of treatment for severe exacerbation of chronic obstructive pulmonary disease.

Autor: Portolés-Callejón A; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España., López-Alfaro R; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna., Giménez-Miranda L; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna., López-Ríos MC; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna., Varela-Aguilar JM; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna; Grupo de Epidemiología Clínica y Riesgo Vascular, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España., Calderón E; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna; Grupo de Epidemiología Clínica y Riesgo Vascular, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España., Medrano FJ; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de EPOC de la Sociedad Española de Medicina Interna; Grupo de Epidemiología Clínica y Riesgo Vascular, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España. Electronic address: medrano@cica.es.
Jazyk: English; Spanish; Castilian
Zdroj: Revista clinica espanola [Rev Clin Esp (Barc)] 2020 Oct; Vol. 220 (7), pp. 417-425. Date of Electronic Publication: 2019 Dec 24.
DOI: 10.1016/j.rce.2019.11.003
Abstrakt: Objective: To define the clinical characteristics of patients hospitalised in pneumology and internal medicine departments for chronic obstructive pulmonary disease (COPD) exacerbation, to assess the compliance with the recommendations of the clinical practice guidelines and to determine the impact on the patients' prognosis.
Methodology: We conducted a retrospective longitudinal study that randomly included patients hospitalised for COPD exacerbation in a tertiary hospital. We collected demographic and clinical variables (degree of dyspnoea and obstruction, previous exacerbations, comorbidities), readmission and mortality data and criteria for compliance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and the Spanish COPD guidelines (GesEPOC). We performed a univariate, multivariate and survival analysis.
Results: The study included 108 patients, and the mean age was 71.48±11.65 years. The readmission rate was 26.4% at 3 months and 43.4% at 1 year. The hospital mortality rate was 3.9%, the mortality rate at 3 months was 21.9%, and the mortality rate at 1 year was 27.4%. The patients hospitalised in the internal medicine department had higher mortality during hospitalisation (p=.043), at 3 months (p=.028) and at 1 year (p=.007) compared with the rates for the pneumology department. Overall compliance with the clinical guidelines was 63% for the clinical evaluation (less for the patients in internal medicine: 56.1% vs. 73.8%, p=.063). For the treatment, the compliance was 26.9% for GOLD and 28.7% for GesEPOC. Compliance with the GOLD guidelines in the use of corticosteroids was associated with a lower rate of long-term readmissions (p=.041) and hospital mortality (p=.007) and 3-month mortality (p=.05).
Conclusions: The clinical profile of the patients is currently similar to that previously reported, but their clinical progression was poorer. Overall compliance with the clinical guidelines for drug treatment was low, and only appropriate use of systemic steroids was associated with a reduction in early mortality and in medium-term readmissions.
(Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
Databáze: MEDLINE
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