Peak Expiratory Flow Rate as Predictor of Inpatient Death in Patients with Chronic Obstructive Pulmonary Disease

Objectives: Few studies analyze hospital deaths and related factors in patients with acute exacerbation of chronic obstructive pulmonary disease who require hospitalization. Methods: A cross-sectional study was done with 284 patients who had been admitted consecutively to the Short Stay Medical Unit at the Juan Canalejo Hospital in A Coruña. Results: Eleven patients (3.9%) died. The independent variables for predicting death were the peak expiratory flow (OR, 0.96; 95% CI, 0.94 to 0.98), long-term oxygen therapy (OR, 12.46; 95% CI, 2.1 to 72.4), and body mass index (OR, 0.73; 95% CI, 0.59 to 0.90). A peak expiratory flow < 150 L/min showed the best specificity and positive predictive value with maximum sensitivity for predicting death. The results of the arterial blood gasses and the functional tests did not predict hospital death. Conclusions: Peak expiratory flow was the most important predictive value for determining the risk of death in patients who required hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Additional studies are required to validate these findings.

[1]  D. Mannino,et al.  Chronic obstructive pulmonary disease surveillance--United States, 1971-2000. , 2002, Respiratory care.

[2]  P. Vermeire,et al.  The burden of chronic obstructive pulmonary disease. , 2002, Respiratory medicine.

[3]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. , 2001, Respiratory care.

[4]  A. Agustí,et al.  Guía clínica para el diagnóstico y el tratamiento de la enfermedad pulmonar obstructiva crónica , 2001 .

[5]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[6]  A. Dirksen,et al.  Peak flow as predictor of overall mortality in asthma and chronic obstructive pulmonary disease. , 2001, American journal of respiratory and critical care medicine.

[7]  H. Javitz,et al.  Direct medical cost of chronic obstructive pulmonary disease in the U.S.A. , 2000, Respiratory medicine.

[8]  R. Pistelli,et al.  Electrocardiographic signs of chronic cor pulmonale: A negative prognostic finding in chronic obstructive pulmonary disease. , 1999, Circulation.

[9]  E. Wouters,et al.  Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[10]  G. Murata,et al.  Precision and Accuracy of Self‐measured Peak Expiratory Flow Rates in Chronic Obstructive Pulmonary Disease , 1998, Southern medical journal.

[11]  G. Murata,et al.  A multivariate model for predicting respiratory status in patients with chronic obstructive pulmonary disease , 1998, Journal of General Internal Medicine.

[12]  J. Vestbo,et al.  Vital prognosis after hospitalization for COPD: a study of a random population sample. , 1998, Respiratory medicine.

[13]  J. Díez,et al.  Papel de la nutrición en la enfermedad pulmonar obstructiva crónica , 1998 .

[14]  P. Poole,et al.  Characteristics of patients admitted to hospital with chronic obstructive pulmonary disease. , 1997, The New Zealand medical journal.

[15]  D. Fleischmann,et al.  Pulmonary hypertension and cor pulmonale , 1997, Der Radiologe.

[16]  G. Moscato,et al.  Relationship between peak expiratory flow (PEF) and FEV1. , 1997, The European respiratory journal. Supplement.

[17]  K. Ashutosh,et al.  Clinical and personality profiles and survival in patients with COPD. , 1997, Chest.

[18]  P. Burge The relationship between peak expiratory flow and respiratory symptoms. , 1997, The European respiratory journal. Supplement.

[19]  L Goldman,et al.  Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) , 1996, American journal of respiratory and critical care medicine.

[20]  B. Dautzenberg,et al.  Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR Observatory. , 1996, Chest.

[21]  R. Cydulka,et al.  Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. , 1996, Annals of emergency medicine.

[22]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[23]  J C Yernault,et al.  Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. , 1995, The European respiratory journal.

[24]  A. Chaouat,et al.  Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. , 1995, Chest.

[25]  R. Pistelli,et al.  Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. , 1995, The American journal of medicine.

[26]  M. J. Burgueño,et al.  Las curvas ROC en la evaluación de las pruebas diagnósticas , 1995 .

[27]  G. Town,et al.  An audit of the assessment and management of patients admitted to Christchurch Hospital with chronic obstructive pulmonary disease. , 1994, The New Zealand medical journal.

[28]  H. M. Vandiviere Pulmonary Hypertension and Cor Pulmonale* , 1993, Southern medical journal.

[29]  A I Mushlin,et al.  The necessary length of hospital stay for chronic pulmonary disease. , 1991, JAMA.

[30]  M. Higgins Chronic airways disease in the United States. Trends and determinants. , 1989, Chest.

[31]  N. Anthonisen,et al.  Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. , 1989, The American review of respiratory disease.

[32]  C K Wells,et al.  Evaluation of clinical methods for rating dyspnea. , 1988, Chest.

[33]  P. Pratt,et al.  Role of conventional chest radiography in diagnosis and exclusion of emphysema. , 1987, The American journal of medicine.

[34]  Phillips Yy,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. , 1987, The American review of respiratory disease.

[35]  D. Navajas,et al.  Spirometric reference values from a Mediterranean population. , 1986, Bulletin europeen de physiopathologie respiratoire.

[36]  T. De,et al.  Parenteral nutrition before gastrointestinal surgery. , 1982 .

[37]  I. D'cruz,et al.  Cardiac failure and infarction ECG pattern in a chronic alcoholic. , 1980, Archives of internal medicine.

[38]  Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. , 1980, Annals of internal medicine.

[39]  H. Thompson,et al.  Prognosis in chronic obstructive pulmonary disease. , 1973, The American review of respiratory disease.