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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)
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1996
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Acute Lung InjuryPulmonary CareAdvanced Lung DiseaseLung InflammationIndex Hospital StayAcute ExacerbationHospital MedicinePatient CharacteristicsAcute CareOutcomes ResearchPulmonary FibrosisPulmonary MedicinePulmonary DiseaseUnderstand PrognosesPatient SafetyPulmonary PhysiologyProspective CohortLung MechanicsSupport InvestigatorsMedicineEmergency Medicine
The study aimed to describe outcomes and determine how patient characteristics influence survival in 1,016 adults hospitalized for severe COPD exacerbation with hypercapnia. Patient demographics, acute physiology, and outcomes were prospectively collected and followed for six months. During hospitalization 11% died, and 49% died within two years; median cost was $7,100, median stay 9 days, 6‑month readmission rate 44%, only 26% were alive with good quality of life at 6 months, and survival correlated independently with illness severity, BMI, age, prior function, oxygenation, heart failure, albumin, and cor pulmonale.
In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective cohort of 1,016 adult patients from five hospitals who were admitted with an exacerbation of COPD and a PaCO2 of 50 mm Hg or more. Patient characteristics and acute physiology were determined. Outcomes were evaluated over a 6 mo period. Although only 11% of the patients died during the index hospital stay, the 60-d, 180-d, 1-yr, and 2-yr mortality was high (20%, 33%, 43%, and 49%, respectively). The median cost of the index hospital stay was $7,100 ($4,100 to $16,000; interquartile range). The median length of the index hospital stay was 9 d (5 to 15 d). After discharge, 446 patients were readmitted 754 times in the next 6 mo. At 6 mo, only 26% of the cohort were both alive and able to report a good, very good, or excellent quality of life. Survival time was independently related to severity of illness, body mass index (BMI), age, prior functional status, PaO2/FI(O2), congestive heart failure, serum albumin, and the presence of cor pulmonale. Patients and caregivers should be aware of the likelihood of poor outcomes following hospitalization for exacerbation of COPD associated with hypercarbia.