What affects mortality ın patients with chronic obstructive pulmonary disease

COPD is a disorder characterised by progressive obstruction of airway which is not totally reversible. The inflammation that occurs during disease course is not only restricted to pulmonary system but also emerges with systemic manifestations. COPD is highly mortal disease and a cure has not been developed yet.In this study we aimed to define the factors effecting mortality rate of COPD patients. Patients who are diagnosed with COPD and having treatment in GUTF Pulmonology Clinic as inpatients between January 2000 and May 2011 have been taken into the study. The following parameters have been assesed; mortality reasons, demographic features, co-morbidities, Charlson co-morbidity score, treatment in remission and treatment strategies of co-morbidities, long term oxygen treatment (LTOT), usage of non-invasive mechanic ventilator at home (NIV), exacerbation datas, age, dyspnea, airway obstruction (ADO) and dyspnea, airway obstruction, smoking, exacerbation index (DOSE) and factors effective on mortality and life time.A total of 753 patients have been taken into study but total data of 324 of the patients have been obtained. Of the study cohort 168 of the patients have been reached via telephone and it was learned that 96 (%57,1) of them were alive and 72 (%42,9) of them were dead. The causes of the deaths were as follows, %47,2 COPD, %33,3 lung cancer, %5,6 congestive hart failure, %5,6 miocard infarction and %2,8 other malignancies.Male prevelance was %85.7 and the mean age was defined as 69.2 ± 9.2 years. A positive history of smoking was seen in 149 (%88.7) of the patients and mean package per year was 54.3±39.2. Mean body mass index (BMI) was 25.7±6.3 kg/m2. There were no difference between the demographic features of alive and exitus patients.While the most frequent co-morbidities of the patients alive were, hypertension (%53.8), atherosclerotic heart disease (%30.2); of whom excitus patients were hypertension (%50) and lung cancer (%41.7). Lung cancer prevelance was higher in excitus group (p<0.001). The number of the patients with 7 or more Charlson co-morbidity score was `0? in living patients and 18 (%25) in excitus group (p<0.001).The compliance of treatment during wellbeing was worse in excitus group (%59,7 vs %33,3 p<0,001). The distribution of drugs for co-morbidity was similar in both groups and extensity of NIV and LTOT usage was also similar.The frequency of exacerbetion during last year, length of hospitalization, type of excacerbetion according to Anthonisen criteria were simillar in both groups. PO2 levels which were performed in the period of the exacerbation of the excitus patients were lower than living group(62,1±11,5 mmHg vs 57,2±16,6 mmHg p=0,03). CRP levels were higher in excitus group (35,0 mg/L vs 14,7 mg/L p=0,002). ADO index (?7) was detected higher in excitus group ( %68,2 vs %47,1 p=0,02 ) but there was not any difference when DOSE index was considered.Existance of lung cancer, Charlson co-morbidity score, CRP and ADO index?7 was found, 6.9, 2.1, 2, 2.4 times mortal respectively when evaluated by using univariate analysis.Existance of lung cancer, ADO index?7 and hypoxia (PaO2 <60 mmHg) was found, 16.1, 3.2, 3.4 times mortal respectively when evaluated by using multivariate analysis. Existance of lung cancer, high Charlson co-morbidity score, inappropirate usage of inhaler treatment and hipoxemia have been found, 3.1, 3.3 and 2 times effective on survey respectively.This study was performed on a cohort of COPD patients with severe and very severe disease course and it was detected that lung cancer, high score of ADO and Charlson co-morbidity, hypoxemia and inappropirate drug usage were associated with mortality. ADO index and Charlson co-morbidity score can be used in defining the prognosis