Original Article

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

Authors: Fernando de la Iglesia, MD, PHD, José Luis Díaz, MD, Salvador Pita, MD, PHD, Ricardo Nicolás, MD, PHD, Vicente Ramos, MD, Carlos Pellicer, MD, Fernando Diz-Lois, MD

Abstract

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.


Key Points


* Chronic obstructive pulmonary disease is a major cause of chronic morbidity and death throughout the world.


* Exacerbations of respiratory symptoms requiring medical intervention are important clinical events in chronic obstructive pulmonary disease, and the economic and social burden is extremely high.


* The risk of dying from an acute exacerbation of chronic obstructive pulmonary disease is closely related to the development of respiratory acidosis, the presence of significant comorbidities, and the need for ventilatory support.


* A peak expiratory flow below 150 L/min is a strong predictor of death in chronic obstructive pulmonary disease, and identifies patients at high risk that may need continuous monitoring and intensive treatment.

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