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)

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)

AF Connors Jr, NV Dawson, C Thomas, FE Harrell Jr, N Desbiens, WJ Fulkerson, P Kussin, P Bellamy, L Goldman and WA Knaus
Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA.

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.

This article has been cited by other articles:

E. M. Clini and N. Ambrosino
Nonpharmacological treatment and relief of symptoms in COPD
Eur. Respir. J., July 1, 2008; 32(1): 218 - 228.
[Abstract] [Full Text] [PDF]

M. E. Falagas, S. G. Avgeri, D. K. Matthaiou, G. Dimopoulos, and I. I. Siempos
Short- versus long-duration antimicrobial treatment for exacerbations of chronic bronchitis: a meta-analysis
J. Antimicrob. Chemother., May 8, 2008; (2008) dkn201v1.
[Abstract] [Full Text] [PDF]

N. Patel, M. DeCamp, and G. J. Criner
Lung Transplantation and Lung Volume Reduction Surgery versus Transplantation in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, May 1, 2008; 5(4): 447 - 453.
[Abstract] [Full Text] [PDF]

N. MacIntyre and Y. C. Huang
Acute Exacerbations and Respiratory Failure in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, May 1, 2008; 5(4): 530 - 535.
[Abstract] [Full Text] [PDF]

C. Gonzalez, E. Servera, and J. Marin
Importance of Noninvasively Measured Respiratory Muscle Overload Among the Causes of Hospital Readmission of COPD Patients
Chest, April 1, 2008; 133(4): 941 - 947.
[Abstract] [Full Text] [PDF]

M T Dransfield, S M Rowe, J E Johnson, W C Bailey, and L B Gerald
Use of {beta} blockers and the risk of death in hospitalised patients with acute exacerbations of COPD
Thorax, April 1, 2008; 63(4): 301 - 305.
[Abstract] [Full Text] [PDF]

B. S. Quon, W. Q. Gan, and D. D. Sin
Contemporary Management of Acute Exacerbations of COPD: A Systematic Review and Metaanalysis
Chest, March 1, 2008; 133(3): 756 - 766.
[Abstract] [Full Text] [PDF]

K. H. Groenewegen, D. S. Postma, W. C. J. Hop, P. L. M. L. Wielders, N. J. J. Schlosser, E. F. M. Wouters, and for the COSMIC Study Group
Increased Systemic Inflammation Is a Risk Factor for COPD Exacerbations
Chest, February 1, 2008; 133(2): 350 - 357.
[Abstract] [Full Text] [PDF]

K. Vijayasaratha and R. A. Stockley
Reported and Unreported Exacerbations of COPD: Analysis by Diary Cards
Chest, January 1, 2008; 133(1): 34 - 41.
[Abstract] [Full Text] [PDF]

R. McGhan, T. Radcliff, R. Fish, E. R. Sutherland, C. Welsh, and B. Make
Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD
Chest, December 1, 2007; 132(6): 1748 - 1755.
[Abstract] [Full Text] [PDF]

M. J Wildman, C. Sanderson, J. Groves, B. C Reeves, J. Ayres, D. Harrison, D. Young, and K. Rowan
Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study
BMJ, December 1, 2007; 335(7630): 1132 - 1132.
[Abstract] [Full Text] [PDF]

E. Fan and D. M Needham
Deciding who to admit to a critical care unit
BMJ, December 1, 2007; 335(7630): 1103 - 1104.
[Full Text] [PDF]

N. Ambrosino and R. Goldstein
Series on comprehensive management of end-stage COPD
Eur. Respir. J., November 1, 2007; 30(5): 828 - 830.
[Full Text] [PDF]

G. Viegi, F. Pistelli, D. L. Sherrill, S. Maio, S. Baldacci, and L. Carrozzi
Definition, epidemiology and natural history of COPD
Eur. Respir. J., November 1, 2007; 30(5): 993 - 1013.
[Abstract] [Full Text] [PDF]

J. Bourbeau, G. Ford, H. Zackon, N. Pinsky, J. Lee, and G. Ruberto
Impact on patients' health status following early identification of a COPD exacerbation
Eur. Respir. J., November 1, 2007; 30(5): 907 - 913.
[Abstract] [Full Text] [PDF]

M. Miravitlles
Review: Do we need new antibiotics for treating exacerbations of COPD?
Therapeutic Advances in Respiratory Disease, October 1, 2007; 1(1): 61 - 76.
[Abstract] [PDF]

A. Anzueto, S. Sethi, and F. J. Martinez
Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, October 1, 2007; 4(7): 554 - 564.
[Abstract] [Full Text] [PDF]

K. F. Rabe, S. Hurd, A. Anzueto, P. J. Barnes, S. A. Buist, P. Calverley, Y. Fukuchi, C. Jenkins, R. Rodriguez-Roisin, C. van Weel, et al.
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary
Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 532 - 555.
[Abstract] [Full Text] [PDF]

G. F. Joos
Are beta2-Agonists Safe in Patients with Acute Exacerbations of COPD?
Am. J. Respir. Crit. Care Med., August 15, 2007; 176(4): 322 - 323.
[Full Text] [PDF]

B. R. Celli and P. J. Barnes
Exacerbations of chronic obstructive pulmonary disease
Eur. Respir. J., June 1, 2007; 29(6): 1224 - 1238.
[Abstract] [Full Text] [PDF]

S. Budweiser, R. A. Jorres, T. Riedl, F. Heinemann, A. P. Hitzl, W. Windisch, and M. Pfeifer
Predictors of Survival in COPD Patients With Chronic Hypercapnic Respiratory Failure Receiving Noninvasive Home Ventilation
Chest, June 1, 2007; 131(6): 1650 - 1658.
[Abstract] [Full Text] [PDF]

I. I. Siempos, G. Dimopoulos, I. P. Korbila, K. Manta, and M. E. Falagas
Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis
Eur. Respir. J., June 1, 2007; 29(6): 1127 - 1137.
[Abstract] [Full Text] [PDF]

D. A Seamark, C. J Seamark, and D. M G Halpin
Palliative care in chronic obstructive pulmonary disease: a review for clinicians
J R Soc Med, May 1, 2007; 100(5): 225 - 233.
[Abstract] [Full Text] [PDF]

G. J. Criner
Optimal Treatment of Chronic Obstructive Pulmonary Disease: The Search for the Magic Combination of Inhaled Bronchodilators and Corticosteroids
Ann Intern Med, April 17, 2007; 146(8): 606 - 608.
[Full Text] [PDF]

R. A. Rabinovich, R. Bastos, E. Ardite, L. Llinas, M. Orozco-Levi, J. Gea, J. Vilaro, J. A. Barbera, R. Rodriguez-Roisin, J. C. Fernandez-Checa, et al.
Mitochondrial dysfunction in COPD patients with low body mass index
Eur. Respir. J., April 1, 2007; 29(4): 643 - 650.
[Abstract] [Full Text] [PDF]

D. Stolz, M. Christ-Crain, N. G. Morgenthaler, J. Leuppi, D. Miedinger, R. Bingisser, C. Muller, J. Struck, B. Muller, and M. Tamm
Copeptin, C-Reactive Protein, and Procalcitonin as Prognostic Biomarkers in Acute Exacerbation of COPD
Chest, April 1, 2007; 131(4): 1058 - 1067.
[Abstract] [Full Text] [PDF]

D. J. Casarett and T. E. Quill
"I'm Not Ready for Hospice": Strategies for Timely and Effective Hospice Discussions
Ann Intern Med, March 20, 2007; 146(6): 443 - 449.
[Abstract] [Full Text] [PDF]

C. G. Cote, L. J. Dordelly, and B. R. Celli
Impact of COPD Exacerbations on Patient-Centered Outcomes
Chest, March 1, 2007; 131(3): 696 - 704.
[Abstract] [Full Text] [PDF]

Y.-C. Wang, J.-M. Lin, C.-Y. Li, L.-T. Lee, Y.-L. Guo, and F.-C. Sung
Prevalence and Risks of Chronic Airway Obstruction: A Population Cohort Study in Taiwan
Chest, March 1, 2007; 131(3): 705 - 710.
[Abstract] [Full Text] [PDF]

British Thoracic Society Guideline Development Gro
Intermediate care--Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline
Thorax, March 1, 2007; 62(3): 200 - 210.
[Full Text] [PDF]

M. C Steiner
Sarcopaenia in chronic obstructive pulmonary disease
Thorax, February 1, 2007; 62(2): 101 - 103.
[Full Text] [PDF]

T.-P. Ng, M. Niti, W.-C. Tan, Z. Cao, K.-C. Ong, and P. Eng
Depressive Symptoms and Chronic Obstructive Pulmonary Disease: Effect on Mortality, Hospital Readmission, Symptom Burden, Functional Status, and Quality of Life
Arch Intern Med, January 8, 2007; 167(1): 60 - 67.
[Abstract] [Full Text] [PDF]

D. Stolz, M. Christ-Crain, R. Bingisser, J. Leuppi, D. Miedinger, C. Muller, P. Huber, B. Muller, and M. Tamm
Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy
Chest, January 1, 2007; 131(1): 9 - 19.
[Abstract] [Full Text] [PDF]

D. D. Sin, N. R. Anthonisen, J. B. Soriano, and A. G. Agusti
Mortality in COPD: role of comorbidities
Eur. Respir. J., December 1, 2006; 28(6): 1245 - 1257.
[Abstract] [Full Text] [PDF]

K. E Steinhauser, E. C Clipp, J. C Hays, M. Olsen, R. Arnold, N. A Christakis, J. H. Lindquist, and J. A Tulsky
Identifying, recruiting, and retaining seriously-ill patients and their caregivers in longitudinal research
Palliative Medicine, December 1, 2006; 20(8): 745 - 754.
[Abstract] [PDF]

A Juan, A Salazar, A Alvarez, J R Perez, L Garcia, and X Corbella
Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalisation.
Emerg. Med. J., November 1, 2006; 23(11): 833 - 837.
[Abstract] [Full Text] [PDF]

N. Takabatake, Y. Shibata, S. Abe, T. Wada, J.-i. Machiya, A. Igarashi, Y. Tokairin, G. Ji, H. Sato, M. Sata, et al.
A Single Nucleotide Polymorphism in the CCL1 Gene Predicts Acute Exacerbations in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., October 15, 2006; 174(8): 875 - 885.
[Abstract] [Full Text] [PDF]

J. Steinmetz, L. S. Rasmussen, and S. L. Nielsen
Long-term Prognosis for Patients With COPD Treated in the Prehospital Setting: Is It Influenced by Hospital Admission?
Chest, September 1, 2006; 130(3): 676 - 680.
[Abstract] [Full Text] [PDF]

D. M. G. Halpin and M. Miravitlles
Chronic Obstructive Pulmonary Disease: The Disease and Its Burden to Society
Proceedings of the ATS, September 1, 2006; 3(7): 619 - 623.
[Abstract] [Full Text] [PDF]

R. Kessler, E. Stahl, C. Vogelmeier, J. Haughney, E. Trudeau, C.-G. Lofdahl, and M. R. Partridge
Patient Understanding, Detection, and Experience of COPD Exacerbations: An Observational, Interview-Based Study.
Chest, July 1, 2006; 130(1): 133 - 142.
[Abstract] [Full Text] [PDF]

L. Nici, C. Donner, E. Wouters, R. Zuwallack, N. Ambrosino, J. Bourbeau, M. Carone, B. Celli, M. Engelen, B. Fahy, et al.
American thoracic society/european respiratory society statement on pulmonary rehabilitation.
Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1390 - 1413.
[Full Text] [PDF]

R Rodriguez-Roisin
COPD exacerbations {middle dot} 5: Management.
Thorax, June 1, 2006; 61(6): 535 - 544.
[Abstract] [Full Text] [PDF]

A M Yohannes, M J Connolly, J J Soler-Cataluna, M A Martinez-Garcia, and P Roman Sanchez
Effect of dichotomising age in multivariate model analysis.
Thorax, June 1, 2006; 61(6): 548 - 549.
[Full Text] [PDF]

A. Papi, F. Luppi, F. Franco, and L. M. Fabbri
Pathophysiology of Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, May 1, 2006; 3(3): 245 - 251.
[Abstract] [Full Text] [PDF]

J. Vestbo
Clinical Assessment, Staging, and Epidemiology of Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, May 1, 2006; 3(3): 252 - 256.
[Abstract] [Full Text] [PDF]

T. Eaton, W. Fergusson, J. Kolbe, C. A. Lewis, and T. West
Short-burst oxygen therapy for COPD patients: a 6-month randomised, controlled study.
Eur. Respir. J., April 1, 2006; 27(4): 697 - 704.
[Abstract] [Full Text] [PDF]

S. F. Vondracek and B. A. Hemstreet
Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease
Am. J. Health Syst. Pharm., April 1, 2006; 63(7): 645 - 652.
[Abstract] [Full Text] [PDF]

D E O'Donnell and C M Parker
COPD exacerbations {middle dot} 3: Pathophysiology.
Thorax, April 1, 2006; 61(4): 354 - 361.
[Abstract] [Full Text] [PDF]

E Sapey and R A Stockley
COPD exacerbations {middle dot} 2: Aetiology.
Thorax, March 1, 2006; 61(3): 250 - 258.
[Abstract] [Full Text] [PDF]

Y.-J. Chen and G. L. Narsavage
Factors related to chronic obstructive pulmonary disease readmission in Taiwan.
West J Nurs Res, February 1, 2006; 28(1): 105 - 124.
[Abstract] [PDF]

G C Donaldson and J A Wedzicha
COPD exacerbations {middle dot} 1: Epidemiology
Thorax, February 1, 2006; 61(2): 164 - 168.
[Abstract] [Full Text] [PDF]

K. R. Chapman, D. M. Mannino, J. B. Soriano, P. A. Vermeire, A. S. Buist, M. J. Thun, C. Connell, A. Jemal, T. A. Lee, M. Miravitlles, et al.
Epidemiology and costs of chronic obstructive pulmonary disease
Eur. Respir. J., January 1, 2006; 27(1): 188 - 207.
[Full Text] [PDF]

T. G. Quinnell, S. Pilsworth, J. M. Shneerson, and I. E. Smith
Prolonged Invasive Ventilation Following Acute Ventilatory Failure in COPD: Weaning Results, Survival, and the Role of Noninvasive Ventilation
Chest, January 1, 2006; 129(1): 133 - 139.
[Abstract] [Full Text] [PDF]

G. B. Toews
Impact of bacterial infections on airway diseases
Eur. Respir. Rev., December 1, 2005; 14(95): 62 - 68.
[Abstract] [Full Text] [PDF]

P. Mallia and S. L. Johnston
Mechanisms and Experimental Models of Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, November 1, 2005; 2(4): 361 - 366.
[Abstract] [Full Text] [PDF]

M. Beckerman, R. Magadle, M. Weiner, and P. Weiner
The Effects of 1 Year of Specific Inspiratory Muscle Training in Patients With COPD
Chest, November 1, 2005; 128(5): 3177 - 3182.
[Abstract] [Full Text] [PDF]

H. Elkington, P. White, J. Addington-Hall, R. Higgs, and P. Edmonds
The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life
Palliative Medicine, September 1, 2005; 19(6): 485 - 491.
[Abstract] [PDF]

M. Vitacca, L. Bianchi, L. Barbano, M. Ziliani, and N. Ambrosino
Effects of Acute on Chronic Respiratory Failure on Hypercapnia and 3-Month Survival
Chest, September 1, 2005; 128(3): 1209 - 1215.
[Abstract] [Full Text] [PDF]

R. Scala, M. Naldi, I. Archinucci, G. Coniglio, and S. Nava
Noninvasive Positive Pressure Ventilation in Patients With Acute Exacerbations of COPD and Varying Levels of Consciousness
Chest, September 1, 2005; 128(3): 1657 - 1666.
[Abstract] [Full Text] [PDF]

C. Ai-Ping, K.-H. Lee, and T.-K. Lim
In-Hospital and 5-Year Mortality of Patients Treated in the ICU for Acute Exacerbation of COPD: A Retrospective Study
Chest, August 1, 2005; 128(2): 518 - 524.
[Abstract] [Full Text] [PDF]

W. Windisch, S. Kostic, M. Dreher, J. C. Virchow Jr, and S. Sorichter
Outcome of Patients With Stable COPD Receiving Controlled Noninvasive Positive Pressure Ventilation Aimed at a Maximal Reduction of PaCO2
Chest, August 1, 2005; 128(2): 657 - 662.
[Abstract] [Full Text] [PDF]

G.P. Currie, M. MacKenzie, and G. Douglas
Assisted hospital discharge in patients with chronic respiratory disorders
QJM, July 1, 2005; 98(7): 541 - 542.
[Full Text] [PDF]

T. A. C. Nizet, F. J. J. van den Elshout, Y. F. Heijdra, M. J. T. van de Ven, P. G. H. Mulder, and H. Th. M. Folgering
Survival of Chronic Hypercapnic COPD Patients Is Predicted by Smoking Habits, Comorbidity, and Hypoxemia
Chest, June 1, 2005; 127(6): 1904 - 1910.
[Abstract] [Full Text] [PDF]

T. J Ringbaek and P. Lange
Outdoor activity and performance status as predictors of survival in hypoxaemic chronic obstructive pulmonary disease (COPD)
Clinical Rehabilitation, March 1, 2005; 19(3): 331 - 338.
[Abstract] [PDF]

S. D. Nathan
Lung Transplantation: Disease-Specific Considerations for Referral
Chest, March 1, 2005; 127(3): 1006 - 1016.