There is a broad spectrum of severity of disease encompassed by people with COPD. Likewise, acute exacerbations range from very mild to severe and life-threatening. Morbidity and mortality among people with COPD occurs most often in the context of exacerbations. Older studies have estimated mortality rates of 4% to 30% among patients hospitalized for acute exacerbations. A study based on data available from the 1996 Nationwide Inpatient Sample (Agency for Healthcare Research and Quality, Rockville, MD) found in-hospital mortality for people with an acute exacerbation to be 2.5% overall.[291] In this study, the median duration of hospitalization was 5 days and 70% of patients were discharged to home without additional in-home health services. Patients who died during hospitalization were shown to be older, had greater levels of underlying comorbidities, and were hospitalized for longer periods. Not surprisingly, a greater rate of mortality was shown for patients who were mechanically ventilated compared with those who were not (28% versus 1.7%). Another study identified an approximately 50% 5-year mortality following hospitalization for COPD exacerbation.[292] Rehospitalization and/or mortality have been associated with lower FEV1, higher PaCO2, lower PaO2, greater APACHE II score, lower BMI, older age, comorbidities, and low physical activity levels.[227][293][294][295][296][297][298] The multidimensional CODEX (comorbidity, obstruction, dyspnea, previous severe exacerbations) index can predict readmission and survival at 3 months and 1 year after hospitalization for COPD exacerbation.[299]

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