Dependence IN Performing Activities as a Predictor of Mortality Following Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation

Introduction: Scant evidence is available on whether dependency for basic (BADL) or instrumental (IADL) activities of daily living can be predictors of mortality after severe COPD exacerbation (COPDE). In addition, it is as yet unclear whether the inclusion of this parameter in a multidimensional score can improve the prediction of mortality. Methodology: Prospective cohort study, with follow-up of patients discharged after COPDE and multivariate analysis of clinical-demographic and dependency variables (Barthel and Lawton and Brody indices) as predictors of mortality. Three scores were generated (including or not including dependency for BADL and IADL) that were compared with each other and with other commonly used multidimensional indices (BODEx, ADO, DOSE, CODEx). Results: In total, 247 patients were included, 112 (45%, 3); and 195 (72.4%) had some dependency for BADL and IADL. Survival was 631.7 (258.8) days, 95% confidence interval (95% CI), 60-912 days. Fifty-four (21.9%, 95% CI 17-27) patients died. Age > 60 years, FEV1 < 50% and Charlson score >= 3 were independent predictors in the 3 models generated. Dependency for BADL and IADL were predictors in each of the models in which they were included. The score that included the dependency for BADL presented the best predictive capacity (area under the curve 0.818, 95% CI 0.757-0.879). Stratification into tertiles differentiated groups with a higher risk of death from the beginning of the follow-up (P<.01). Conclusions: Dependence for activities of daily living, especially the most elementary ones, is an independent predictor of mortality after a severe COPDE that is comparable to clinical variables. Its inclusion in multidimensional scores clearly improves predictive capacity. (C) 2019 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.