Abstract
Objective of the study was to estimate the case-fatality of a severe exacerbation from long-term survival data presented in the literature.
A literature search identified studies reporting at least 1.5 year survival after a severe COPD exacerbation resulting in hospitalization. Each study's survival curve was divided into a critical and a stable period. Mortality during the stable period was then estimated by extrapolating the survival curve during the stable period back to the time of exacerbation onset. Case-fatality was defined as the excess mortality that results from an exacerbation and was calculated as 1 minus the (backwardly) extrapolated survival during the stable period at the time of exacerbation onset. The 95% confidence intervals of the estimated case-fatalities were obtained by bootstrapping. A random effect model was used to combine all estimates into a weighted average with 95%-confidence interval.
The meta-analysis based on six studies that fulfilled the inclusion criteria resulted in a weighted average case-fatality rate of 15.6% (95%CI:10.9%–20.3%), ranging from 11.4% to 19.0% for the individual studies.
A severe COPD exacerbation requiring hospitalization not only results in higher mortality risks during hospitalization, but also in the time period after discharge and contributes substantially to total COPD mortality.
- ERS
