Is Acute Exacerbation of COPD (AECOPD) Related to Viral Infection Associated with Subsequent Mortality or Exacerbation Rate?



Omar Kherad*, 1, Pierre-Olivier Bridevaux2, Laurent Kaiser3, Jean-Paul Janssens2, Olivier T. Rutschmann4
1 Department of Internal Medicine and University of Geneva, La Tour Hospital, Geneva, Switzerland
2 Division of Pulmonary Diseases, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland
3 Central Laboratory of Virology, Division of Infectious Diseases, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland
4 Department of Community, Primary Care and Emergency Medicine, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland


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© Kherad et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Internal Medicine and University of Geneva, La Tour Hospital, 3 avenue J.-D. Maillard 1217 Geneva, Switzerland; Tel: +41 22719.60.99; Fax: +41 22 719.67.01; E-mail: omarkherad@gmail.com


Abstract

Background:

There is a growing interest in better defining risk factors associated with increased susceptibility to exacerbation in patients with COPD.

Introduction:

The aim of the study was to determine whether identification of a respiratory virus during a severe acute exacerbation of COPD (AECOPD) increases the risk of subsequent exacerbations and mortality during a one-year followup.

Methods:

Secondary analysis of 86 COPD patients admitted for AECOPD between June 2007 and December 2008 at Geneva’s University Hospital who were followed up for 1 year. Fifty-one percent of index AECOPD were related to viral infection. Rate of AECOPD, time to next AECOPD, and all-cause mortality were compared between patients with vs without viral index AECOPD.

Results:

Eighty-one cases were included in this secondary follow-up analysis. Mean exacerbation rate was 1.9 AECOPD per person-year for patients with viral index AECOPD vs 4.0 AECOPD per person year for those with non-viral index AECOPD. Incidence rate ratio (IRR) for subsequent AECOPD during one year follow up was lower for patients with viral index AECOPD (IRR 0.57; [CI 95% 0.39-0.84]), after controlling for previous exacerbations, and was strongly associated with the number of exacerbations in the year preceding the index AECOPD. During the one-year follow-up period, 16 patients (19%) died. In a Cox regression model, patients with a proven viral infection did not have a higher mortality (HR 0.56 [CI 95% 0.20 -1.58]).

Conclusion:

Viral AECOPD was not associated with a higher rate of subsequent exacerbations or mortality during the following year.

Keywords: : COPD, exacerbation, phenotype, virus..