Patients were divided according to the cause of death, and underlying characteristics were compared using a Kruskal-Wallis test, Fisher exact test, or x2 test, as appropriate. Results were considered statistically significant at p < 0.05. Analyses were performed using a statistical software package (JMP, version 7; SAS Institute; Cary, NC). 
Results We identified 43 decedents (31 men; 72%) with COPD in whom an autopsy was performed. All of them were admitted to the hospital with symptoms of severe exacerbation of disease, and all died within the first 24 h of hospital admission. The median age at death was 70 years (IQR, 65 to 75 years). The median duration of COPD was 10 years (IQR, 5 to 15 years). Based on autopsy findings, the main causes of death were cardiac failure (n = 16; 37%), pneumonia (n = 12; 28%), PTE (n = 9; 21%), and respiratory failure (n = 6; 14%) Five patients who died of cardiac failure had predominant right heart insufficiency.
Thirty-three patients (77%) had at least one, and 25 (58%) had two or more comorbidities defined as a clinical diagnosis of chronic heart failure, diabetes mellitus, liver cirrhosis, osteoporosis, and pathologic findings of ventricular ulcer, carcinomas, or diffuse atherosclerosis. Of six patients who were found to have carcinomas on autopsy, three had lung carcinoma (all of them died of cardiac failure), two had breast cancer, and one had urinary bladder cancer. Six patients were found to have evidence of deep vein thrombosis on autopsy; four of them died of PTE.
Baseline characteristics, clinical signs, and symptoms as well as laboratory findings were nonspecific. All patients presented with severe dyspnea. Patients with pneumonia were more likely to present with productive cough. Eight of nine patients with PTE presented with tachycardia. Patients with pneumonia and PTE had an elevated creatinine level. ECG and chest radiographic findings also had limited diagnostic value (Table 3). Patients who died due to cardiac failure and PTE were more likely to have evidence of cardiomegaly on chest radiograph. In patients with cardiac failure, vascular congestion was present on hospital admission in most of the cases.
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