Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia

Abstract

BackgroundPneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD) exacerbation and influence their outcomes.MethodsWe examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006–2012.ResultsWe identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%). Pneumonia was frequent in first-time exacerbations (36.1%), but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days), intensive care unit admission (7.7% vs 12.5%), and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17–1.24). Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11–1.18), and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07–1.13). In contrast, the aHR of a subsequent exacerbation was 8%–13% lower for patients with pneumonic exacerbations.ConclusionsPneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care utilization and higher mortality. Nonpneumonic COPD exacerbations predict increased risk of subsequent exacerbations.

Development of a nomogram for predicting in-hospital mortality of patients with exacerbation of chronic obstructive pulmonary disease

“…Some studies have reported that pneumonia is associated with higher in-hospital or 30-day mortality;25,26 these findings are consistent with the results of our study. However, other studies have failed to show a significant association between pneumonia and mortality; the in-hospital mortality was relatively low in these studies, around 3% 27,28…”

Time to move from prognostication to diagnosis and treatment of heart disease in acute exacerbation of COPD

“…Cardiovascular comorbidity was common (41% hypertension, 20% heart failure). The primary end-point of 30-day mortality occurred in 27 patients (7.6%), congruent with existing literature reporting variable rates of 4.6-12% short-term mortality [2,3]. The authors focus on the performance of myocardial injury markers, recognising that cardiac disease is a common cause of death in patients with COPD [4].…”

No difference in long term survival in patients hospitalized for pneumonic versus non‐pneumonic acute exacerbations of COPD

“…2,3 While pAECOPD is considered a distal airway or parenchymal infection with radiological consolidation and increased inflammatory parameters, npAECOPD is usually caused by a bronchial infection. It is also unclear whether patients with pAECOPD have distinct clinical characteristics or increased morbidity compared with npAECOPD patients.…”

“…6 Very few studies have compared long-term mortality in pAECOPD versus npAECOPD. 3 We conducted a retrospective audit study of all hospitalizations for COPD from 1 January to 31 December 2005 at the Departments of Internal and Respiratory Medicine in Trondheim University Hospital (Norway), Aalesund Hospital (Norway), and € Ostersund Hospital (Sweden). 4 A study using the Danish National Patient Registry found a 30-day mortality of 12.1% in firsttime pAECOPD versus 8.3% in first-time npAECOPD cases.…”