Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation

Quintana, José M.; Esteban, Cristóbal; García-Gutiérrez, Susana; Aguirre, Urko; González, Nerea; Lafuente, Iratxe; Baré, Marisa; Larrea, Nerea Fernández de; Rivas-Ruiz, Francisco

doi:10.1159/000365996

Cited by 15 publications

(15 citation statements)

References 26 publications

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“…This effect was independent of COPD severity and the main confounders identified in the present study. This finding is in line with those of other international studies [ 16 , 27 , 28 , 29 ] and the ECLIPSE study. In the latter study, at least one hospitalized exacerbation the previous year was the main predictor of at least one hospitalized exacerbation over the following 2 years with a hazard ratio of 2.71 (95%CI, 2.24–3.29) [ 18 ].…”

Section: Discussionsupporting

confidence: 93%

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

et al. 2016

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Background and AimExacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs—particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients.MethodsThis was a retrospective population-based cohort study. We selected 900 patients with confirmed COPD aged ≥35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission. We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1–4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year.ResultsOf the patients, 16.4% had ≥1 severe exacerbations, varying from 9.3% in mild GOLD grade 1 to 44% in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95% confidence interval [CI], 3.53–12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41–17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated.ConclusionsHospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality.

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Section: Discussionsupporting

confidence: 93%

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

et al. 2016

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“…Other strong predictors we found were infiltration, GOLD stage, supported living, admission in the last two year and LTOT …”

Section: Discussionmentioning

confidence: 70%

Risk stratification for short‐term mortality at hospital admission for acute exacerbations of COPD

Sprooten

Rohde

Lawyer³

et al. 2019

Respirology

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Background and objective: Exacerbations of chronic obstructive pulmonary disease (ECOPD) are associated with increased in-hospital and short-term mortality. Developing an easy-to-use model to predict adverse outcomes will be useful in daily clinical practice and will facilitate management decisions. We aimed to assess mortality rates and potential predictors for short-term mortality after severe ECOPD. Classification and Regression Tree (CART) model was used to identify predictors of adverse outcome. Methods: A retrospective observational cohort study, including all patients admitted to Maastricht University Medical Center with ECOPD between June 2011 and December 2014 was performed. The last admission was taken into account, and its demographic, clinical and biochemical data were recorded. Results: A total of 364 hospitalized patients were enrolled. Mean (SD) age was 70.5 (10.2) years, 54.4% were male and mean FEV 1 45.2% (17.7) of predicted. The in-hospital and 90-day mortality were, respectively, 8.5 and 16.2%. Independent risk factors for 90-day mortality were: PaC0 2 (odds ratio (OR): 1.31; 95% confidence interval (CI): 1.00-0.35), age (OR: 1.09; CI: 0.06-0.11), body mass index (BMI) < 18.5 kg/m 2 (OR: 2.72; 95% CI: 0.53-1.47) and previous admission for ECOPD in last 2 years (OR: 1.29; 95% CI: −0.14, −0.65). The CART model selected PaCO 2 ≥ 9.1 kPa, age > 80 years, BMI < 18.5 kg/m 2 and previous admission for ECOPD as the most discriminatory factors. Conclusion: According CART analysis, high PaCO 2 and age, low BMI and previous admission for ECOPD in last 2 years were the strongest predictors of 90-day mortality in patients with severe ECOPD. In absence of any of these factors, no patients died, suggesting that this model indeed enables risk stratification.Data presented as n (%) or medium with standard deviation depicted after AE, unless otherwise stated. † (Pearson) chi-square. ABG, arterial blood gas; ALAT, alanineaminotranferase; ASAT, aminotransferase; BMI, body mass index; BP, blood pressure; CRP, C-reactive protein; CVP, central venous pressure; ECG, electrocardiogram; FiO 2 , fraction of inspired oxygen; LDH, lactic acid dehydrogenase; Na, sodium; NT proBNP, brain natriuremic peptide; SaO 2 , oxygen saturation measured in arterial blood gas; SpO 2 , oxygen saturation measured by pulse oximetry; WBC, white blood cell.Respirology (2019) 24, 765-776

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“…38 Eight studies analyzed potential drivers of COPDrelated readmission to hospital for patients admitted with an exacerbation of COPD. [39][40][41][42][43][44][45][46] Among those that explored readmission for another exacerbation in the shorter term (within 30 days or within 2 months), history of coronary heart disease, 46 hospitalizations in the previous year 44 and baseline FEV 1 <30% predicted (vs ≥50% predicted) 43 were identified as independent drivers of increased readmission risk, but this is not an exhaustive summary. Interestingly, though perhaps not surprisingly, taking 150 mins of moderate-to-strenuous exercise each week was independently associated with a lower risk of readmission for an exacerbation within 30 days.…”

Section: Hrumentioning

confidence: 99%

<p>Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review</p>

Iheanacho¹,

Zhang

King

et al. 2020

COPD

232

130

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Background and Objectives: Chronic obstructive pulmonary disease (COPD) affects over 250 million people globally, carrying a notable economic burden. This systematic literature review aimed to highlight the economic burden associated with moderate-to-very severe COPD and to investigate key drivers of healthcare resource utilization (HRU), direct costs and indirect costs for this patient population. Materials and Methods: Relevant publications published between January 1, 2006 and November 14, 2016 were captured from the Embase, MEDLINE and MEDLINE In-Process databases. Supplemental searches from relevant 2015-2016 conferences were also performed. Titles and abstracts were reviewed by two independent researchers against predefined inclusion and exclusion criteria. Studies were grouped by the type of economic outcome presented (HRU or costs). Where possible, data were also grouped according to COPD severity and/or patient exacerbation history. Results: In total, 73 primary publications were included in this review: 66 reported HRU, 22 reported direct costs and one reported indirect costs. Most of the studies (94%) reported on data from either Europe or North America. Trends were noted across multiple studies for higher direct costs (including mean costs per patient per year and mean costs per exacerbation) being associated with increasingly severe COPD and/or a history of more frequent or severe exacerbations. Similar trends were noted according to COPD severity and/or exacerbation history for rate of hospitalization and primary care visits. Multivariate analyses were reported by 29 studies and demonstrated the statistical significance of these associations. Several other drivers of increased costs and HRU were highlighted for patients with moderate-to-very severe COPD, including comorbidities, and treatment history. Conclusion: Moderate-to-very severe COPD represents a considerable economic burden for healthcare providers despite the availability of efficacious treatments and comprehensive guidelines on their use. Further research is warranted to ensure cost-efficient COPD management, to improve treatments and ease budgetary pressures.

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Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation

Cited by 15 publications

References 26 publications

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

Risk stratification for short‐term mortality at hospital admission for acute exacerbations of COPD

<p>Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review</p>

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