Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

Abstract

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.

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

“…DM is a risk factor for AECOPD 18. Patients with DM and AECOPD frequently (50%–80% of patients) presented with hyperglycemia during their hospital stay and experienced longer hospital stays and higher mortality rates than patients without DM 19,20.…”

Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study

“…Other studies have also found higher odds for older age, 51,53,54 severity, 51,55 comorbidities such as HF (in COPD patients), cancer, renal failure, 55 depression 56 and diabetes. 53 For COPD, Fidahussein et al 54 also found an association for LOS. Not all studies reported sex differences, although some agreed with our finding of higher odds for males for both conditions.…”

Hospitalization due to exacerbation of COPD: "Real-life" outcomes

“…Thorough assessment of these patients on admission, using laboratory tests, comorbidities assessment, and objective instruments to quantify dyspnea and symptoms (mMRC, VAS and CAT) is essential to reduce hospital stay, prevent readmission and decrease mortality. 36,37 Patients admitted due to eCOPD are a heterogeneous group that can be grouped into three clusters as described, although we did not find an association between these clusters and the outcomes of hospitalization. Studies with a larger sample of patients are needed to confirm the findings reported here and to relate them to the outcomes of hospitalizations due to eCOPD.…”