Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Crisafulli, Ernesto; Ortega, S; Torres, Antoni

doi:10.1097/cpm.0000000000000090

Cited by 11 publications

(7 citation statements)

References 44 publications

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“…Same factors are associated with the risk of failure and relapse, 31 and clinicians should identify them in every AECOPD patient to implement effective interventions.…”

Section: Risk Factors For Relapse and Failure Of Aecopdmentioning

confidence: 99%

Acute exacerbations of COPD: risk factors for failure and relapse

Mantero¹,

Rogliani²,

Pasquale³

et al. 2017

COPD

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Acute exacerbations are a leading cause of worsening COPD in terms of lung function decline, quality of life, and survival. They also have a relevant economic burden on the health care system. Determining the risk factors for acute exacerbation and early relapse could be a crucial element for a better management of COPD patients. This review analyzes the current knowledge and underlines the main risk factors for recurrent acute exacerbations. Comprehensive evaluation of COPD patients during stable phase and exacerbation could contribute to prevent treatment failure and relapses.

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“…Same factors are associated with the risk of failure and relapse, 31 and clinicians should identify them in every AECOPD patient to implement effective interventions.…”

Section: Risk Factors For Relapse and Failure Of Aecopdmentioning

confidence: 99%

Acute exacerbations of COPD: risk factors for failure and relapse

Mantero¹,

Rogliani²,

Pasquale³

et al. 2017

COPD

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“…Although the majority of readmissions in COPD patients are not respiratory-related [ 12 ], around 20% are readmitted due to AECOPD within 30 days after discharge [ 13 ]. Although several predictors have been identified [ 14 , 15 ] and certain interventions have been proposed [ 16 ] there is not enough evidence at present to recommend a single disease-specific approach to address the problem [ 12 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

et al. 2016

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Background and ObjectiveTwenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients.MethodsThe cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years.ResultsPatients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5).ConclusionIn conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death.

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“…99,100 Several predictors of early readmission with AECOPD have been described. [101][102][103] A Canadian study considering a long follow-up (17 years) in a large cohort of hospitalized patients with COPD (>70,000) reported a mortality rate of 69%, with deaths peaking in the first week of hospitalization. 88 Several factors have been associated with the increased mortality in severe AECOPD, 23 including older age, male sex, prior hospitalization, weight loss/low body mass index, pulmonary hypertension, lung cancer, and need for long-term oxygen therapy at discharge.…”

Section: Discussionmentioning

confidence: 99%

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

Crisafulli

Manco

Ferrer

et al. 2020

Semin Respir Crit Care Med

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Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.

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Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cited by 11 publications

References 44 publications

Acute exacerbations of COPD: risk factors for failure and relapse

Acute exacerbations of COPD: risk factors for failure and relapse

Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

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