Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD

Abstract

PurposeCOPD is a heterogeneous disease, and the available prognostic indexes are therefore limited. This study aimed to identify the factors associated with acute exacerbation leading to hospitalization.Patients and methodsThis was a retrospective study of consecutive patients with COPD (meeting the Global Initiative for Chronic Obstructive Lung Disease [GOLD] diagnostic criteria) hospitalized at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2016. During follow-up after first hospitalization, the patients who had been rehospitalized within 1 year for acute exacerbation were grouped into the frequent exacerbation (FE) group, while the others were grouped into the infrequent exacerbation (IE) group. The baseline demographic, clinical, laboratory, pulmonary function, and imaging data were compared between the two groups.ResultsCompared with the IE group, the FE group had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (P=0.005), FEV1%pred (P=0.002), maximal mid-expiratory flow (MMEF25–75%pred) (P=0.003), and ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) (P=0.03) and higher resonant frequency (Fres; P=0.04). According to generations of bronchi, the percentage of the wall area (%WA) of lobes was found to be higher in the FE group. Emphysema index (EI), mean emphysema density (MED)whole and MEDleft lung in the FE group were significantly worse than in the IE group (P<0.05). Using logistic regression, exacerbation hospitalizations in the past year (odds ratio [OR] 14.4, 95% CI 6.1–34.0, P<0.001) and EI >10% (OR 2.9, 95% CI 1.2–7.1, P=0.02) were independently associated with frequent acute exacerbation of COPD (AECOPD) hospitalization.ConclusionExacerbation hospitalizations in the past year and imaging features of emphysema (EI) were independently associated with FE hospitalization.

Predictive Factors of Multiple Hospitalizations for Acute Exacerbations of COPD

“…In our study, frequent exacerbations were highly associated with multiples admissions. This is in accordance with several other reports [4] [18]. Santibanez et al concluded in their study to the fact that a prior history of hospitalized exacerbations of COPD was associated with new admission for AECOPD with a statistically significant dose-response association.…”

“…Garcia Aymerich et al get 63% as a rate of readmission during a mean period of follow-up of 1.1 years [5]. A lower rate of 45% of readmission in one year after discharge was found in the study of Wei et al [4]. In our study, only 26% COPD patients had a mean number of hospitalizations per year more than 2.…”

“…Indeed, some COPD patients have an increased risk of recurrence of an AECOPD following hospitalization [3]. Readmissions for AECOPD are known to have pejorative consequences [4]. The hospital readmission rate for AECOPD remains high through the world despite improvement in the management of COPD.…”

The features of AECOPD with carbon dioxide retention

“…Imaging examinations were performed using a 64-detector CT scanner (SOMATOM Definition AS, Siemens, Erlangen, Germany) with subjects holding their breath at full inspiration in the supine position. Technical parameters were based on our prior study [ 13 ] .…”

“…All CT images were automatically analyzed using the FACT-Digital Lung software [ 14 , 15 ]. The percentage of the wall area (%WA) of different generations of bronchi in each lobe, the extent of emphysema in the whole lung, right lung, left lung, and emphysema heterogeneity index (HI) were expressed according to our prior study [ 13 , 15 , 16 ].…”