Temporal Trends in Outcomes for Adults Hospitalized With Chronic Obstructive Pulmonary Disease Exacerbations

Lima, Fabio V.; Yen, Tzyy Yun M.; Patel, Jignesh

doi:10.1378/chest.1983717

Cited by 8 publications

(8 citation statements)

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“…The median (IQR) length of hospital stay for patients with acute asthma has been estimated at 2 (1–3) days [ 53 ]. The mean (SD) range of length of hospital stay for adults hospitalized with acute COPD exacerbation has been reported at 4.5 (3.3) to 6 days, and up to 16 (16.7) days for ICU admissions [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

et al. 2021

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The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

et al. 2021

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“…Acute exacerbation of COPD (AECOPD) is defined as an acute worsening of respiratory symptoms in COPD which require additional therapy [ 1 ]. AECOPD contributes significantly to mortality among patients with COPD [ 3 ], especially for those who require intensive care unit (ICU) admission with a high mortality rate of 16.9% to 48.8% [ 4 , 5 ]. The severity of exacerbations reflected by clinical results is strongly correlated with patient prognosis.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

Peng

Gong²,

Wu³

et al. 2022

BMC Pulm Med

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Background Acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) contributes significantly to mortality among patients with COPD in Intensive care unit (ICU). This study aimed to develop a nomogram to predict 30-day mortality among AECOPD patients in ICU. Methods In this retrospective cohort study, we extracted AECOPD patients from Medical Information Mart for Intensive Care III (MIMIC-III) database. Multivariate logistic regression based on Akaike information criterion (AIC) was used to establish the nomogram. Internal validation was performed by a bootstrap resampling approach with 1000 replications. The discrimination and calibration of the nomogram were evaluated by Harrell’s concordance index (C-index) and Hosmer–Lemeshow (HL) goodness-of-fit test. Decision curve analysis (DCA) was performed to evaluate its clinical application. Results A total of 494 patients were finally included in the study with a mean age of 70.8 years old. 417 (84.4%) patients were in the survivor group and 77 (15.6%) patients were in the non-survivor group. Multivariate logistic regression analysis based on AIC included age, pO2, neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), invasive mechanical ventilation and vasopressor use to construct the nomogram. The adjusted C-index was 0.745 (0.712, 0.778) with good calibration (HL test, P = 0.147). The Kaplan–Meier survival curves revealed a significantly lower survival probability in the high-risk group than that in the low-risk group (P < 0.001). DCA showed that nomogram was clinically useful. Conclusion The nomogram developed in this study could help clinicians to stratify AECOPD patients and provide appropriate care in clinical setting.

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“…The latest epidemiological survey of COPD in China shows that the prevalence of COPD among people aged 40 and above is as high as 13.7%, and there are currently an estimated 100 million cases of COPD in China [ 3 ]. AECOPD is one of the leading causes of hospitalization, which significantly increases the mortality rate of AECOPD patients [ 4 ]. Early identification of risk factors for poor prognosis can help stratify patient management and reduce mortality, readmission rates and the socioeconomic burden [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymphocyte count for in-hospital mortality in patients with severe AECOPD

Long

Cao

et al. 2022

BMC Pulm Med

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Background Patients with severe acute exacerbations of chronic obstructive pulmonary disease often have a poor prognosis. Biomarkers can help clinicians personalize the assessment of different patients and mitigate mortality. The present study sought to determine if the lymphocyte count could act as a risk factor for mortality in individuals with severe AECOPD. Methods A retrospective study was carried out with 458 cases who had severe AECOPD. For analysis, patients were divided into two groups on the basis of lymphocyte count: < 0.8 × 109/L and ≥ 0.8 × 109/L. Results Patients who fulfilled the criteria for inclusion were enrolled, namely 458 with a mean age of 78.2 ± 8.2 years. Of these patients, 175 had a low lymphocyte count. Compared to patients with normal lymphocyte counts, those with low counts were older (79.2 ± 7.4 vs. 77.5 ± 8.6 years, p = 0.036), had lower activities of daily living scores on admission (35.9 ± 27.6 vs. 47.5 ± 17.1, p < 0.001), and had a greater need for home oxygen therapy (84.6 vs. 72.1%, p = 0.002). Patients with low lymphocytes had higher mortality rates during hospitalization (17.1 vs. 7.1%, p = 0.001), longer hospital stay (median [IQR] 16 days [12–26] vs. 14 days [10–20], p = 0.002) and longer time on mechanical ventilation (median [IQR] 11.6 days [5.8–18.7] vs. 10.9 days [3.8–11.6], p < 0.001). The logistic regression analysis showed lymphocyte count < 0.8 × 109/L was an independent risk factor associated with in-hospital mortality (OR 2.74, 95%CI 1.33–5.66, p = 0.006). Conclusion Lymphocyte count could act as a predictor of mortality in patients with severe AECOPD.

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Temporal Trends in Outcomes for Adults Hospitalized With Chronic Obstructive Pulmonary Disease Exacerbations

Cited by 8 publications

References 0 publications

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

Prognostic value of lymphocyte count for in-hospital mortality in patients with severe AECOPD

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