UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations

Abstract

Background: Limited comparative data exist on the outcomes of patients presenting with chronic obstructive pulmonary disease (COPD) exacerbations with or without radiological pneumonia. Objective: To examine the outcome differences amongst these patients. Methods: We analysed 2008 UK National COPD audit data to examine the characteristics, management and outcomes, inpatient- and 90-day mortality and length of stay of patients admitted with COPD exacerbations. Results: Of 9,338 admissions, 16% (1,505) had changes consistent with pneumonia indicated on the admission chest X-ray. They tended to be older (mean ages 75 vs. 72 years), male (53 vs. 50%), more likely to come from care homes, with more disability, higher BMI and co-morbidity, lower albumin but higher urea levels, and less likely to be current smokers. COPD exacerbations with pneumonia were associated with worse outcomes: inpatient mortality was 11 and 7% and 90-day mortality was 17 and 13% for pneumonia and non-pneumonia patients, respectively (p < 0.001). After adjusting for factors that are significantly different between the 2 groups, including age, sex, place of residence, level of disability, co-morbidity, albumin and urea levels, estimated risk ratios for inpatient and 90-day mortality for pneumonia compared to non-pneumonia cases in this series were 1.19 (1.01,1.42) and 1.09 (0.96,1.23), respectively. The adjusted risk ratio of a prolonged acute hospital stay of more than 7 days was 1.15 (1.07, 1.23). Conclusions: Patients who present with radiological pneumonia have worse outcomes compared to those admitted without pneumonia in exacerbation of COPD.

Chronic Obstructive Pulmonary Disease Exacerbations: Better Standards – Better Prognosis?

“…In this survey, 822,500 hospital-admitted patients with COPD exacerbations had on average a hospital stay of 4.3 days. In the study of Myint et al [8] , the LOS was markedly increased to 7-14 days in AECOPD patients with concomitant radiological findings of pneumonia. Although patients with concomitant infiltrates were more likely to suffer from comorbidities and a higher level of disability, radiological detection of pneumonia was still an independent risk factor for a longer hospital stay.…”

“…The strength of this study is its statistical power due to the high number of cases. Taking into account that in a recent review of inhospital management of AECOPD [12] up to 13% of COPD patients did not receive any X-ray upon admission, the study by Myint et al [8] in this journal might call for stricter management programs in the future.…”

“…In this issue of Respiration , the paper of Myint et al [8] shows that concomitant infiltrates in AECOPD, suspected as pneumonia, worsen various important outcome pa- tal mortality and for increasing the costs of treatment. Therefore, risk stratification is one of the important issues of hospital admissions.…”

“…In the study of Myint et al [8] , patients without the predominant clinical findings of pneumonia, presenting with severe symptoms of AECOPD, are not likely to be scored for pneumonia risk stratification and therefore might not receive adequate treatment. This is the first study looking at the impact of the X-ray findings on the prognosis of AECOPD.…”

Decline of Health Status Sub-Domains by Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Survey

“…Clearly, those identified by the necessity for hospital admission are those most likely to cause deterioration in HS, demonstrated by high rates of 1-year mortality after hospital admission for exacerbations [9,10]. Recently, a large survey of COPD admissions in the UK revealed that severity of exacerbations based upon unexpected radiological infiltrates may affect prognosis also in terms other than mortality [11,12.] In ambulatory patients for whom a course of corticosteroids and/or antibiotics is sufficient treatment for the exacerbations [5,8,13], the evidence also supports such a deleterious role, albeit with a less hazardous outcome.…”