Risk Factors for Frequent Hospital Readmissions for Acute Exacerbations of COPD
Clinical Medicine Research
Volume 2, Issue 6, November 2013, Pages: 167-173
Received: Nov. 24, 2013; Published: Dec. 20, 2013
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Authors
Gaude Gajanan, Department of Pulmonary Medicine, KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, INDIA
Hattiholi Jyothi, Department of Pulmonary Medicine, KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, INDIA
Chaudhury Alisha, Department of Pulmonary Medicine, KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, INDIA
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Abstract
Background: Acute exacerbations of COPD (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The aim of this study was to EVALUATE the factors responsible for the repeated admissions for AECOPD. Methodology: We conducted a prospective study of 235 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous readmissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post discharge. All the patients were followed up for a period of two years after discharge to evaluate the readmissions for the acute exacerbations. Results: Among 149 COPD patients who were admitted and assessed for AECOPD, there were 278 readmissions for AECOPD over a follow-up period of 24 months. Of these, 27% had one readmission, while rest 78% had two or more readmissions during this period. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients and low prevalence of vaccination and use of domiciliary oxygen therapy among COPD patients. A total of 15.4% mortality was observed in the present study. The multivariate logistic regression analysis for repeated admissions revealed that disease duration >10 years (OR =0.50; 95% CI: 0.27 -0.93), non-use of inhaled corticosteroids (ICS +LABA) (OR = 2.31; 95% CI: 2.26–4.88), lower serum albumin level (<2gm/dl) (OR = 0.48; 95% CI: 0.26–0.88), MRC dyspnea grade > 3 (OR = 1.15; 95% CI: 2.56–4.89), body mass index (BMI) <20 (OR =0.62, 95% CI: 0.31-1.23) and non-use of Tiotropium (OR = 1.21, 95% CI: 0.67-2.19) were independently associated with frequent readmissions for AECOPD. Conclusion: The repeated exacerbations in COPD were common with major burden to the society. The major factors influencing frequency of repeated COPD exacerbations were disease duration, non-prescription of inhaled corticosteroids (ICS +LABA) and Tiotropium, lower serum albumin level (<2gm/dl), lower BMI and MRC dyspnea grade > 3.
Keywords
COPD, Acute Exacerbation, AECOPD, Repeated Exacerbation, Hospitalization
To cite this article
Gaude Gajanan, Hattiholi Jyothi, Chaudhury Alisha, Risk Factors for Frequent Hospital Readmissions for Acute Exacerbations of COPD, Clinical Medicine Research. Vol. 2, No. 6, 2013, pp. 167-173. doi: 10.11648/j.cmr.20130206.20
References
[1]
Rabe KF, Hurd S, Anzueto A (2007). Global Initiative for Chronic Obstructive Lung Disease, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176:532-555.
[2]
Houlguin F, Folch E, Redd SC, et al (2005). Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest 128:2005-2011.
[3]
Mnanino DM, Buist AS (2007). Global burden of COPD: risk factors, prevalence, and future trends. Lancet 370:765-773.
[4]
Connors AF, Dawson NV, Thomas C et al (1996). Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 154: 959–67.
[5]
National Institutes of Health (2002). National Heart, Lung and Blood Institute. Morbidity and Mortality: 2002 Chart Book on Cardiovascular, Lung and Blood Diseases. May 2002. [Cited 5 September 2003] Available from URL: http://www.nhlbi.nih.gov (accessed on October 12th, 2013).
[6]
Garcia-Aymerich J, Farrero E, Félez MA, et al (2003). Risk factors of re-admission to hospital for a COPD exacerbation: a prospective study. Thorax 58: 100–5.
[7]
Pouw EM, Ten Velde GP, Croonen BH, at al (2000). Kester AD, Schols AH, Wouters EF. Early non-elective re-admission for chronic obstructive pulmonary disease is associated with weight loss. Clin Nutr 19: 95–9.
[8]
Rodriguez-Roisin R, Anzueto A, Bourbeau J, at al (2010). Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary (Updated 2010). 1-117.
[9]
Groenewegen KH, Schols AM, Wouters EF (2003). Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 124:459-467.
[10]
Bahadori K, FitzGerald JM, Levy RD, at al (2009). Risk factors and outcomes associated with chronic obstructive pulmonary disease exacerbations requiring hospitalization. Can Respir J 16(4):e43-e49.
[11]
Wang Q, Bourbeau J (2005). Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD. Respirology 10:334-340.
[12]
Celli BR (1997). Is pulmonary rehabilitation an effective treatment for chronic obstructive pulmonary disease? Yes. Am J Respir Crit Care Med 155: 781–3.
[13]
Nichols KL, Baken L, Nelson A (1999). Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med 130: 397–403.
[14]
Vestbo J, Prescott E, Lange P et al (1998). Vital prognosis after hospitalization for COPD: a study of a random population sample. Respir Med 92: 772–776.
[15]
Advisory Committee on Immunization Practices (ACIP) (1998). Prevention and control of influenza: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep 47: 1–26.
[16]
Kesseler R, Faller M, Weitzenblum E et al (2001). "Natural history" of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am J Respir Crit Care Med 164:219-224.
[17]
McGhan R, Radcliff T, Fish R et al (2009). Predictors of rehospitalization and death after a severe exacerbation of COPD. Lung 187:128-135.
[18]
Abusaid GH, Barbagelata A, Tuero E et al (2009). Diastolic dysfunction and COPD exacerbation. Postgrad Med 121:76-81.
[19]
Douglas SL, Daly BJ, Gordon N et al (2002). Survival and quality of life: short-term versus long-term ventilator patients. Crit Care Med 30: 2655–62.
[20]
Baker EH, Janaway CH, Philips BJ et al (2006). Hyperglecemia is associated with poor outcomes in patients admitted to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax 61:284-289.
[21]
Garcia-Aymerich J, Barreiro E, Farrero E et al (2000). Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study). Eur Respir J 16: 1037–1042.
[22]
Horn SD, Sharkey PD, Buckle JM et al (1991). The relationship between severity of illness and hospital length of stay and mortality. Med Care 29:305-317.
[23]
Skyba P, Kluchova Z, Joppa P ET AL (2009). Nutritional status in relation to respiratory impairment and systemic inflammation in patients with acute exacerbation of COPD. Med Sci Mon 15:CR528-CR533.
[24]
Tsimogianni AM, Papiris SA, Stathopoulos GT ET AL (2009). Predictors of outcome after exacerbation of chronic obstructive pulmonary disease J Gen Intern Med 24:1043-1048.
[25]
Emerman CL, Effron D, Lukens TW (1991). Spirometric criteria for hospital admission of patients with acute exacerbation of COPD. Chest 99:595-599.
[26]
Seemungal TA, Donaldson GC, Paul EA et al (1998). Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157(5 Pt 1):1418-1422.
[27]
Dusser D, Bravo M-L, Iacono P (2006). The effect of tiotropium on exacerbations and airflow in patients with COPD. Eur Respir J 27: 547–555.
[28]
McGhan R, Radcliff T, Fish R et al (2007). Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 132:1748-1755.
[29]
Tashkin DP, Celli B, Senn S et al (2008). A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 359: 1543–1554.
[30]
Calverley PMA, Anderson JA, Celli B et al (2007). Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–789.
[31]
Soler-Catalufia JJ, Martinez-Garcia MA, Roman Sanchez E et al (2005). Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 60:925-931.
[32]
Fruchter O, Yigla M (2008). Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Respirology 13:851-855.
[33]
Wang Q, Bourbeau J (2005). Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD. Respirology 10:334–340.
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