Age-adjusted Charlson comorbidity score is associated with the risk of empyema in patients with COPD

Abstract

Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of pneumonia than the general population due to their impaired lung defense. They also have a higher risk of empyema and more comorbidities than patients without COPD. This study aimed to evaluate the risk of empyema in patients with COPD after adjusting for age and comorbidities using the age-adjusted Charlson comorbidity index (ACCI).Data were retrieved from the National Health Insurance Research Database. COPD patients were defined as inpatients aged >40 years with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for COPD. In total, 558,660 COPD patients were enrolled and separated into 3 groups by ACCI score to represent the severity of comorbidity (≤2, 3-5, and >5). Other comorbidities assessed included autoimmune diseases, gastroesophageal reflux disease, dyslipidemia, chest wall injury, and thoracostomy.Of the 558,660 patients, 36,556 (6.54%) had low ACCI scores (≤2), 208,292 (37.28%) had moderate ACCI scores (3-5), and 313,812 (56.17%) had high ACCI scores (>5). The mean ages of the low, moderate, and high groups were 50.66, 70.62, and 78.05 years, respectively. The hazard ratio (HRs) for empyema were 1.26 (95% confidence interval (CI) = 1.13-1.40) in the moderate ACCI group and 1.55 (95% CI = 1.39-1.72) in the high ACCI group compared with the low ACCI group. The overall incidence of empyema in COPD patients was 2.57 per 1000 person-years.This is the first study to use ACCI scores to analyze the risk of empyema in patients with COPD. Patients with high ACCI scores were older and had more complicated comorbidities, resulting in a higher risk of empyema and poor prognosis. The subgroup analysis indicated that COPD patients with comorbid autoimmune disease, gastroesophageal reflux disease, chest wall injury, or history of thoracostomy did not have a higher risk of empyema than patients without these comorbidities.Empyema is an important issue in patients with COPD and is associated with significant morbidity and mortality. Awareness of the risk factors for empyema, close monitoring, and early intervention may improve patient outcomes and decrease mortality.

Two Decades of Thoracic Empyema in Ontario, Canada

“…Studies have shown that diabetes and a higher comorbidity index in patients with COPD chestjournal.org are independent risk factors for the development of empyema. 8 The observed increase in the incidence of thoracic empyema may reflect the greater presence of such risk factors in an aging population. The increasing comorbidity as measured according to the CCI would support this theory.…”

The therapeutic effects of qigong in patients with chronic obstructive pulmonary disease in the stable stage: a meta-analysis

“…[3–5] Symptoms such as dyspnoea, sputum, cough, gasping and difficulty breathing always occur in patients with COPD; lung function declines over time, and medication does not fully reverse the airflow limitation. [6, 7] In addition, the inflammation and/or the changes in repair mechanisms that are accompanied by the release of inflammation mediators may induce or aggravate comorbid diseases such as lung cancer, osteoporosis, cardiovascular disease, depression, anxiety, muscle weakness, and diabetes. [8, 9] It is therefore one common condition that is encountered by most COPD patients in primary care settings who need perpetual medical management.…”

Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era

“…Like our study, they used the CCI to analyze morbidity and mortality risk in their population. They observed an increased incidence over time of thoracic empyema in patients aged 50–70 and postulated that this trend both reflects a change in the etiology of empyema from risk factors affecting a younger or more at risk population (intravenous drug use, tuberculosis) as well as the greater presence of risk factors such as COPD and diabetes – both independent risk factors for empyema development – in the aging population [ 21 ]. Our study likewise had older patients (an average age of 59.44) with significant comorbidities as measured according to the CCI, supporting the changing epidemiological trends reported in Nayak et al [ 20 ]…”