Bronchiectasis in patients hospitalized with acute exacerbation of COPD in Spain: Influence on mortality, hospital stay, and hospital costs (2006-2014) according to gender

Abstract

PurposeThe objectives of this study were to analyze the characteristics of male and female patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) during 2006–2014 according to the presence or absence of bronchiectasis and to study the factors associated with in-hospital mortality (IHM) in patients hospitalized with AE-COPD and concomitant bronchiectasis.MethodsWe used the Spanish National Hospital Database to analyze patients admitted with AE-COPD as their primary diagnosis. Patients included in the study were stratified according to the presence or absence of bronchiectasis as their secondary diagnosis.ResultsWe identified 386,646 admissions for AE-COPD, of which 19,679 (5.09%) involved patients with concomitant bronchiectasis. When patients with and without bronchiectasis were compared, we observed that the incidence of infection by Pseudomonas aeruginosa was substantially higher in the former, as were the mean stay, cost, and percentage of readmissions, although IHM and comorbidity were lower. The course of patients with AE-COPD and bronchiectasis was characterized by a gradual increase in prevalence and mean age among men and no differences in prevalence or lower mean age in women. Mortality was 4.24% and 5.02% in patients with and without bronchiectasis, respectively, although significance was lost after a multivariate adjustment (OR 0.94; 95% CI, 0.88–1.01). The factors associated with IHM were older age, higher comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission.ConclusionsThe prevalence of admission with AE-COPD and bronchiectasis increased in men but not in women during the study period. In patients hospitalized with AE-COPD, we did not find differences in mortality when comparing the presence and absence of bronchiectasis. The analysis of temporal trends revealed a significant reduction in mortality from 2006 to 2014 in male patients with COPD and concomitant bronchiectasis, but not among women. It is important to consider the factors associated with IHM such as age, comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission to better identify those patients who are at greater risk of dying during hospitalization.

Impact of Radiographic Bronchiectasis in COPD

“…Of all of these, 14 duplicates were removed. After reviewing the titles and abstracts, 76 full-text articles were identified and reviewed, and, finally, 18 studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in this systematic review and meta-analysis. The flow diagram of article selection according to the PRISMA guideline 13 is illustrated in Figure 1.…”

“…A total of 415,257 subjects with COPD from 18 observational studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were eligible for this meta-analysis, and bronchiectasis was present in 25,929 subjects (6.24%). The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100).…”

“…The sample size ranged from 54 to 386,646, and 6 studies [17][18]20,22,25,33 had a small population (N < 100). Ten studies 11,[17][18][19][20]25,[27][28][32][33] were prospective (cohort studies) and 8 [21][22][23][24]26,[29][30][31] were retrospective (case-control studies) in design. The minimum study duration lasted for 1 year and the maximum lasted for 10 years.…”

“…Overall, the pooled data from the 18 studies 11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] found that subjects with COPD and with bronchiectasis were older than those without bronchiectasis (WMD 0.57 y, 95% CI 0.45-0.70; P < .001, I 2 ¼ 46%). Pooled estimates from the 16 11,[17][18][19][21][22][23][24][25][26][27][28][29][30][31] studies found that there were no statistical differences with respect to sex (OR 0.95, 95% CI 0.84-1.09; P ¼ .48, I 2 ¼ 66%), as show in Table 2. Ten studies 11,19,[22][23][24][25][26][27][28][29]32 were included in the assessment of BMI, and these showed that the presence of bronchiectasis in the subjects with COPD was associated with a lower BMI (WMD -0.42 kg/m 2 , 95% CI -0.73 to À0.11; P ¼ .007, I 2 ¼ 43%) compared with subjects with COPD and without bronchiectasis.…”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…Another recent research in Spain analysed the characteristics of men and women hospitalised with AECOPD during 2006‐2014 according to the presence or absence of bronchiectasis. 5.09% of hospitalised patients with AECOPD had concomitant bronchiectasis, with a higher frequency in men and older persons.…”