Impact of comorbidities on the duration of COPD patients' hospital episodes

Kinnunen, Tuija; Säynäjäkangas, Olli; Tuuponen, T; Keistinen, Timo

doi:10.1053/rmed.2003.1438

Cited by 33 publications

(23 citation statements)

References 9 publications

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“…Surprisingly and contrary to some previous studies [4,5,6,7,8,9,17,18], age and comorbidities did not affect outcome, nor even did cardiovascular diseases, which were highly prevalent in our cohort. This is consistent with Anzueto [36] reporting that cardiac comorbidity is a risk factor for poor outcome in moderate COPD patients, but impairment of respiratory function prevails over cardiac disease in more severe COPD (our patients were hospitalised for an exacerbation and 76% were in GOLD stage III or IV).…”

Section: Discussioncontrasting

confidence: 99%

“…Some of the most frequently recognised predictors of mortality are higher age, lower BMI, lower FEV 1 , hypercapnia, hypoxaemia, hypoalbuminaemia, comorbidity, cor pulmonale, previous exacerbations or admissions, LTOT and severity of dyspnoea [4,5,6,7,8,9,10,11,12,13]. Furthermore, factors associated with prolonged hospitalisations include higher respiratory rate, dyspnoea, comorbidity, cor pulmonale and weekend admission [12,16,17]. Readmissions after hospitalisation for an exacerbation are frequent events, ranging from 14 to 16% in the first month after discharge and 25–58% in the first year [5,19].…”

Section: Discussionmentioning

confidence: 99%

“…need for hospitalisation, ICU admission, length of hospital stay, changes in lung function and HRQL, readmission or mortality) [4,5,6,7,8,9,10,11,12,13,16,17,18,19,20,21]. Regarding exacerbations requiring hospital treatment, some of the most frequently recognised risk factors for mortality and readmission are age, low body mass index (BMI), low forced expiratory volume in 1 s (FEV 1 ), hypercapnia, need for long-term oxygen therapy (LTOT), comorbidity and previous exacerbations [4,5,6,7,8,9,10,11,12,13,18,19,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Adverse Outcome in Patients Hospitalised for Exacerbation of Chronic Obstructive Pulmonary Disease

Matković

Huerta²,

Soler³

et al. 2012

Respiration

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Background: It is crucial to identify risk factors for poor evolution of patients admitted to hospital with chronic obstructive pulmonary disease (COPD) in order to provide adequate intensive therapy and closer follow-up. Objectives: To identify predictors of adverse outcomes in patients hospitalised for exacerbation of COPD. Methods: A prospective, observational study was conducted in patients admitted for exacerbation of COPD. Demographic and clinical parameters were evaluated, including different multidimensional prognostic scores. Adverse outcomes included the following: death during hospitalisation or 1-month follow-up, intensive care unit admission, invasive or non-invasive mechanical ventilation, prolonged hospitalisation (>11 days) and COPD-related emergency visit or readmission within 1 month after discharge. Univariate and multivariate analysis were performed. Results: Of 155 patients included, an adverse outcome occurred in 69 (45%). Patients with an adverse outcome had lower forced expiratory volume in 1 s (p = 0.004) and more frequent exacerbations (p = 0.011), more frequently used oxygen at home (p = 0.042) and presented with lower pH (p < 0.001), lower ratio of arterial oxygen pressure to the fraction of inspired oxygen (p = 0.006), higher arterial carbon dioxide pressure (p < 0.001) and a worse score on several prognostic indices at admission. Independent predictors of adverse outcome were exacerbation of COPD in the previous year [odds ratio 3.9, 95% confidence interval (CI) 1.6–9.9; p = 0.004], hypercapnia (odds ratio 9.4, 95% CI 3.7–23.6; p < 0.001) and hypoxaemia (odds ratio 4.3, 95% CI 1.5–12.6; p = 0.008). In the presence of all three characteristics, the probability of an adverse outcome was 95%, while hypercapnia was the strongest prognostic factor with a risk of 54%. Conclusions: Patients with previous exacerbation of COPD, hypercapnia and hypoxaemia had the highest risk of an unfavourable evolution. The calculation of prognostic indices did not provide additional discriminative power.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Adverse Outcome in Patients Hospitalised for Exacerbation of Chronic Obstructive Pulmonary Disease

Matković

Huerta²,

Soler³

et al. 2012

Respiration

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“…8,9,20,28,29 It is reasonable to expect stay to be longer in subjects with multiple underlying health conditions. A Charlson comorbidity index score Ն 3 in our study identified subjects with prolonged stay.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

et al. 2014

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BACKGROUND: Hospital admissions for COPD exacerbations account for 70% of total costs of COPD treatment, and the duration of hospital stay is directly related to this cost. The aim of this study was to investigate possible associations of demographic, clinical, laboratory, and functional parameters with stay of subjects admitted for COPD exacerbations and to provide a score for the prediction of the need for prolonged hospitalization. METHODS: We included 164 consecutive subjects admitted to 2 respiratory medicine departments of 2 tertiary hospitals for a COPD exacerbation, and we evaluated laboratory, clinical, and functional parameters possibly related to the duration of hospital stay. RESULTS: Seven parameters evaluated on subject admission (Antonisen type of exacerbation, number of Exacerbations in the previous year, Charlson index of comorbidities, Oxygenation, Partial pressure of P aCO 2 in arterial blood gases, Dyspnea according to the Borg dyspnea scale, and history of chronic respiratory Failure) were able to predict stay and were included in a simple score named AECOPD-F. The area under the curve of the score for the prediction of prolonged hospital stay is 0.960, and a cutoff point > 3 predicts prolonged stay with a sensitivity of 84.5% and a specificity of 92.5% (95% CI 0.917-0.984). The AECOPD-F score was validated in a second group of 88 subjects admitted to the hospital for a COPD exacerbation. In the validation group, subjects with a score > 3 required prolonged stay compared with those with a score < 3 (8.0 [6.0 -10.0] vs 6.5 [4.0 -9.0] d, respectively, P ‫؍‬ .007). CONCLUSION: The AECOPD-F score could accurately predict stay in hospitalized COPD subjects. The implementation of this score in clinical practice could be useful in the discharge planning of such subjects.

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“…Co-morbid conditions, such as cardiovascular disease often coexist with COPD, leading to worse outcomes 2 . Both co-morbidity and increasing age are associated with less effective COPD self-management 3 , more frequent hospitalisation 4 and higher mortality [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Walker

Pompilio²,

Zanaboni

et al. 2018

Am J Respir Crit Care Med

125

130

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Scientific Knowledge on the Subject: Despite observational studies suggesting that COPD exacerbation can be detected using a combination of symptoms and physiological measures, such as pulse and oxygen saturation, larger randomized controlled trials have not shown any effect of telemonitoring on time to first hospital admission (TTFH), hospitalization and quality of life. Tested tele-monitoring programs had a negligible impact on healthcare costs, and, in some cases, resulted in an increased healthcare utilisation. What This Study Adds to the Field:This randomized controlled trial of 312 COPD patients is the first using only objective lung function data measured daily by the forced oscillation technique to prompt early intervention. Despite being feasible and well accepted by patients, this approach did not affect TTFH and quality of life. However, it significantly reduced healthcare costs, mostly due to a reduction in duration and frequency of subsequent hospitalisations, which was greatest in patients hospitalised the year before recruitment.This article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org 3 AbstractRationale Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation.Objectives To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities.Methods This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49.6% grade II, 50.4% grade III-IV), with a history of exacerbation in the previous year and at least one non-pulmonary co-morbidity. Patients were randomised to usual care (n=158) or tele-monitoring (n=154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily and in a subgroup with congestive heart failure (n=37) cardiac parameters were monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. Measurements and Main resultsPrimary outcomes were time to first hospitalisation (TTFH) and change in EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescriptions, hospitalisation, CAT, PHQ-9 and MLHF questionnaire scores, quality-adjusted life years and healthcare costs. Tele-monitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores. Tele-medicine was associated with fewer repeat hospitalizations (-54%, p=0.017). Previously hospitalised patients showed the greatest reduction in hospitalization rate (-53%, p=0.017) with large potential for cost savings (-3736€/patient/year, p=0.010). ConclusionsIn older COPD patients with co-morbidities remote monitoring of lung function by FOT and cardiac parameters did not change TTFH and EQ-5D. However patients at risk of hospitalisation may benefit fr...

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Impact of comorbidities on the duration of COPD patients' hospital episodes

Cited by 33 publications

References 9 publications

Predictors of Adverse Outcome in Patients Hospitalised for Exacerbation of Chronic Obstructive Pulmonary Disease

Predictors of Adverse Outcome in Patients Hospitalised for Exacerbation of Chronic Obstructive Pulmonary Disease

Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

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