In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study

Ho, Te-Wei; Tsai, Yi-Ju; Ruan, Sheng‐Yuan; Huang, Chun-Ta; Lai, Feipei; Yu, Chong‐Jen

doi:10.1371/journal.pone.0114866

Cited by 93 publications

(80 citation statements)

References 45 publications

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“…This study confirms age as a risk factor for one-year mortality as shown by other authors (Connors et al, 1996; Almagro et al, 2002; Groenewegen, Schols & Wouters, 2003; Kim, Clark & Camargo, 2006; Piquet et al, 2013; Ho et al, 2014). Male gender is also associated with increased mortality, although not statistically significant.…”

Section: Discussionsupporting

confidence: 92%

“…One-year mortality in COPD patients is 4.3–43%, depending on the subgroup examined (Table 1) (Connors et al, 1996; Almagro et al, 2002; Groenewegen, Schols & Wouters, 2003; Kim, Clark & Camargo, 2006; Coleta et al, 2008; Fan et al, 2007; Gershon et al, 2010; Piquet et al, 2013; Ho et al, 2014; Müllerova et al, 2015). Mortality shows a downward trend in recent studies.…”

Section: Introductionmentioning

confidence: 99%

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One-year mortality after severe COPD exacerbation in Bulgaria

Mekov

Slavova

Tsakova

et al. 2016

PeerJ

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IntroductionOne-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined.AimTo examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients’ characteristics and comorbidities.MethodsA total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM), arterial hypertension (AH), and metabolic syndrome (MS). Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register.ResultsOne-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%, p = 0.107). There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%, p = 0.013). The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%, p = 0.009). There is a trend for increased mortality in the group with FEV1 < 50% (11.5 vs. 4.4%, p = 0.094). Cox regression shows 3.7% increase in mortality rate for 1% decrease in FEV1, 5.2% for 1% decrease in PEF, 7.8% for one year age increase and 8.1% for 1 CAT point increase (all p < 0.05).ConclusionsThis study finds relatively low one-year mortality in COPD patients after surviving severe exacerbation. Grade C and FEV1 > 80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

One-year mortality after severe COPD exacerbation in Bulgaria

Mekov

Slavova

Tsakova

et al. 2016

PeerJ

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“…In-hospital mortality for COPD varies from between < 10% and 60%, based on the severity level of the population studied 50 and the 1-year rate is about one in four (28% for Canadian discharge data between 2001 and 2004; 51 and 25% within 1 year of admission for the first acute exacerbation between 2005 and 2007 in Taiwan). 52 Our mortality rate within 1 year of an index COPD admission was 24%.…”

Section: Comparison With Previous Workmentioning

confidence: 71%

Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study

Bottle

Honeyford

Chowdhury

et al. 2018

Health Serv Deliv Res

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BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete.ObjectivesTo model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions.DesignObservational study.SettingEnglish NHS.ParticipantsAll patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.InterventionsNone.Main outcome measuresOne-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD.Data sourcesPatient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information.ResultsOne-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor;p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase;p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP;p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98;p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator.LimitationsData lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated.ConclusionsFollowing an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators.Future workHospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Unlike osteoporosis, in which the most common cause of mortality is fractures, 26,27 mortality related to COPD is multifactorial and includes exacerbations of COPD, respiratory infections, and worsening of other medical illnesses that are commonly comorbid with COPD, including coronary artery disease, heart failure, hypertension, and stroke. 25,28,29 Literature in nondepressed patients with COPD has shown that advanced age, overall medical burden, exercise tolerance, daily physical activity, home oxygen therapy use or noninvasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing are associated with mortality on follow-up. 25,[30][31][32] These findings suggest that overall debility predicts mortality in patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

“…25,28,29 Literature in nondepressed patients with COPD has shown that advanced age, overall medical burden, exercise tolerance, daily physical activity, home oxygen therapy use or noninvasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing are associated with mortality on follow-up. 25,[30][31][32] These findings suggest that overall debility predicts mortality in patients with COPD.…”

Section: Discussionmentioning

confidence: 99%