Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia

Abstract

It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.

Influence of Pneumonia on the Survival of Patients with COPD

“…However, it is noteworthy that the decrease in survival begins to occur at 18 months from the first episode of pneumonia. This finding is consistent with those of the two previously cited studies [14,15], since there was no association between pneumonia and increased mortality at 30 days, although an association was found in the long term, possibly owing to COPD itself more than to pneumonia. This observation could be explained by the possibility that, despite being an acute disease, pneumonia leads to the deterioration of symptoms and quality of life in patients with COPD [16], which may not be fully recovered after resolution of pneumonia, thus leading to poorer long-term progress.…”

“…In their study on community-acquired pneumonia (CAP) in patients with and without COPD, Bonnesen et al [14] concluded that the presence of COPD is not a risk factor for mortality at 30 days in patients who have had an episode of community-acquired pneumonia. In contrast, Sharafkhaneh et al [15], who performed a similar study, proposed that pneumonia and COPD affect short-and long-term mortality differently, with pneumonia having a greater short-term effect, and COPD a greater long-term effect.…”

“…Various studies have shown that the presence of COPD worsens the course of patients with pneumonia [14,15], although few studies have focused on patients with COPD and thus have shown the effect of pneumonia on this disease. In this sense, Pasquale et al [16] studied symptoms and quality of life in patients diagnosed with COPD who had pneumonia, although they did not analyze data on the consumption of health care resources and mortality resulting from pneumonia.…”

Advances in the causes and management of community acquired pneumonia in adults

“…1 In addition, pneumonia is often the direct cause of death ascribed to other common causes, such as Alzheimer's disease, lung cancer, and chronic obstructive lung disease. [16][17][18] Figure 1 illustrates the difficulty in improving mortality due to CAP. Pneumonia and influenza have remained in the top 10 causes of death in the US since 1900.…”

Chronic Obstructive Pulmonary Disease and Risk of Mortality in Patients with Venous Thromboembolism—The Tromsø Study

“…40 Infection is known to be a provoking factor for VTE, 41 and concomitant respiratory infection increases the mortality risk in COPD patients. 42 Moreover, COPD represents a chronic inflammatory state which may influence the risk of adverse outcome. 43 In our study, the impact of COPD on VTE-related mortality was neither explained by concomitant cancer, infections, nor arterial cardiovascular diseases since the risk estimates of VTE-related mortality remained essentially unchanged when active cancer, acute medical conditions, and a history of MI and stroke were included in the adjustment models.…”