Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

Abstract

Background and ObjectiveTwenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients.MethodsThe cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years.ResultsPatients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5).ConclusionIn conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death.

Exacerbations of COPD

“…The most important prognostic factor was exacerbation-related hospitalisation. In particular, readmission within 30 days after COPD exacerbation was correlated with an increased risk of mortality [28]. The most important predictor of frequent exacerbations is a history of exacerbations [29].…”

Association between Emergency Visits with Acute Exacerbation and Exercise Performance in Chronic Obstructive Pulmonary Disease

“…It was stated that COPD patients with low pulmonary functions and poor dyspnea scores returned to hospital within 30 days after hospital discharge (23). In another study, dyspnea was considered to be a significant risk factor for hospital revisits (24).…”

Clinical Factors Associated with an Increased Risk of Death at and During Hospitalization for an Acute Exacerbation of COPD (AECOPD) and for a Short Period after Discharge

“…In the context of post-discharge mortality, early hospital readmission for a new event of AECOPD (for example, in a period within 30 days from discharge) is a variable that "per se" influences prognosis of patients. Although several variables have been found to be predictors of early readmission [20][21][22] , in fact, is has been demonstrated that readmission of patients to hospital in this period have a higher subsequent and progressive risk of death until in long follow-up period of 3-year [23] . Starting from the concept that a predictor of a 30-day readmission is the variable ≥ 2 previous exacerbation in a period of 1-year prior to index hospitalization (Hazard Ratio-HR = 2.47, 95% CI 1.51-4.05, p < 0.001) [23] , the relationship in the events of AECOPD between the past and the prognosis is very close.…”

“…Although several variables have been found to be predictors of early readmission [20][21][22] , in fact, is has been demonstrated that readmission of patients to hospital in this period have a higher subsequent and progressive risk of death until in long follow-up period of 3-year [23] . Starting from the concept that a predictor of a 30-day readmission is the variable ≥ 2 previous exacerbation in a period of 1-year prior to index hospitalization (Hazard Ratio-HR = 2.47, 95% CI 1.51-4.05, p < 0.001) [23] , the relationship in the events of AECOPD between the past and the prognosis is very close. Moreover, a study published in 2012 reported the presence of at least one previous exacerbation of COPD in the previous year [OR = 3.9, 95% CI 1.6-9.9, p = 0.004)] [19] as an independent predictor of adverse outcome defined by death during hospitalisation or the 1-month follow-up.…”