Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression

Abstract

The aim of the present study was to analyse the risk of rehospitalisation in patients with chronic obstructive pulmonary disease and associated risk factors.This prospective study included 416 patients from a university hospital in each of the five Nordic countries. Data included demographic information, spirometry, comorbidity and 12 month followup for 406 patients. The hospital anxiety and depression scale and St. George's Respiratory Questionnaire (SGRQ) were applied to all patients.The number of patients that had a re-admission within 12 months was 246 (60.6%). Patients that had a re-admission had lower lung function and health status. A low forced expiratory volume in one second (FEV1) and health status were independent predictors for re-admission. Hazard ratio (HR; 95% CI) was 0.82 (0.74-0.90) per 10% increase of the predicted FEV1 and 1.06 (1.02-1.10) per 4 units increase in total SGRQ score. The risk of rehospitalisation was also increased in subjects with anxiety (HR 1.76 (1.16-2.68)) and in subjects with low health status (total SGRQ score .60 units). When comparing the different subscales in the SGRQ, the closest relation between the risk of rehospitalisation was seen with the activity scale (HR 1.07 (1.03-1.11) per 4 unit increase).In patients with low health status, anxiety is an important risk factor for rehospitalisation. This may be important for patient treatment and warrants further studies. KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression, health status, rehospitalisation, risk factors C hronic obstructive pulmonary disease (COPD) is associated with intermittent exacerbations characterised by acute deterioration in the symptoms of chronic dyspnoea, cough and sputum production. Hospitalisations because of acute exacerbations are an important part of the care of patients with COPD. Multiple studies have been conducted in order to identify risk factors for COPD hospitalisations and there is also an increasing interest in modifying the risk factors in order to reduce the rate of rehospitalisation [5]. Risk factors that have been identified in previous studies are as follows: 1) low lung function [4,6,7]; 2) increasing age [7]; 3) poor quality of life [1,8,9]; 4) low physical function [4,8]; 5) history of frequent past exacerbations [1]; 6) history of previous admissions [4,6]; 7) under prescription of long-term oxygen therapy [6]; 8) hypercapnoea; and 9) pulmonary hypertension [10]. Interventions that decrease the risk of hospitalisations in COPD patients include vaccinations for influenza [11], smoking cessation [12] and pulmonary rehabilitation [13]. A study by DAHLÉ N and JANSON [14] found that anxiety and depression were related to a higher risk of relapse in patients with asthma and COPD that were admitted for emergency treatment. There is, however, limited data available regarding the level of anxiety and depression and the risk for hospital re-admission for COPD. There is also a lack of data on re-admission rates of COPD from Northern Europe and many previous s...

Associations between mental disorders and the common cold in adults: A population-based cross-sectional study

“…As several researchers have suggested [41][42][43][44], there is a need to routinely employ screening tools for anxiety and depression in nonpsychiatric medical settings. Anxiety and depression are associated with an increased risk of relapse rates in patients with chronic breathing disorders after treatment [38,45]. Additionally, there is a report documenting that pulmonary rehabilitation has provided improvement in both physical performance and levels of anxiety and depression in patients with chronic obstructive pulmonary disease [46].…”

Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

“…Among stable COPD patients, decreased physical activity has been shown to be associated with readmission. 20,21 Taken together, these two predictors of admission, conceptually, constitute half of the elements in the recently developed multidimensional BODE index (bodymass index, airflow obstruction, dyspnea, and exercise capacity). 22 The BODE index has been validated in predicting the risk of death and hospital admission in stable COPD patients 22,23 ; whether this index predicts admission in the emergency setting or whether other composite measures perform better deserves further research.…”

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Therefore, NIV is currently widely used as a first line treatment in patients with severe COPD-AE. The clinical features demonstrated to have an association with the development of COPD-AE include a history of prior COPD-AE, hypercapnia, a lower forced expiratory volume in one second (FEV1) % predicted, the BODE (body mass index (BMI), airflow obstruction, dyspnea and exercise capacity) index, an impaired health status, hypoxemia, pulmonary hypertension and comorbidities (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although clinical predictors of the development of COPD-AE have been investigated in a number of previous studies, those affecting the need to initiate NIV in stable COPD outpatients who develop COPD-AE have not been sufficiently studied.…”