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Chronic obstructive pulmonary disease stage and risk of hospitalization for infectious disease

¹ Department of Infectious Diseases and ²Department of Cardiology and Respiratory Medicine, Hvidovre University Hospital, Copenhagen, Denmark ³The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark; and ⁴ North West Lung Centre, South Manchester University Hospital, Trust, Manchester, United Kingdom

tlb{at}dadlnet.dk

Abstract

BackgroundRespiratory tract infections are a frequent complication of chronic obstructive pulmonary disease (COPD ) but little is known about the incidence, association and risk of infectious diseases related to impaired lung function.

MethodsParticipants in the Copenhagen City Heart Study had lung function measured at baseline and were followed for up to 25 years. All hospitalizations due to any infection were identified through registry linkage. Impaired lung function was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging system.

Main resultsA total of 3333 infectious disease hospitalizations (IDH) occurred during 230653 personyears of follow up (P-Y) corresponding to an overall incidence of 145 (95% confidence interval: 139-149) IDH per 10000 P-Y. The incidence increased with GOLD stage from 131 (126-136) for normal to 170 (146-193) for mild, 230 (207-253) for moderate, and 394 (330-459) for severe/very severe COPD, respectively. The trend in risk persisted after the control of background characteristics using Cox proportional hazards analysis (adjusted relative risks: 1.06 (95% CI: 0.92-1.23), 1.39 (1.24-1.56), and 2.21 (1.84-2.64), respectively, P=0.001). In subgroup analysis, the increased risk was associated with lower and upper respiratory tract infections, pyothorax, and tuberculosis but not with influenza, sepsis, skin infections, urinary tract infections, diarrhoeal disease or other infectious diseases.

ConclusionsThe presence of obstructive lung disease is a significant predictor of infectious disease hospitalization caused by respiratory tract infections, but not of hospitalizations due to infections out site the respiratory system.

Key Words: chronic obstructive pulmonary disease • infection • lung function • hospitalization • epidemiology