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Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD^*

^* From the University of Colorado Health Sciences Center (Dr. Sutherland), Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine; Denver Health and Hospital Authority (Dr. McGhan); Denver Veterans Affairs Medical Center (Drs. Radcliffe and Welsh), University of Colorado Health Sciences Center (Mr. Fish), Department of Medicine, Division of Health Care Policy and Research; and National Jewish Medical and Research Center (Dr. Make), Denver, CO.

Correspondence to: Ryan McGhan, MD, 2841 DeBarr Rd, St 771, Anchorage, AK 99508; e-mail: ryanmcghan11{at}hotmail.com

Abstract

Background: Patients who survive a severe exacerbation of COPD are at high risk of rehospitalization for COPD and death. The objective of this study was to determine predictors of these events in a large cohort of Veterans Affairs (VA) patients.

Methods: We identified 51,353 patients who were discharged after an exacerbation of COPD in the VA health-care system from 1999 to 2003, and determined the rates of rehospitalization for COPD and death from all causes. Potential risk factors were assessed with univariate and multivariate survival analysis.

Results: On average, the cohort was elderly (mean age, 69 years), predominately white (78% white, 13% black, 3% other, and 6% unknown), and male (97%), consistent with the underlying VA population. The risk of death was 21% at 1 year, and 55% at 5 years. Independent risk factors for death were age, male gender, prior hospitalizations, and comorbidities including weight loss and pulmonary hypertension; nonwhite race and other comorbidities (asthma, hypertension, and obesity) were associated with decreased mortality. The risk of rehospitalization for COPD was 25% at 1 year, and 44% at 5 years, and was increased by age, male gender, prior hospitalizations, and comorbidities including asthma and pulmonary hypertension. Hispanic ethnicity and other comorbidities (diabetes and hypertension) were associated with a decreased risk of rehospitalization.

Conclusions: Age, male gender, prior hospitalizations, and certain comorbid conditions were risk factors for death and rehospitalization in patients discharged after a severe COPD exacerbation. Nonwhite race and other comorbidities were associated with decreased risk.

Key Words: age • chronic obstructive • comorbidity • exacerbation • gender • hospitalization • mortality • population groups • pulmonary disease • race • risk factors • US Department of Veterans Affairs

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