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Predictors of Rehospitalization and Death After a Severe Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

¹University of Colorado Health Sciences Center, Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine ²Denver Health and Hospital Authority ³Denver Veterans Affairs Medical Center ⁴University of Colorado Health Sciences Center, Department of Medicine, Division of Health Care Policy and Research ⁵National Jewish Medical and Research Center

ryanmcghan11{at}hotmail.com

Abstract

BackgroundPatients who survive a severe exacerbation of chronic obstructive pulmonary disease (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 Administration (VA) patients.

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

ResultsOn average, the cohort was elderly (mean age 69 years), predominately white (78% white, 13% black, 3% other, 6% unknown) and male (97%), consistent with the underlying population of the VA. The risk of death was 21% at one 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 one 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.

ConclusionsAge, 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 WordsPulmonary Disease, Chronic Obstructive, Exacerbation, Hospitalization, Mortality, Risk Factors, United States Department of Veterans Affairs, Population Groups, Age, Comorbidity, Race, Gender

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				D. M. Mannino Understanding COPD Hospitalizations: The Devil Is Always in the Details! Chest, December 1, 2007; 132(6): 1731 - 1732. [Full Text] [PDF]