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Erschienen in: Lung 2/2018

14.02.2018 | COPD

Readmission Due to Exacerbation of COPD: Associated Factors

verfasst von: Alicia Cerezo Lajas, Enrique Gutiérrez González, César Llorente Parrado, Luis Puente Maestu, Javier de Miguel-Díez

Erschienen in: Lung | Ausgabe 2/2018

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Abstract

Objectives

To compare characteristics of patients readmitted after discharge by chronic obstructive pulmonary disease (COPD) exacerbation with those who were not readmitted and to identify factors associated with readmission risk.

Patients and Methods

We randomly selected a group of 40 COPD patients with high frequency of readmissions (HFR), who had ≥ 2 admissions by COPD exacerbation within 30 days after the last admission in 2015, and another group of 40 COPD patients with low frequency of readmissions (LFR), with 0–1 admissions in that period.

Results

Patients of the HFR group, compared to those in LFR group, were more frequently males (p = 0.009), older (p = 0.022), had a higher degree of dyspnea (p = 0.044), worse lung function (p = 0.049), belonged more frequently to exacerbator emphysema phenotype (p < 0.001), and had a higher frequency of diabetes (p = 0.049). The variables independently associated with increased risk of HFR were sex (OR 0.06, 95% CI 0.01–0.63, in women in relation to males), exacerbator emphysema phenotype (OR 28.61, 95% CI 3.59 compared to non-exacerbator phenotype), complications during hospitalization (OR 0.09, 95% CI 0.01–0.62, compared with those without complications), destabilized heart failure (OR 5.25, 95% CI 1.11–24.75, compared to those who did not), and length of hospital stay (OR 0.79, 95% CI 0.65–0.95, per day).

Conclusions

Chronic obstructive pulmonary disease patients with HFR are more frequently male, older, have worse dyspnea, lower lung function, belong more frequent to exacerbator emphysema phenotype, and more frequently diabetics. The variables that continued to be independent predictors of HFR in the multivariate analysis were sex, phenotype, occurrence of complications during admission, destabilized heart failure, and length of hospital stay.
Literatur
1.
Zurück zum Zitat Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J et al (2017) Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 195:557–582CrossRefPubMed Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J et al (2017) Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 195:557–582CrossRefPubMed
2.
Zurück zum Zitat Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA et al (2017) Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017. Pharmacological treatment of stable phase. Arch Bronconeumol 53:324–335PubMed Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA et al (2017) Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017. Pharmacological treatment of stable phase. Arch Bronconeumol 53:324–335PubMed
3.
Zurück zum Zitat Escarrabill J, Torrente E, Esquinas C, Hernández C, Monsó E, Freixas M et al (2015) Clinical audit of patients hospitalized due to COPD exacerbation. MAG-1 study. Arch Bronconeumol 51:483–489PubMed Escarrabill J, Torrente E, Esquinas C, Hernández C, Monsó E, Freixas M et al (2015) Clinical audit of patients hospitalized due to COPD exacerbation. MAG-1 study. Arch Bronconeumol 51:483–489PubMed
4.
Zurück zum Zitat Llauger Roselló MA, Pou MA, Domínguez L, Freixas M, Valverde P, Valero C (2011) Treating COPD in chronic patients in a primary-care setting. Arch Bronconeumol 47:561–570CrossRefPubMed Llauger Roselló MA, Pou MA, Domínguez L, Freixas M, Valverde P, Valero C (2011) Treating COPD in chronic patients in a primary-care setting. Arch Bronconeumol 47:561–570CrossRefPubMed
6.
Zurück zum Zitat Calle Rubio M, Morales Chacón B, Rodríguez Hermosa JL (2010) Exacerbation of chronic obstructive pulmonary disease. Arch Bronconeumol 46(Suppl 7):21–25CrossRefPubMed Calle Rubio M, Morales Chacón B, Rodríguez Hermosa JL (2010) Exacerbation of chronic obstructive pulmonary disease. Arch Bronconeumol 46(Suppl 7):21–25CrossRefPubMed
8.
Zurück zum Zitat Nasser R, Epstein D, Azzam R, Gofman I, Saliba W, Hardak E et al (2017) The effect of clinical and physiological instability at discharge following hospitalization for acute exacerbation of COPD on early readmission: a cohort study. Chest 151:1192–1194CrossRefPubMed Nasser R, Epstein D, Azzam R, Gofman I, Saliba W, Hardak E et al (2017) The effect of clinical and physiological instability at discharge following hospitalization for acute exacerbation of COPD on early readmission: a cohort study. Chest 151:1192–1194CrossRefPubMed
9.
Zurück zum Zitat Goto T, Faridi MK, Gibo K, Toh S, Hanania NA, Camargo CA Jr et al (2017) Trends in 30-day readmission rates after COPD hospitalization, 2006–2012. Respir Med 130:92–97CrossRefPubMed Goto T, Faridi MK, Gibo K, Toh S, Hanania NA, Camargo CA Jr et al (2017) Trends in 30-day readmission rates after COPD hospitalization, 2006–2012. Respir Med 130:92–97CrossRefPubMed
10.
Zurück zum Zitat De Granda-Orive JI, Solano-Reina S (2016) Chronic obstructive pulmonary disease mortality. SEPAR COPD-Smoking year. Arch Bronconeumol 52:407–408PubMed De Granda-Orive JI, Solano-Reina S (2016) Chronic obstructive pulmonary disease mortality. SEPAR COPD-Smoking year. Arch Bronconeumol 52:407–408PubMed
11.
Zurück zum Zitat McGhan R, Radcliff T, Fish R, Sutherland ER, Welsh C, Make B (2007) Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 132:1748–1755CrossRefPubMed McGhan R, Radcliff T, Fish R, Sutherland ER, Welsh C, Make B (2007) Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 132:1748–1755CrossRefPubMed
12.
Zurück zum Zitat Vidal García I, Calvo Álvarez U, Lijó Carballeda C, Souto Alonso A, Diego Roza C, Mejuto Martí MJ et al (2012) Características de pacientes con EPOC ingresados por exacerbación en el área sanitaria de Ferrol. Pneuma 8:4–7 Vidal García I, Calvo Álvarez U, Lijó Carballeda C, Souto Alonso A, Diego Roza C, Mejuto Martí MJ et al (2012) Características de pacientes con EPOC ingresados por exacerbación en el área sanitaria de Ferrol. Pneuma 8:4–7
13.
Zurück zum Zitat Sharif R, Parekh TM, Pierson KS, Kuo YF, Sharma G (2014) Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 11:685–694CrossRefPubMedPubMedCentral Sharif R, Parekh TM, Pierson KS, Kuo YF, Sharma G (2014) Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 11:685–694CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Lau CS, Siracuse BL, Chamberlain RS (2017) Readmission after COPD exacerbation scale: determining 30-day readmission risk for COPD patients. Int J Chron Obstruct Pulmon Dis 12:1891–1902CrossRefPubMedPubMedCentral Lau CS, Siracuse BL, Chamberlain RS (2017) Readmission after COPD exacerbation scale: determining 30-day readmission risk for COPD patients. Int J Chron Obstruct Pulmon Dis 12:1891–1902CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Roberts MH, Clerisme-Beaty E, Kozma CM, Paris A, Slaton T, Mapel DW (2016) A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulm Med 16:68CrossRefPubMedPubMedCentral Roberts MH, Clerisme-Beaty E, Kozma CM, Paris A, Slaton T, Mapel DW (2016) A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulm Med 16:68CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Nishimura K, Izumi T, Tsukino M, Oga T (2002) Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 121:1434–1440CrossRefPubMed Nishimura K, Izumi T, Tsukino M, Oga T (2002) Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 121:1434–1440CrossRefPubMed
17.
Zurück zum Zitat Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA (1999) Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 54:581–586CrossRefPubMedPubMedCentral Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA (1999) Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 54:581–586CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Gaude GS, Rajesh BP, Chaudhury A, Hattiholi J (2015) Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization. Lung India 32:465–472CrossRefPubMedPubMedCentral Gaude GS, Rajesh BP, Chaudhury A, Hattiholi J (2015) Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization. Lung India 32:465–472CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Shah T, Press VG, Huisingh-Scheetz M, White SR (2016) COPD readmissions: addressing COPD in the era of value-based healthcare. Chest 150:916–926CrossRefPubMedPubMedCentral Shah T, Press VG, Huisingh-Scheetz M, White SR (2016) COPD readmissions: addressing COPD in the era of value-based healthcare. Chest 150:916–926CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Tsoumakidou M, Tzanakis N, Voulgaraki O, Mitrouska I, Chrysofakis G, Samiou M et al (2004) Is there any correlation between the ATS, BTS, ERS and GOLD COPD’s severity scales and the frequency of hospital admissions? Respir Med 98:178–183CrossRefPubMed Tsoumakidou M, Tzanakis N, Voulgaraki O, Mitrouska I, Chrysofakis G, Samiou M et al (2004) Is there any correlation between the ATS, BTS, ERS and GOLD COPD’s severity scales and the frequency of hospital admissions? Respir Med 98:178–183CrossRefPubMed
21.
Zurück zum Zitat Castillo A, Edriss H, Selvan K, Nugent K (2017) Characteristics of patients with congestive heart failure or chronic obstructive pulmonary disease readmissions within 30 days following an acute exacerbation. Qual Manag Health Care 26:152–159CrossRefPubMed Castillo A, Edriss H, Selvan K, Nugent K (2017) Characteristics of patients with congestive heart failure or chronic obstructive pulmonary disease readmissions within 30 days following an acute exacerbation. Qual Manag Health Care 26:152–159CrossRefPubMed
22.
Zurück zum Zitat Almagro P, Cabrera FJ, Díez J, Boixeda R, Alonso Ortiz MB, Murio C et al (2012) Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study. Chest 142:1126–1133CrossRefPubMed Almagro P, Cabrera FJ, Díez J, Boixeda R, Alonso Ortiz MB, Murio C et al (2012) Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study. Chest 142:1126–1133CrossRefPubMed
23.
Zurück zum Zitat De Miguel Díez J, Gómez García T, Puente Maestu L (2010) Comorbidities in COPD. Arch Bronconeumol 46(Suppl 11):20–25CrossRefPubMed De Miguel Díez J, Gómez García T, Puente Maestu L (2010) Comorbidities in COPD. Arch Bronconeumol 46(Suppl 11):20–25CrossRefPubMed
24.
Zurück zum Zitat González G, Servera E, Ferris G, Blasco ML, Marín J (2004) Risk factors of readmission in acute exacerbation of moderate-to-severe chronic obstructive pulmonary disease. Arch Bronconeumol 40:502–507CrossRefPubMed González G, Servera E, Ferris G, Blasco ML, Marín J (2004) Risk factors of readmission in acute exacerbation of moderate-to-severe chronic obstructive pulmonary disease. Arch Bronconeumol 40:502–507CrossRefPubMed
25.
Zurück zum Zitat Simmering JE, Polgreen LA, Comellas AP, Cavanaugh JE, Polgreen PM (2016) Identifying patients with COPD at high risk of readmission. Chronic Obstr Pulm Dis 3:729–738PubMedPubMedCentral Simmering JE, Polgreen LA, Comellas AP, Cavanaugh JE, Polgreen PM (2016) Identifying patients with COPD at high risk of readmission. Chronic Obstr Pulm Dis 3:729–738PubMedPubMedCentral
26.
Zurück zum Zitat Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R et al (2017) The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD. Thorax 72:686–693CrossRefPubMedPubMedCentral Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R et al (2017) The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD. Thorax 72:686–693CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Alfageme I, Vázquez R, Reyes N, Muñóz J, Fernández A, Hernández M et al (2006) Clinical efficacy of anti-pneumococcal vaccination in patients with COPD. Thorax 61:189–195CrossRefPubMed Alfageme I, Vázquez R, Reyes N, Muñóz J, Fernández A, Hernández M et al (2006) Clinical efficacy of anti-pneumococcal vaccination in patients with COPD. Thorax 61:189–195CrossRefPubMed
28.
Zurück zum Zitat Lee TA, Weaver FM, Weiss KB (2007) Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma. J Gen Intern Med 22:62–67CrossRefPubMedPubMedCentral Lee TA, Weaver FM, Weiss KB (2007) Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma. J Gen Intern Med 22:62–67CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Schembri S, Morant S, Winter JH, MacDonald TM (2009) Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax 64:567–572CrossRefPubMed Schembri S, Morant S, Winter JH, MacDonald TM (2009) Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax 64:567–572CrossRefPubMed
30.
Zurück zum Zitat Schenkein JG, Nahm MH, Dransfield MT (2008) Pneumococcal vaccination for patients with COPD: current practice and future directions. Chest 133:767–774CrossRefPubMed Schenkein JG, Nahm MH, Dransfield MT (2008) Pneumococcal vaccination for patients with COPD: current practice and future directions. Chest 133:767–774CrossRefPubMed
31.
Zurück zum Zitat Jurado Gámez B, Feu Collado N, Jurado García JC, García Gil F, Muñoz Gomariz E, Jiménez Murillo L et al (2013) Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada. Arch Bronconeumol 49:10–14CrossRefPubMed Jurado Gámez B, Feu Collado N, Jurado García JC, García Gil F, Muñoz Gomariz E, Jiménez Murillo L et al (2013) Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada. Arch Bronconeumol 49:10–14CrossRefPubMed
32.
Zurück zum Zitat Groenewegen KH, Schols AM, Wouters EF (2003) Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 124:459–467CrossRefPubMed Groenewegen KH, Schols AM, Wouters EF (2003) Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 124:459–467CrossRefPubMed
33.
Zurück zum Zitat Almagro P, Barreiro B, Ochoa de Echaguen A, Quintana S, Rodriguez Carballeira M, Heredia JL (2006) Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease. Respiration 73:311–317CrossRefPubMed Almagro P, Barreiro B, Ochoa de Echaguen A, Quintana S, Rodriguez Carballeira M, Heredia JL (2006) Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease. Respiration 73:311–317CrossRefPubMed
34.
Zurück zum Zitat Villar Álvarez F, Méndez Bailón M, De Miguel Díez J (2009) Chronic obstructive pulmonary disease and heart failure. Arch Bronconeumol 45:387–393CrossRefPubMed Villar Álvarez F, Méndez Bailón M, De Miguel Díez J (2009) Chronic obstructive pulmonary disease and heart failure. Arch Bronconeumol 45:387–393CrossRefPubMed
35.
Zurück zum Zitat Echave-Sustaeta J, Comeche Casanova L, García Luján R, Sayas Catalan J, de la Cámara AG, Encuentra AL (2010) Prognosis following acute exacerbation of COPD treated with non-invasive mechanical ventilation. Arch Bronconeumol 46:405–410CrossRefPubMed Echave-Sustaeta J, Comeche Casanova L, García Luján R, Sayas Catalan J, de la Cámara AG, Encuentra AL (2010) Prognosis following acute exacerbation of COPD treated with non-invasive mechanical ventilation. Arch Bronconeumol 46:405–410CrossRefPubMed
36.
Zurück zum Zitat Chu CM, Chan VL, Lin AWN, Wong IWY, Leung WS, Lai CKW (2004) Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax 59:1020–1025CrossRefPubMedPubMedCentral Chu CM, Chan VL, Lin AWN, Wong IWY, Leung WS, Lai CKW (2004) Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax 59:1020–1025CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Hartl S, Lopez-Campos JL, Pozo-Rodriguez F, Castro-Acosta A, Studnicka M, Kaiser B et al (2016) Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J 47:113–121CrossRefPubMed Hartl S, Lopez-Campos JL, Pozo-Rodriguez F, Castro-Acosta A, Studnicka M, Kaiser B et al (2016) Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J 47:113–121CrossRefPubMed
38.
Zurück zum Zitat Maciá Soler L, Latour Pérez J, Moncho Vasallo J, Mariscal Crespo MI, Orts Cortés MI (2011) Modelo de hospitalización y frecuencia de reingreso en pacientes con exacerbación de EPOC. Enferm Glob 10:1–10 Maciá Soler L, Latour Pérez J, Moncho Vasallo J, Mariscal Crespo MI, Orts Cortés MI (2011) Modelo de hospitalización y frecuencia de reingreso en pacientes con exacerbación de EPOC. Enferm Glob 10:1–10
39.
Zurück zum Zitat Sundararajan L, Balami J, Packham S (2010) Effectiveness of outpatient pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 30:121–125CrossRefPubMed Sundararajan L, Balami J, Packham S (2010) Effectiveness of outpatient pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 30:121–125CrossRefPubMed
40.
Zurück zum Zitat Williams V, Bruton A, Ellis-Hill C, McPherson K (2010) The effect of pulmonary rehabilitation on perceptions of breathlessness and activity in COPD patients: a qualitative study. Prim Care Respir J 19:45–51CrossRefPubMed Williams V, Bruton A, Ellis-Hill C, McPherson K (2010) The effect of pulmonary rehabilitation on perceptions of breathlessness and activity in COPD patients: a qualitative study. Prim Care Respir J 19:45–51CrossRefPubMed
41.
Zurück zum Zitat Hansen LO, Young RS, Hinami K, Leung A, Williams MV (2011) Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155:520–528CrossRefPubMed Hansen LO, Young RS, Hinami K, Leung A, Williams MV (2011) Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155:520–528CrossRefPubMed
Metadaten
Titel
Readmission Due to Exacerbation of COPD: Associated Factors
verfasst von
Alicia Cerezo Lajas
Enrique Gutiérrez González
César Llorente Parrado
Luis Puente Maestu
Javier de Miguel-Díez
Publikationsdatum
14.02.2018
Verlag
Springer US
Erschienen in
Lung / Ausgabe 2/2018
Print ISSN: 0341-2040
Elektronische ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-018-0093-y

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