To ascertain 6-month post-discharge rates of hospital readmissions and mortality and evaluate factors predicted of re-hospitalizations and mortality in patients with acute exacerbation of COPD (AECOPD).
We conducted a prospective cohort study of 155 patients with moderate to severe COPD who were admitted for acute exacerbations to two large general hospitals, and determined hospital readmissions and mortality for AECOPD during a 6-month follow up period. Information on potential risk factors, including socio-demographic characteristics, clinical and functional status, patient care, and quality of life (St George quality of life, SGQOL) was collected during hospitalization.
During the 6-month post-discharge period, 76 patients (49%) had at least one hospital readmissions, and 21 (13.5%) patients died. Multivariate analysis revealed that hospital readmissions were predicted by previous frequent readmissions (OR= 5.12; 95% CI: 2.52 to10.42) and FEV1<45% predicted (OR= 2.16; 95% CI: 1.07 to 4.39); worse Symptoms Score of SGQOL was shown to be a significant predictor of readmissions in univariate analysis but not multivariate analysis. Mortality was significantly predicted by previous frequent readmissions (OR= 5.13; 95% CI: 1.51 to17.37), older age (OR= 4.43; 95% CI: 1.27 to15.46), FEV1<45% predicted (OR= 3.28; 95% CI: 1.00 to 10.72), and poor patient compliance (OR= 3.47; 95% CI: 1.03 to 11.65). Univariate analysis also showed that mortality was significantly predicted by lower BMI and psychiatric disorder, but they were not significant predictors in multivariate analyses.
Readmission and mortality for COPD exacerbation were predicted by disease severity, psychosocial and health care factors.
Modifications of these factors are potential methods for the decrease of mortality and hospital readmission in patients with acute exacerbations of COPD.
C. Zhenying, Gerontological Research Programme, NUS