Natural history of COPD is characterized by intermittent COPD exacerbations. COPD exacerbations often require hospitalization, are associated with significant morbidity and mortality, and contribute to the rising cost of care for these patients. Studies have shown that more than 13% of hospitalizations are from COPD exacerbations. Knowledge of patient characteristics and their role in causation and outcome in COPD exacerbation is crucial. Our study analyzed multiple variables to determine their effect on length of stay and outcome in patients hospitalized to the non ICU settings.
Our study is a retrospective analysis of admissions for COPD exacerbations at two tertiary care hospitals in Winnipeg, Canada. The preliminary results include 45 consecutive admissions. Multiple variables for each admission were recorded. These included outpatient therapy, previous admissions, laboratory results, pre-admission pulmonary function tests, sputum cultures, and antibiotic use. Statistical analysis was carried out to determine if these variables had a significant effect on length of stay or outcome.
The majority of admissions were for female patients (63.4%). Average age was approximately 69.9 years. A significant proportion of patients had no co-morbid conditions (82.9%). Absolute mean outpatient FEV1 was 0.89L/sec. Average length of stay was 10 days. Neither the use of home oxygen (p=0.6836) nor the use of inhaled corticosteroids (p=0.5565) was found to correlate with patient outcome. Outpatient FEV1 or the sputum culture positivity did not predict patient outcome. The only variable that achieved significance for predicting outcome was antibiotic use. Patients who received antibiotic of any type, were more likely to be discharged home (p=.0263). None of the variables affected length of hospital stay.
Outcome of patients admitted for COPD exacerbation in non ICU setting is excellent as only 1 out of 45 consecutive patients died. FEV1, other comorbidities and treatment modalities did not affect the outcome.
Patients with COPD exacerbation consume significant resources but have a much lower mortality. Further efforts should be directed at earlier discharge planning and shortening length of stay in these patients.
M. Gupta, None.