SESSION TITLE: COPD Exacerbation Risk
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM
PURPOSE: Prior data suggested that among Anthonisen criteria only an increase in sputum purulence was a predictor of clinical failure among mild to moderate COPD outpatients who did not receive antibiotics. In addition the use of a point-of-care C-reactive protein (CRP) test (cutoff > 40 mg/L) significantly increased the predictive accuracy of failure. However, limited data are available regarding the translation of these findings among hospitalized acutely exacerbated COPD (AECOPD) patients who did not receive antibiotics. Our aim was to determine the risk factors associated with not receiving antibiotics among hospitalized AECOPD patients and the impact on 1-year pneumonia hospitalization rate.
METHODS: We used a prospectively collected dataset included in the EXODUS (Exacerbations of Obstructive Lung disease managed in UK Secondary care) study of COPD patients admitted to one of 12 hospitals around the United Kingdom between 2009 and 2011. Inclusion criteria were hospitalized AECOPD who did not receive antibiotics during admission. Primary outcomes were prediction of receiving antibiotics during hospital admission and 1-year pneumonia hospitalization rate as the dependent variable in the multivariate logistic regression analysis.
RESULTS: Our cohort identified 1421 hospitalized AECOPD patients, of whom n=259 (18%) did not receive antibiotics on admission. There were no statistical significant differences regarding age, gender, comorbid conditions, lung function and COPD therapies among AECOPD patients who did not receive antibiotics and the patients who received antibiotic therapy. However, patients who did not receive antibiotics were more likely to have Anthonisen criteria Type 3 (mild exacerbation) (31% vs. 19%, p<0.001). After correcting for severity of AECOPD by Anthonisen criteria, AECOPD patients who did not receive antibiotics were more likely to have a 1-year pneumonia related hospitalization (13.5% vs. 7.7%, Odds ratio 2.04, 95% Confidence Interval 1.34, 3.10; p=0.001).
CONCLUSIONS: Hospitalized AECOPD had different Anthonisen criteria, but not receiving antibiotics was associated with higher 1-year pneumonia related hospitalization rate. Further studies should assess if colonization with potentially pathogenic bacteria may influence these results.
CLINICAL IMPLICATIONS: Understanding antibiotic selection and initiation in AECOPD hospitalized patients may predict need for hospitalization in COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Luis Reyes, Marcos Restrepo, Oriol Sibila, Stuart Schembri, Peter Williamson, Philip Short, Ahsan Akram, Aran Singanayagam, James Chalmers
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