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Clinical Characteristics and Outcome of Hospitalized Pneumonic COPD Exacerbation in Ramathibodi Hospital: Retrospective Review FREE TO VIEW

Theerasuk Kawamatawong; Tananchai Petnak
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Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand

Chest. 2014;146(4_MeetingAbstracts):29A. doi:10.1378/chest.1995239
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SESSION TITLE: COPD Diagnosis and Evaluation Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To identify clinical characteristics, outcome and cost of treatment of COPD patients with pneumonic exacerbations requiring hospitalization in comparison with nonpneumonic exacerbations.

METHODS: Retrospective study of hospitalized patients with diagnosis code of J441 from electronic medical record files during 2012 -2013. Chest radiography and clinical presentation were reviewed for the presence of clinically compatible pneumonia at the first 72 hours of admission. SPSS version 17 was used for data analysis

RESULTS: Total 61 episodes of hospitalized COPD exacerbation in Ramathibodi Hospital were reviewed. Patients mean age was 81.2 ±8.7 years and male patients were 72%. The previously prescribed ICS or ICS-LABA therapies were noted in 77% while LAMA was 44% of those patients. Clinically compatible pneumonia was diagnosed in 39.3% of exacerbation episodes within 72 hours of the admission. Endotracheal tube intubations were used in 29% while NIPPV uses were used 61% of admission episodes. Approximately 85.2% of patients were discharged from hospital while death was only 14.5%. However re-admissions were observed in 26% of exacerbated patients. There was no significant difference in length of stay between pneumonic and non-pneumonic COPD exacerbation (p 0.54). Furthermore, no association between history of ICS and ICS-LABA uses and the presence of pneumonic exacerbation was demonstrated (p 0.35). Regarding outcomes, deaths were noted in 6 from 18 pneumonic exacerbations while 3 from 34 in non pneumonic exacerbations died however there was not statistically significant difference (p 0.06). The significantly higher median cost of treatment for hospitalized pneumonic exacerbation was 2,679 USD (135-11,986) versus 1,357 USD (164-9,333) in patients with nonpneumonic exacerbation (p 0.04).

CONCLUSIONS: Pneumonic cause was observed in one-third of hospitalized COPD exacerbation. There was trend of an increased mortality in exacerbated patients with pneumonia. The higher hospitalization cost was observed in pneumonic than nonpneumonic exacerbation.

CLINICAL IMPLICATIONS: The attention on COPD patients presenting with exacerbation with pneumonia must be paid due to poor treatment outcome, the longer duration of stay and the increased healthcare cost utilization.

DISCLOSURE: The following authors have nothing to disclose: Theerasuk Kawamatawong, Tananchai Petnak

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