M Spielmanns1,2, F Axer3, C Nell4, A R Koczulla4, T Boeselt4, F Magnet5,6, J H Storre7,5, W Windisch5,6. 1. Medizinische Klinik und ambulante pneumologische Rehabilitation in Leverkusen (APRiL), St. Remigius Krankenhaus Leverkusen-Opladen, An St. Remigius 29, 51379, Leverkusen, Deutschland. spielmanns@k-plus.de. 2. Lehrstuhl Pneumologie, Universität Witten/Herdecke, Witten, Deutschland. spielmanns@k-plus.de. 3. Medizinische Klinik und ambulante pneumologische Rehabilitation in Leverkusen (APRiL), St. Remigius Krankenhaus Leverkusen-Opladen, An St. Remigius 29, 51379, Leverkusen, Deutschland. 4. Department of Medicine, Pulmonary and Critical Care Medicine, University Marburg, Marburg, Deutschland. 5. Abteilung Pneumologie, Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln, Deutschland. 6. Lehrstuhl Pneumologie, Universität Witten/Herdecke, Witten, Deutschland. 7. Universitätsklinikum Freiburg, Freiburg, Deutschland.
Abstract
BACKGROUND: Prognostic factors for clinical failure of acute exacerbation in patients with COPD (AECOPD) are of special importance in order to choose an adequate therapy and resources during inpatient treatment. Our database was analyzed to identify predictors for a negative outcome. MATERIALS AND METHODS: In a retrospective analysis medical records of 616 patients (299 women; 317 men) hospitalized for AECOPD between January 2011 and January 2016 were analyzed in order to evaluate demographic and clinical parameters leading to adverse events. Only the first admission was considered. Logistic regression analysis was performed to determine the relative risk (odds ratio (OR) leading to severe adverse events such as intensive care unit (ICU) admission, mechanical ventilation (invasive or noninvasive), early readmission to ICU and hospital and death). RESULTS: An increased risk of an ICU admission was found for patients with a coronary heart disease (OR = 5.734; p = 0.009) and for patients requiring an antibiotic therapy (OR = 11.721; p = 0.003). An increased risk for rehospitalisation and mortality was found for age (OR = 1.034; p = 0.028) and a longer duration of the hospital stay (OR = 1.063; p = 0.042). A lower C‑reactive protein (CRP) level was associated with a lower risk of readmission to the hospital (OR = 0.991; p = 0.03). An increased risk of ventilator therapy was found for patients with chronic heart failure (OR = 6.166; p = 0.02) and sleep apnea syndrome (OR = 6.698; p = 0.003), diabetes (OR = 3.754; p = 0.041) and a long stay in the ICU (OR = 2.018; p = 0.000). CONCLUSIONS: Comorbidities in patients with AECOPD were found to be a major risk factor for ICU admission and mechanical ventilation. Elderly patients and patients with prolonged hospital stay showed a higher risk for readmission and mortality. Patients with a low CRP blood level seemed to have a lower risk for rehospitalisation.
BACKGROUND: Prognostic factors for clinical failure of acute exacerbation in patients with COPD (AECOPD) are of special importance in order to choose an adequate therapy and resources during inpatient treatment. Our database was analyzed to identify predictors for a negative outcome. MATERIALS AND METHODS: In a retrospective analysis medical records of 616 patients (299 women; 317 men) hospitalized for AECOPD between January 2011 and January 2016 were analyzed in order to evaluate demographic and clinical parameters leading to adverse events. Only the first admission was considered. Logistic regression analysis was performed to determine the relative risk (odds ratio (OR) leading to severe adverse events such as intensive care unit (ICU) admission, mechanical ventilation (invasive or noninvasive), early readmission to ICU and hospital and death). RESULTS: An increased risk of an ICU admission was found for patients with a coronary heart disease (OR = 5.734; p = 0.009) and for patients requiring an antibiotic therapy (OR = 11.721; p = 0.003). An increased risk for rehospitalisation and mortality was found for age (OR = 1.034; p = 0.028) and a longer duration of the hospital stay (OR = 1.063; p = 0.042). A lower C‑reactive protein (CRP) level was associated with a lower risk of readmission to the hospital (OR = 0.991; p = 0.03). An increased risk of ventilator therapy was found for patients with chronic heart failure (OR = 6.166; p = 0.02) and sleep apnea syndrome (OR = 6.698; p = 0.003), diabetes (OR = 3.754; p = 0.041) and a long stay in the ICU (OR = 2.018; p = 0.000). CONCLUSIONS: Comorbidities in patients with AECOPD were found to be a major risk factor for ICU admission and mechanical ventilation. Elderly patients and patients with prolonged hospital stay showed a higher risk for readmission and mortality. Patients with a low CRP blood level seemed to have a lower risk for rehospitalisation.
Authors: Xavier Soler; Eduardo Gaio; Frank L Powell; Joe W Ramsdell; Jose S Loredo; Atul Malhotra; Andrew L Ries Journal: Ann Am Thorac Soc Date: 2015-08
Authors: Pedro Almagro; Bienvenido Barreiro; Anna Ochoa de Echaguen; Salvador Quintana; Mónica Rodríguez Carballeira; José L Heredia; Javier Garau Journal: Respiration Date: 2005-09-06 Impact factor: 3.580