Javier de Miguel-Díez1, Ana López-de-Andrés2, María D Esteban-Vasallo3, Valentín Hernández-Barrera4, José M de Miguel-Yanes5, Manuel Méndez-Bailón6, Rodrigo Jiménez-García4. 1. Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. 2. Preventive Medicine and Public Health Teaching and Research Unit, Rey Juan Carlos University, Alcorcón, Madrid, Spain. Electronic address: ana.lopez@urjc.es. 3. Madrid Regional Health Authority, Public Health Directorate, Madrid, Spain. 4. Preventive Medicine and Public Health Teaching and Research Unit, Rey Juan Carlos University, Alcorcón, Madrid, Spain. 5. Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Universidad Complutense de Madrid (UCM). Spain. 6. Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid (UCM), Madrid, Spain.
Abstract
BACKGROUND: The objectives of this study were to examine incidence and in-hospital outcomes of Clostridium difficile infection (CDI) among patients with COPD, to compare clinical variables among COPD patients with matched non-COPD patients hospitalized with CDI, and to identify factors associated with in-hospital mortality (IHM) among COPD patients. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients aged 40 years or over with a primary or secondary diagnosis of CDI. For each COPD patient, we selected a sex, age, readmission status and year-matched non-COPD patient. RESULTS: We identified 44,695 patients with CDI (19.36% with COPD). Incidence of CDI has increased significantly from 2001 to 2015 besides COPD status. Incidence was higher in COPD patients than in patients without this disease (IRR 2.24; 95%CI 2.18-2.29). IHM decreased significantly over time in patients without COPD (from 13.98% in 2001-03 to 10.99% in 2013-15), but there were no changes in those with COPD (from 12.93% in 2001-03 to 13.37% in 2013-15). In COPD patients, higher mortality rates were associated with older age, comorbidities, severe CDI, longer length of hospital stay and readmission. Primary diagnosis of CDI was associated with lower IHM in this group of patients (OR 0.66; 95%CI 0.56-0.77) in comparison with secondary diagnosis. CONCLUSIONS: Incidence of CDI was twice higher in COPD patients than in matched non-COPD controls and is increasing overtime in both groups. Our results suggest that the management of CDI has improved in Spain during the study period.
BACKGROUND: The objectives of this study were to examine incidence and in-hospital outcomes of Clostridium difficileinfection (CDI) among patients with COPD, to compare clinical variables among COPDpatients with matched non-COPDpatients hospitalized with CDI, and to identify factors associated with in-hospital mortality (IHM) among COPDpatients. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients aged 40 years or over with a primary or secondary diagnosis of CDI. For each COPDpatient, we selected a sex, age, readmission status and year-matched non-COPDpatient. RESULTS: We identified 44,695 patients with CDI (19.36% with COPD). Incidence of CDI has increased significantly from 2001 to 2015 besides COPD status. Incidence was higher in COPDpatients than in patients without this disease (IRR 2.24; 95%CI 2.18-2.29). IHM decreased significantly over time in patients without COPD (from 13.98% in 2001-03 to 10.99% in 2013-15), but there were no changes in those with COPD (from 12.93% in 2001-03 to 13.37% in 2013-15). In COPDpatients, higher mortality rates were associated with older age, comorbidities, severe CDI, longer length of hospital stay and readmission. Primary diagnosis of CDI was associated with lower IHM in this group of patients (OR 0.66; 95%CI 0.56-0.77) in comparison with secondary diagnosis. CONCLUSIONS: Incidence of CDI was twice higher in COPDpatients than in matched non-COPD controls and is increasing overtime in both groups. Our results suggest that the management of CDI has improved in Spain during the study period.
Authors: Javier de Miguel-Díez; Ana López-de-Andres; Valentín Hernández-Barrera; José M de Miguel-Yanes; Manuel Méndez-Bailón; Rodrigo Jiménez-García Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-03-27
Authors: Javier de-Miguel-Díez; Ana López-de-Andrés; Valentín Hernández-Barrera; José M De Miguel-Yanes; Manuel Méndez-Bailón; Nuria Muñoz-Rivas; Rodrigo Jiménez-García Journal: PLoS One Date: 2019-08-19 Impact factor: 3.240