Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease

Patients with chronic obstructive pulmonary disease (COPD) are susceptible to acute exacerbations, cardiovascular disease, and premature death. To compare the risk of COPD exacerbation, cardiovascular diseases, and mortality between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and no use in patients with type 2 diabetes mellitus (T2DM) and COPD. The study included 299,168 patients diagnosed with T2DM and COPD in the National Health Insurance Research Database from January 1, 2009, to December 31, 2020. Cox proportional hazards models were used to examine the relative hazard of major adverse cardiovascular events, hospitalization for COPD, noninvasive positive pressure ventilation (NIPPV), invasive mechanical ventilation, lung cancer, and mortality between SGLT-2 inhibitor users and nonusers. We used propensity score matching to select 1288 pairs of SGLT-2 inhibitor users and nonusers. In the matched cohorts, SGLT-2 inhibitor use was associated with a significantly lower risk of mortality (aHR 0.64, 95% CI 0.43-0.95), NIPPV (aHR 0.48, 95% CI 0.27-0.87), and hospitalization for COPD (aHR 0.82, 95% CI 0.69-0.98) than SGLT-2 inhibitor non-use. Subgroup and dose-response analyses showed that SGLT-2 inhibitor use was associated with a significantly lower risk of mortality, NIPPV, and hospitalization for COPD (p<0.05) than no use of SGLT-2 inhibitors. This population-based cohort study showed that SGLT-2 inhibitors use was associated with a lower risk of COPD exacerbations, ventilator support, and mortality than non- SGLT-2 inhibitors use in patients with T2DM and COPD. SGLT-2 inhibitors may have a role in treating patients with COPD and diabetes.

Pulmonologists provide quality care, however, their number is not adequate to take care of all the chronic obstructive pulmonary disease (COPD) needs of the population and their services come with a cost. Their optimal role should be defined, ideally based on evidence, to ensure that their abilities are applied most efficiently where needed. To determine if concomitant pulmonologist and primary care physician care after COPD hospital or emergency department discharge was associated with better health outcomes than primary care services alone. A population cohort study was conducted in Ontario, Canada from 2004 to 2011. All individuals with a COPD hospital or emergency department discharge were included. Patients who visited both a pulmonologist and a primary care physician within 30 days of the index discharge were matched to patients who had visited a primary care physician alone using propensity scores. The composite outcome of death, COPD hospitalization or COPD emergency department visit was compared using proportional hazards regression. In the propensity score matched sample, 39.7% of patients who received concomitant care and 38.9% who received primary care only died or visited the emergency department visit or hospital for COPD within 1 year (adjusted hazard ratio 1.08, 95% confidence interval 1.00-1.17). The former, however, were more likely to receive diagnostic testing and medications. Patients who received concomitant care after COPD emergency department or hospital discharge did not have better outcomes than those who received primary care alone, however, they did receive more testing and medical management.

IntroductionThe biomarker soluble urokinase plasminogen activator receptor (suPAR) has been associated with increased mortality in chronic obstructive pulmonary disease (COPD), while elevated blood eosinophils have been associated with better survival. We hypothesized that suPAR and blood eosinophil count are independent risk factors for readmission and mortality after an acute admission in patients with COPD.MethodsThis retrospective cohort study comprised 4022 patients with prevalent COPD acutely admitted to Hvidovre Hospital, Denmark. Irrespective of cause of admission, suPAR and blood eosinophils were measured, and patients were followed up to 365 days. Associations with 365-day respiratory readmission, all-cause readmission and all-cause mortality were investigated by Cox regression analyses adjusted for age, sex, Charlson score and C-reactive protein.ResultssuPAR was significantly elevated in patients who later experienced readmission or died. At 365 days, hazard ratios (HRs) for all-cause readmission and mortality reached 1.61 (95% CI 1.40–1.85; p<0.0001) and 3.40 (95% CI 2.64–4.39; p<0.0001), respectively, for COPD patients in the fourth suPAR quartile compared to patients in the first suPAR quartile. High blood eosinophils (>300 cells/μL) were associated with lower risk of mortality (HR 0.49, 95% CI 0.39–0.62; p<0.0001) compared with patients with <150 cells/μL. When stratifying patients by suPAR quartiles and blood eosinophil counts, the highest relative mortality rate was found in patients belonging to both the fourth suPAR quartile and the low blood eosinophil (<150 cells/μL) group.ConclusionIn this cohort of COPD patients acutely admitted to a hospital, elevated suPAR concentrations were associated with both higher risk of all-cause readmission and mortality, whereas higher blood eosinophil count was associated with lower risk of mortality.

Background and aimsRecently a multidimensional grading system based on the body mass index (B), degree of airflow obstruction (O), dyspnea (D) and exercise capacity (E) - the BODE index - has begun to be used increasingly for the evaluation of chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to investigate the relationship between the BODE index and disease duration, annual exacerbation and hospitalization rates, health related quality of life and systemic inflammatory markers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α and interleukin (IL)-8.Materials and methodsIn 88 stable COPD patients we evaluated the body-mass index, pulmonary function tests, Modified Medical Research Council dyspnea scale and six-minute walk test (6 MWT). BODE scores were determined. Disease duration, number of exacerbations and hospitalization in the previous year were recorded. We also performed arterial blood gases analysis, administered the St. George's Respiratory Questionnaire (SGRQ) and measured serum levels of CRP, TNF-α, IL-8.ResultsAccording to BODE score 52% of patients were BODE 1, 21% BODE 2, 15% BODE 3 and 12% were BODE 4. There was a significant relationship between BODE index and COPD stage as classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (p < 0.001). Correlations between BODE score and disease duration (p = 0.011), number of exacerbations (p < 0.001) and hospitalizations (p < 0.001) in the last year were also observed. SGRQ symptom, activity, emotion scores and total scores were found to be significantly correlated to BODE (p < 0.001). Serum CRP levels and BODE were also correlated (p = 0.014); however, no correlation was found between serum levels of TNF-α and IL-8 and BODE.ConclusionsAs the BODE index shows a strong correlation with various prognostic and follow up parameters of COPD and systemic inflammation, its use should be considered for the evaluation of COPD patients.

Background: Chronic Obstructive Pulmonary Disease (COPD) becomes burdensome and reduces the quality of life in COPD patients and their families. Understanding the factors affecting the quality of life could improve the process of care and treatment of these patients. Therefore, this study aimed to investigate the factors that influence and can predict the quality of life in COPD patients. Methods: A total of 281 COPD patients were included and analyzed by spirometry measurement, BODE index and its components (body mass index; BMI, forced expiratory volume in one second % predicted; FEV1%predicted, dyspnea score of the modified Medical Research Council; mMRC, and distance in the six-minute walking test; 6MWT).Quality of life was assessed by the St. George’s Respiratory Questionnaire (SGRQ). Results: The total SGRQ score was 42.1±17.4. The mMRC dyspnea score, ABCD group classification of COPD and BODE index moderately correlated with the total SGRQ score. Weak correlations were found between BMI, FEV1%predicted and 6MWT. Multiple regression analysis showed that the mMRC dyspnea score, BODE index, age, and COPD group D were important predictors of quality of life in COPD patients with R2 of 0.467. Conclusion: The mMRC dyspnea score, BODE index, age, and COPD group D could predict the quality of life in the COPD patients in this study.

<b>Introduction:</b> As chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, the COPD strategy of the Spanish National Health System establishes as objectives to achieve the implementation of circuits, programs and means for the boarding of COPD. <b>Aims and objectives:</b> Find out whether the implementation of an integrated care pathway for COPD patients in Bilbao-Basurto Integrated Health Organitation achieves: 1. Improve the early diagnosis of people with COPD. 2. Reduce their morbidity-mortality and improve the quality of life related to health. <b>Methods:</b> Definition and implementation of clinical routes for the opportunistic screening, diagnosis, classification, registration and plan of initial and follow-up action in the patient with COPD in stable phase and in the exacerbations of COPD. Validation of patients according to stratification criteria and incorporation of new patients to the healthcare circuit. <b>Results:</b> Coverage of COPD in the OSI Bilbao-Basurto increased in 2017 until 73,26%(starting point in 2012 of 11.64%), with a parallel increase in the spirometric diagnosis (97,52%) and monitoring (have doubled the Three-year follow-up spirometry). It was a significant cessation of smoking in patients with COPD after the implementation of the Plan (in 2017 52,99%). It increased the percentage of COPD patients who have received influenza vaccination (67% in 2017). Hospital readmissions in COPD patients (from 17.23% in 2012 to 9,52% in 2017) was reduced in a striking way. <b>Conclusions:</b> Implementation of an integrated care pathway for COPD improve the population health manegement and reduce the potential health inequalities.

Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

Background: COPD is associated with progressive morbidity leading to increased use of healthcare resources including hospital admissions. Our nurse-led COPD service works to assess, treat, facilitate discharge and follow up patients with acute exacerbation. It receives referrals from hospital wards, community healthcare teams and patients themselves. Aims: To ascertain factors leading to 90-day readmissions in patients managed by the COPD unit and to evaluate for correlation between source of referral and readmission. Methods: Data on 100 consecutive patients seen by the COPD service from January 2014 was evaluated for smoking status, social circumstances, deprivation index, co-morbidity, body mass index, sputum culture, and blood gas analysis. We tested these as risk factors for readmission using a binomial logistic regression analysis. Results: The 90-day readmission rate was 19%, with ward referral patients being 3.4 times more likely to be readmitted than self-referrals (p=0.067). Amongst the other variables, the only significant risk factor for readmission was presence of co-morbidity (odds ratio 2.014, p=0.022, 95% CI 1.106 to 3.666). Conclusion: Our readmission rates are significantly lower than the UK average (Price, LC et al. Thorax 2006; 61:837-84) (Buckingham, RJ et al. 2008 Report of the National COPD Audit 2008). It reflects the intensive support our COPD service provides post-discharge. In-patients with co-morbidities are more likely to be readmitted due to disease burden. Further research comparing usual vs targeted management of co-morbidity in COPD patients should be undertaken to see if it can reduce readmission rates.

Introduction: Hospital readmissions are critical in the natural history of severe COPD patients. However, its prediction is complicated in clinical practice. The electronic nose is a non-invasive technology capable of distinguish volatile organic compounds (VOC) breath-prints in exhaled breath. Objective: We aim to explore if an electronic nose can reliably predict the presence of future hospital readmissions in admitted patients with Chronic Obstructive Pulmonary Disease (COPD) and frequent severe exacerbations. Methods: Eighty-eight hospitalized COPD patients with two ore more severe exacerbations in the previous year were included. On admission, clinical, functional, microbiological and laboratory data were recorded. During the first 24 hours of admission, exhaled breath was collected in Tedlar bags and VOCs breath-prints were detected by the commercially available electronic nose Cyranose 320®. Cross-validation accuracy was assessed using principal component reduction analysis (PCA). Patients were followed during 90 days after discharge. Results: Seventeen patients (19%) were readmitted at 30-days, and 33 patients (37%) were readmitted at 90-days. No clinical differences on admission were observed among patients who were readmitted or not. However, VOC breath-prints were different among both groups. In predicting 30-day readmission, the accuracy was of 87.5%, sensitivity of 90% and specificity of 76.5% (AUROC 0.85, p Conclusions: An electronic nose may identify admitted severe COPD patients at risk of 30-day and 90-day readmission. Suported by SEPAR, FUCAP.

In addition to the traditional biomedical parameters, quality of life (QoL) evaluation has found its well-deserved place in the overall assessment of patients with chronic obstructive pulmonary disease (COPD). The impact of socioeconomic status (SES) was rarely evaluated in QoL studies in such patients with no such studies having been conducted in Poland. The aim of our study was to compare QoL between COPD patients and the control group and to evaluate the impact of SES, selected demographic characteristics, smoking and bronchial tree obstruction on the QoL in COPD patients. We enrolled 120 patients with COPD (98 men and 22 women; mean age: 62.3 years) with no comorbidities and 85 healthy individuals (39 men and 46 women; mean age: 56.0 years). All the COPD patients underwent spirometry. QoL was assessed with the SF-36 Health Survey and the St George's Respiratory Questionnaire. To assess SES, demographic variables and smoking we used a questionnaire of our own authorship. COPD patients showed a significantly lower QoL compared to controls. Univariate analysis demonstrated effects of educational background, income, occupation, employment status and bronchial obstruction on the individual QoL domains. Multivariate regression analysis revealed that the sociodemographic factors significantly affecting the overall QoL included: present occupation, employment status, monthly income, educational background and total exposure to cigarette smoke. No effects of age, sex or smoking status on the QoL in COPD were shown. The QoL in patients with COPD is affected by many factors. In addition to spirometric abnormalities the significant factors that modify QoL are: educational background, monthly income, present occupation and employment status, while sex, age and smoking status do not significantly affect QoL.

ObjectiveIn this investigation, we aimed to explore risk factors for 90-day hospital readmission among patients with cirrhosis and ascites in an Asian population.MethodsIn this retrospective study, we included consecutive patients diagnosed with cirrhosis and ascites hospitalized in Renji Hospital between 2018 and 2022 to elucidate risk factors for 90-day readmission. We conducted multivariate logistic regression analysis to identify readmission risk factors.ResultsWe included 265 patients with cirrhosis and ascites. A 43% readmission rate was observed within 90 days. After adjustment for multiple covariates, we found that readmission within 90 days was independently linked to reduced levels of hemoglobin (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.97) and serum albumin (OR 0.88, 95% CI 0.83–0.93), and higher Model for End-Stage Liver Disease and sodium (MELD-Na) scores (OR 1.04, 95% CI 1.01–1.07) at discharge.ConclusionsPatients with cirrhosis who have ascites are frequently rehospitalized within 90 days after discharge. Lower hemoglobin or albumin and higher MELD-Na scores at discharge may be the main risk factors for hospital readmission.

Background: Chronic Obstructive Pulmonary Disease (COPD) often coexists with cardiovascular disease (CVD), compounding limitations in physical function and quality of life. While pulmonary rehabilitation (PR) is well-established for improving outcomes in COPD, evidence regarding its efficacy in patients with concurrent cardiac comorbidities remains limited. Objective: To assess the effectiveness of pulmonary rehabilitation in improving exercise tolerance among COPD patients with coexisting cardiac conditions. Methods: A randomized controlled trial was conducted over 12 months at tertiary hospitals in Pakistan. A total of 110 stable COPD patients with cardiac comorbidities were randomized equally into intervention and control groups. The intervention group received an 8-week structured PR program in addition to standard care, while the control group received standard care alone. Primary outcome was change in six-minute walk distance (6MWD). Secondary outcomes included Modified Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT), and St. George’s Respiratory Questionnaire (SGRQ). Data were analyzed using paired and independent t-tests, with p &lt; 0.05 considered statistically significant. Results: The intervention group showed a significant mean increase in 6MWD (63.2 m, p &lt; 0.001), while the control group had a non-significant change (6.5 m, p = 0.186). mMRC and CAT scores significantly improved in the intervention group (p &lt; 0.001), with negligible changes in controls. SGRQ total scores decreased by 12.8 points in the intervention group (p &lt; 0.001), indicating better quality of life. No adverse events were reported. Conclusion: Pulmonary rehabilitation significantly enhances exercise capacity and symptom burden in COPD patients with cardiac comorbidities. These findings support integrating PR into routine care for this high-risk group.

Chronic obstructive pulmonary disease (COPD) is common in patients with aortic aneurysms. Severe COPD is associated with an increased risk of aneurysm rupture and perioperative complications. This study assesses the outcomes of COPD and non-COPD patients after fenestrated-branched endovascular aortic aneurysm repair (FBEVAR). A single institution, retrospective study of FBEVAR patients between 2011 and 2020 compared outcomes between COPD and non-COPD patients. COPD patients were stratified by Global Initiative for Chronic Obstructive Lung Disease criteria and oxygen dependence. Outcome measures included 30-day mortality, pulmonary complications, major adverse events (MAE), and mid-term survival. 387 patients (71% male, age 72 years, interquartile range [68-79]) underwent FBEVAR. 181 patients (47%) had COPD. Smoking history was more frequent in COPD patients (P = .022). Among COPD patients, 20.4% were oxygen-dependent. Technical success, defined as successful delivery of the main aortic endograft and all intended side branches, was 98.4%. 30-day mortality (P = .83) and MAE rates (P = .87) were similar between groups. While not statistically significant, COPD patients had more frequent pulmonary complications (6.1% vs. 2.4%, P = .13) and were more frequently discharged on oxygen (P = .002). There were no differences in intensive care unit or hospital length of stay between groups (P = .29; P = .85, respectively). 5-year survival was similar between groups (P = .10). Oxygen-dependent COPD and severe-very severe COPD were associated with decreased mid-term survival (Hazard Ratio 2.39, P = .048). FBEVAR is safe and effective for treating complex aortic pathology in COPD patients, including oxygen-dependent patients. Patients with more severe COPD were more frequently discharged on oxygen. Mid-term survival was slightly reduced in patients with oxygen-dependent and severe-very severe COPD. Level 3, non-randomized controlled cohort/follow-up study.

We tested whether increased concentrations of the acute-phase reactant fibrinogen correlate with pulmonary function and rate of chronic obstructive pulmonary disease (COPD) hospitalization. We measured plasma fibrinogen and forced expiratory volume in 1 s (FEV(1)), and assessed prospectively COPD hospitalizations in 8,955 adults from the Danish general population. Smokers with plasma fibrinogen in the upper and middle tertile (> 3.3 and 2.7-3.3 g/L) had 7% (95% confidence interval [CI]: 5-8%) and 2% (0-3%) lower percentage predicted FEV(1) than smokers with fibrinogen in the lower tertile (< 2.7 g/L). The equivalent decreases in nonsmokers were 6% (4-7%) and 0% (-1-2%), respectively. Individuals with plasma fibrinogen in the upper and middle tertile had COPD hospitalization rates of 93 and 60 compared with 52 per 10,000 person-years in individuals with fibrinogen in the lower tertile (log-rank: p < 0.001 and p = 0.31). After adjusting for age, body mass index, sex, pack-years, and recent respiratory infections, relative risks for COPD hospitalization were 1.7 (95% CI: 1.1-2.6) and 1.4 (0.9-2.1) in individuals with fibrinogen in the upper and middle versus lower tertile. In conclusion, elevated plasma fibrinogen was associated with reduced FEV(1) and increased risk of COPD. This could not be explained by smoking alone.

To investigate the correlations between lipid ratio/oxidative stress status in chronic obstructive pulmonary disease (COPD) patients and pulmonary hypertension as well as the prognosis. Methods: A total of 120 patients with COPD were randomly selected and served as the COPD group and 30 healthy persons were selected as the control group. The ratios of low density lipoprotein (LDL)/high-density lipoprotein (HDL), triglyceride (TG)/HDL and total cholesterol (TC)/HDL were measured. The superoxide dismutase (SOD) activity, malondialdehyde (MDA) content and total antioxidant capacity (T-AOC) level in the control group and COPD patients were detected. Pulmonary hypertension incidence and 3-year survival rate for COPD patients were statistically analyzed. Spearman rank correlation method was used to analyze relationship between lipid ratio /oxidative stress status and pulmonary hypertension. Results: Compared with control group, the ratios of LDL/HDL, TG/HDL and TC/HDL, and the serum MDA level in the COPD group were increased, while the serum SOD and T-AOC level in the COPD group were decreased; compared with stable period, lipid ratios and MDA levels in the acute period were elevated, while serum SOD and T-AOC levels were reduced (P<0.05). Pulmonary hypertension incidence and 3-year survival rates in the COPD group were 56.67% and 81.67% respectively; the lipid ratios and serum MDA levels in COPD patients with pulmonary hypertension were elevated compared with that in COPD patients without pulmonary hypertension; the serum SOD and T-AOC levels in COPD patients with pulmonary hypertension were reduced compared with that in patients without pulmonary hypertension (P<0.05). Spearman rank correlation analysis showed that ratios of LDL/HDL, TG/HDL and TC/HDL, and the serum MDA levels in COPD patients were positively correlated with 3-years pulmonary hypertension incidence (r=0.752, 0.748, 0.752, 0.748; P<0.05), and negatively correlated with 3-years survival rate (r=-0.722, -0.751, -0.736, -0.748; P<0.05); serum SOD and T-AOC levels in COPD patients were negatively correlated with 3-years pulmonary hypertension (r=-0.711, -0.734; P<0.05), and positively correlated with 3-year survival rate (r=0.726, 0.733; P<0.05). Conclusion: Blood lipid ratio and oxidative stress levels in COPD patients are elevated while antioxidant abilities were attenuated. The lipid ratio and oxidative stress status in COPD patients is closely related to the prognosis of pulmonary hypertension. Therefore, blood lipid ratio and oxidative stress status may be used in evaluation of pulmonary hypertension and prognosis for COPD patients.