title: Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.
abstract: BACKGROUND
  Various studies have tried to delimit the predictors of hospital length of stay (LOS) for patients with exacerbated chronic obstructive pulmonary disease (eCOPD), but have been disadvantaged by certain limiting factors.
  
  
  OBJECTIVE
  Our goal was to prospectively identify predictors of LOS in these patients and to validate our results.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  Subjects were patients with eCOPD who visited 16 hospital emergency departments (EDs) and who were admitted to the hospital.
  
  
  METHODS
  Data were recorded on possible predictor variables at the ED visit, on admission and 24 hours later, during hospitalization, and on discharge. LOS and prolonged LOS (≥ 9 days, considering the 75th percentile of LOS in our sample) were the outcomes of interest. Multivariate multilevel linear and logistic regression models were employed.
  
  
  RESULTS
  A total of 1,453 patients were equally divided between derivation and validation samples. The hospital variable was the best predictor of LOS. Multivariate predictors of LOS, as log-transformed variables, were the hospital, baseline dyspnea and physical activity levels and fatigue at 24 hours, intensive care or intensive respiratory care unit admission, the need for antibiotics, and complications during hospitalization. Predictors of prolonged LOS were also the hospital, baseline dyspnea and fatigue at 24 hours, ICU or IRCU admission, and complications during hospitalization (AUC: 0.77). Models were validated in the validation sample (AUC: 0.75).
  
  
  CONCLUSIONS
  We identified a number of modifiable factors, including baseline dyspnea, physical activity level, and hospital variability, that influenced the LOS of patients with eCOPD who were admitted to the hospital.
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain, josemaria.quintanalopez@osakidetza.net.
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Anette
authors.initials: A
authors.lastname: Unzurrunzaga
authors.forename: Susana
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.forename: Nerea
authors.initials: N
authors.lastname: Gonzalez
authors.forename: Iratxe
authors.initials: I
authors.lastname: Lafuente
authors.forename: Marisa
authors.initials: M
authors.lastname: Bare
authors.forename: Nerea Fernandez
authors.initials: NF
authors.lastname: de Larrea
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivas
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Esteban
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000175:diagnosis; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D057566:Self Report; D055815:Young Adult