Predictive Model of Hospital Admission for COPD Exacerbation.
BACKGROUND
The objective of this work was to determine predictive factors of hospital admission for exacerbation during primary care visits in patients with COPD.


METHODS
A retrospective cohort study was undertaken to assess risk of hospital admission for COPD exacerbation in primary care patients from November 1, 2010 to October 31, 2013. Data sources were primary care electronic medical records and the hospital discharge minimum data set. A total of 2,501 subjects >40 y of age with a spirometry-based COPD diagnosis were included and followed up for 3 y. The dependent variable was hospital admission for exacerbation; independent variables were: clinical parameters, spirometry results, and severity of disease (according to Global Initiative for Chronic Obstructive Lung Disease criteria). The association of these variables with hospital admission was analyzed with the adjusted odds ratio using a logistic regression model.


RESULTS
Mean age of subjects at the beginning of the study was 68.4 y (SD = 11.6), and 75% were men. Severity was mild in 50.8% of subjects, moderate in 35.3%, severe in 9.4%, and very severe in 4.4%. After 3 y, 32.5% of subjects had been admitted for exacerbation. Predictive values for hospital admission were: age, sex, previous exacerbations, number of visits to the primary care center, comorbidities, smoking, severity (Global Initiative for Chronic Obstructive Lung Disease), and influenza immunization. The area under the receiving operator characteristic curve was 0.72.


CONCLUSIONS
This model can identify patients at high risk of hospital admission for COPD exacerbation in our setting. Further studies are needed to validate the model in different populations and settings.
Biomedical Research Institute (IRB) of Lleida, the Public Health Agency of Catalonia, Health Department, and the Catalan Institute of Health (ICS), Catalonia, Spain. jmontser@alumni.unav.es.
Josep
J
Montserrat-Capdevila
Public Health Agency of Catalonia, Health Department, IRB of Lleida, and the Faculty of Medicine, University of Lleida, Catalonia, Spain.
Pere
P
Godoy
Lleida Research Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol, Universitat Autònoma of Barcelona, and the Cardiovascular Department, Epidemiology Unit, University Hospital Vall d'Hebron, Barcelona, Catalonia, Spain.
Josep Ramon
JR
Marsal
University Hospital Arnau de Vilanova, Lleida, Catalonia, Spain, the Respiratory Diseases Group, IRB of Lleida, Catalonia, Spain, and the Biomedical Research Centre/Respiratory Diseases Network (CIBERES), Madrid, Spain. The authors have disclosed no conflicts of interest.
Ferran
F
Barbé
D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry
chronic airways disease; database; electronic medical records; exacerbations; preventive medicine; primary care