Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit.
Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes.
Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Vienna, Austria Dept of Respiratory and Critical Care, Otto Wagner Hospital, Vienna, Austria sylvia.hartl@wienkav.at.
Sylvia
S
Hartl
Hospital Universitario Virgen del Roc, Seville, Spain.
Jose Luis
JL
Lopez-Campos
Respiratory Dept and Research Institute, doce de Octubre University Hospital, CIBERES, Madrid, Spain.
Francisco
F
Pozo-Rodriguez
Respiratory Dept and Research Institute, doce de Octubre University Hospital, CIBERES, Madrid, Spain.
Ady
http://orcid.org/0000-0001-7591-6011
A
Castro-Acosta
Respiratory Dept, Paracelsus Medical University Salzburg, Salzburg, Austria.
Michael
M
Studnicka
Respiratory Dept, Paracelsus Medical University Salzburg, Salzburg, Austria.
Bernhard
B
Kaiser
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
C Michael
CM
Roberts
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D054869:Clinical Audit; D015897:Comorbidity; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006295:Health Resources; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry / Q000706:statistics & numerical data