title: Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study.
abstract: OBJECTIVE
  Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients.
  
  
  METHODS
  The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years.
  
  
  RESULTS
  Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51-4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10-5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5).
  
  
  CONCLUSIONS
  In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death.
authors.affiliation: Respiratory Department, Clinic Institute of Respiratory (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS) - CIBERES - University of Barcelona (UB), Barcelona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Crisafulli
authors.affiliation: 6th Respiratory Department, Sotiria Hospital, Athens, Greece.
authors.forename: Adamantia
authors.initials: A
authors.lastname: Liapikou
authors.affiliation: Respiratory Department, Clinic Institute of Respiratory (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS) - CIBERES - University of Barcelona (UB), Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Huerta
authors.affiliation: Respiratory Department, Clinic Institute of Respiratory (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS) - CIBERES - University of Barcelona (UB), Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.affiliation: Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chetta
authors.affiliation: Respiratory Department, Clinic Institute of Respiratory (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS) - CIBERES - University of Barcelona (UB), Barcelona, Spain.
authors.forename: Nestor
authors.initials: N
authors.lastname: Soler
authors.affiliation: Respiratory Department, Clinic Institute of Respiratory (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques Agusti Pi i Sunyer (IDIBAPS) - CIBERES - University of Barcelona (UB), Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission; D011336:Probability; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000382:microbiology / Q000401:mortality*; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome