title: Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia.
abstract: BACKGROUND
  Pneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD) exacerbation and influence their outcomes.
  
  
  METHODS
  We examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006-2012.
  
  
  RESULTS
  We identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%). Pneumonia was frequent in first-time exacerbations (36.1%), but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days), intensive care unit admission (7.7% vs 12.5%), and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17-1.24). Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11-1.18), and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07-1.13). In contrast, the aHR of a subsequent exacerbation was 8%-13% lower for patients with pneumonic exacerbations.
  
  
  CONCLUSIONS
  Pneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care utilization and higher mortality. Nonpneumonic COPD exacerbations predict increased risk of subsequent exacerbations.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Madsen
authors.affiliation: Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Løkke
authors.affiliation: Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Hilberg
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Reimar W
authors.initials: RW
authors.lastname: Thomsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology* / Q000628:therapy
keywords: COPD; exacerbation; incidence; mortality; pneumonia