title: Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia.
abstract: It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.
authors.affiliation: a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.|b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Sharafkhaneh
authors.affiliation: e DoD/VA Vision Center of Excellence , Bethesda , MD , USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Spiegelman
authors.affiliation: d Allied Health Sciences, Baylor College of Medicine , Houston , TX , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Main
authors.affiliation: a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.|c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Tavakoli-Tabasi
authors.affiliation: a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.|b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA.
authors.forename: Charlie
authors.initials: C
authors.lastname: Lan
authors.affiliation: a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.|c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Musher
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D065840:Protective Factors; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D000067251:Symptom Flare Up; D014481:United States / Q000453:epidemiology
keywords: COPD epidemiology; COPD exacerbation; health-care utilization; respiratory infection