Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Abstract

Tingting Xu,1,* Wei Sun,2,* Hongqing Zhao,3,* Xinmin Wang,4 Qi Yuan,1 Xijie Zhang,1 Shan Mao,5 Xiuwei Zhang,6 Mingming Zhao,7 Zebo Sheng,8 Mingshun Zhang,9 Mao Huang,1 Ningfei Ji1 1Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Wuxi Second People’s Hospital, Wuxi, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Shuyang Hospital of Traditional Chinese Medicine, Suqian, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Nanjing Jiangning Hospital, Nanjing, People’s Republic of China; 7Department of Respiratory and Critical Care Medicine, Nanjing Gaochun People’s Hospital, Nanjing, People’s Republic of China; 8Department of Respiratory and Critical Care Medicine, Changshu First People’s Hospital, Suzhou, People’s Republic of China; 9Department of Immunology, Nanjing Medical University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao Huang; Ningfei Ji, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel/Fax [phone], Email [email protected]; [email protected]: Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups.Patients and Methods: Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters.Results: The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, P< 0.001), the COPD Assessment Test (CAT) score (20 vs 17, P< 0.001), the blood eosinophil percentage (1.5 vs 2.0, P< 0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥ 9 years), more symptoms (CAT ≥ 10), and lower blood eosinophils (Eos < 2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations.Conclusion: These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.Keywords: chronic obstructive pulmonary disease, acute exacerbation, eosinophils, prognosis

Keywords

• chronic obstructive pulmonary disease
• acute exacerbation
• eosinophils
• prognosis