Abstract
Background: A 30-day readmission to hospital for COPD exacerbation (COPDE) occurs in about 20% of patients, with clinical and economic impact. Data on prognosis of these patients readmitted earlier are poorly understood.
Objective: to evaluate the effect of a early COPDE occurring in a period of 30 days after discharge and requiring hospitalization on prognosis of patients.
Design: A prospective observational study in a university hospital in Spain.
Patients: Based on the presence of a new readmission for COPDE within 30 days of discharge, the study cohort (n=378) was divided into patients with (n=68) and without (n=310) a 30-day readmission.
Main Measures: Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospitalization; mortality data were determined by evaluating three follow-up periods: 6 months, 1 year and 3 years.
Key Results: Patients with a 30-day readmission had worse lung function, dyspnea perception and clinical severity. ≥2 prior COPDE (HR, 2.47; 95% CI, 1.51 to 4.05) was the only variableindependently associated with a 30-day readmission. Analyses of prognosis in all follow-up periods showed higher rate of mortality for patients with 30-day readmission in comparison to patients without; moreover 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10 to 5.59). In patients with a 30-day readmission, the estimated absolute increase in risk of 6-months death was 17% (number needed to harm [NNH], 6), 1-year death was 19% (NNH, 6) and 3-years death was 24% (NNH, 5).
Conclusion: A 30-day readmission influences the risk of mortality in patients with COPDE.
- Copyright ©ERS 2015