Abstract
Background: Pneumonia may be a major contributor to hospitalizations for COPD exacerbations. We examined the incidence and outcomes of hospitalizations for exacerbations with and without pneumonia in Denmark, 2006-2012.
Methods: Using nationwide databases we retrieved complete individual-level data on first-time and successive exacerbations among patients ≥40 years. We estimated exacerbation rates with and without pneumonia per 100,000 persons. We used logistic regression to estimate odds ratios (ORs) of 30-day mortality for with exacerbations with and without pneumonia, adjusted for age, sex, comorbidity, and use of medication as proxy for COPD severity.
Results: We identified 156,743 hospitalizations for COPD exacerbation, including 63,591 (41%) first-time exacerbations. Pneumonia was frequent in first exacerbations (46%) but declined in successive exacerbations to 27% in the seventh and following exacerbations. Exacerbations with pneumonia increased by 49%, from 1.23 per 1000 population in 2006 to 1.83 in 2012 while exacerbations without pneumonia increased by 21%, from 1.55 to 1.88. 30-day mortality was 13.1% in patients with first exacerbation with pneumonia and 9.1% in those without pneumonia (aOR 1.25, 95% CI 1.19-1.32). Presence of pneumonia also predicted increased mortality at second exacerbation (aOR 1.22, 95% CI 1.13-1.32), and up to the seventh and following exacerbations (aOR 1.30, 95% CI 1.13-1.50).
Conclusions: More than 40% of hospitalized exacerbations in Denmark are associated with pneumonia. Presence of pneumonia predicts increased mortality, both in first and successive exacerbations, and after adjustment for prognostic factors.
- © 2014 ERS