Abstract
BackgroundChronic obstructive pulmonary disease (COPD) patients may experience an acute exacerbation (AECOPD) that requires hospitalisation. The length of hospital stay (LHS) has a great economic impact on the health-care system. Knowing the predictors of prolonged LHS could help to identify possible interventions.MethodsWe performed a prospective study to identify the clinical predictors of prolonged LHS in patients hospitalised for AECOPD. We divided the study sample by LHS into normal (≤7 days) and prolonged LHS (> 7 days) groups. Outcomes were the need for non-invasive and invasive mechanical ventilation (NIMV and IMV), intensive care unit (ICU) admission, and the 3-year mortality.ResultsWe enrolled 437 patients, of which 213 and 224 had normal LHS and prolonged LHS, respectively. Patients with a prolonged LHS had more prior hospitalisations for AECOPD, a worse mMRC (modified Medical Research Council) dyspnoea score, a higher prevalence of long-term oxygen therapy and a higher rate of congestive heart disease. During the current admission, this group also tended to require NIMV, IMV and ICU admission and the mortality risks at 6 months, 1 year and 3 years were higher. In the multivariate regression analysis, an mMRC dyspnoea score ≥ 2 (odds ratio-OR 2.24; 95% confidence interval-CI 1.34 to 3.74; p = 0.002) and the presence of acute respiratory acidosis (OR 2.75; 95% CI 1.49 to 5.05; p = 0.001) predicted a prolonged LHS at admission.ConclusionsThe presence of an mMRC ≥2 and acute respiratory acidosis at admission independently increased the risk of a prolonged LHS for AECOPD.
Highlights
The recent Global Burden of Disease study reported that chronic obstructive pulmonary disease (COPD) was a prevalent cause of death worldwide [1]
We aimed to identify the clinical variables at the time and before hospital admission that increase the risk of prolonged length of hospital stay (LHS) in patients hospitalised for Acute exacerbations of COPD (AECOPD)
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) document [2], AECOPD was defined as a recent worsening of respiratory symptoms that required a change in domiciliary therapy, with the need for hospitalisation based on the severity of AECOPD and the presence of indicators [2]
Summary
The recent Global Burden of Disease study reported that chronic obstructive pulmonary disease (COPD) was a prevalent cause of death worldwide [1]. The length of hospital stay (LHS) for an AECOPD is related to several factors. These include age [5], disease severity [5, 6], the presence of comorbidities [7, 8], high carbon dioxide partial pressures (PCO2) [7], the need of mechanical ventilation [6] or an intensive care unit. (ICU) [9], a low serum albumin level [7], the dyspnoea perception [10] and the respiratory rate [8] Other variables, such as admissions at the weekend [8] and social factors [11], have been considered relevant. Knowing the predictors of prolonged LHS could help to identify possible interventions
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