Predictors of readmission at 60 days after an admission by a COPD exacerbated

Abstract

Introduction COPD patients suffer repeated exacerbations (eCOPD) in the course of their disease. Some of them, causes the patient being admitted to a hospital. But, after discharge for that index admission, the rate of a new readmission at 30 to 90 days for these patients is higher than 20%. Exploring preventable factors related to those readmissions, and mainly at the time the patient is discharged from their index admission, has not been solve so far. Our goal was to explore possible variables related to readmissions up to 60 days after an index admission by an eCOPD. Methods This was a prospective cohort study of patients who attended an emergency department (ED) at one of 16 hospitals and were admitted by an eCOPD. Information on possible predictor variables was recorded from the medical records and from the patient during the ED stay, 24 hours after admission to the hospital, during admission, and at hospital discharge. A readmission after an eCOPD within 2 months was the outcome of interest. Multivariable logistic regression models were employed for patients admitted to the hospital from the ED. Results Of the 1537 patients included in the study, 382 (24.85%) had a readmission within 60 days from the index admission. In the multivariable logistic model, variables related to those readmissions at 60 days were: eCOPD-related hospital admissions in the previous year [for those with 2 admissions vs. none, the odds ratio (OR) was 2.444 95% confidence intervals (95% CI): 1.579–3.783]; if > 2 vs. none, the OR was 3.340 (95% CI: 2.250–4.958); the baseline FEV1% [if FEV1% was 30–49 the OR was 1.158 (95% CI: 0.819–1.638); if FEV1% was Conclusions The severity of the disease and its evolution (as measured by the FEV1% and the eCOPD-related hospital admissions in the previous year) jointly with an indirect measure of the presence of other comorbidities (use of diuretics for cardiac disease) had a relationship with readmissions at 60 days. But also had the presence of severe fatigue and psychological distress at the time of discharge. These latest variables should be taken into account when introducing possible preventive measures at discharge time from an index admission to reduce readmissions in these patients. Finally, another modifiable variable, though more complex, was the hospital where the patient was admitted.