Predictors of short-term COPD readmission.

Abstract

COPD readmissions have a great impact on patients' quality of life and mortality. Our goal was to identify factors related to 60-day readmission. We conducted a prospective observational cohort study with a nested case-control study, with 60days of follow-up after the index admission. Patients readmitted were matched, by age, baseline forced expiratory volume in 1s and month at admission, with patients admitted in the same period but not readmitted at 2months. Data were collected on sociodemographic and clinical characteristics and health-related quality of life data at the index admission and events from discharge to readmission within 60days. Conditional logistic (60-day readmission) and Cox (days to readmission) regression models were constructed. Both multivariable analyses identified the following as predictors: any admission in the preceding 2months (OR: 2.366; HR: 1.918), hematocrit at ED arrival ≤ 35% (OR: 2.949; HR: 1.570), pre-existing cardiovascular disease (valvular disease or myocardial infarction) (OR: 1.878; HR: 1.490); NIMV at discharge (OR: 0.547; HR: 0.70); no appointment with a specialist after discharge (OR: 5.785; HR: 3.373) and patient-reported need for help at home (OR: 2.978; HR: 2.061). The AUC for the logistic model was 0.845 and the c-index for the Cox model was 0.707. EuroQol EQ-5D score before the admission was correlated with a lower risk of readmission (OR: 0.383; HR: 0.670). As conclusions, we have identified factors related to 60-day readmission and summarized the findings in easy-to-use scoring scales that could be incorporated into the daily clinical routine and may help establish preventive measures to reduce future readmissions.Registration: Clinical Trial Registration NCT03227211.