PROTECTIVE METABOLIC RESERVES? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR ACUTE EXACERBATION OF COPD: A PROPENSITY SCORE MATCH ANALYSIS

Abstract

SESSION TITLE: Tuesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: To determine the relationship between obesity and the rate of hospital readmission within 30 days, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute exacerbation of chronic obstructive pulmonary disease (A-COPD). METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of A-COPD and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature (1). The primary outcome was in-hospital mortality. Secondary outcomes were complications of A-COPD, length of hospital stay (LOS), and total hospitalization costs and charges. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders (2). Independent risk factors for readmission were identified using multivariate logistic regression model (3). RESULTS: In total, 2,150,061 hospital admissions with a primary diagnosis of A-COPD were identified, of which 17.56% (377,640) were obese. After PS matching with similar demographic and clinical characteristics, 370,655 obese patients with A-COPD were paired with 370,655 non-obese patients with A-COPD. Among obese patients with A-COPD, in-hospital morality (OR 0.66, CI 0.59-0.72, p<0.001) was lower in comparison to non-obese patients with A-COPD. However, medical comorbidities were higher among obese patients with A-COPD, including atrial fibrillation, acute respiratory failure, acute kidney injury, renal dialysis, and oxygen use. Obese patients admitted with A-COPD had a longer mean LOS (7.2 days vs 6.7 days, p <0.001), a higher mean total hospital charge ($67,501 vs $61,721, p <0.001), and a higher mean total hospital cost ($16,821 vs $15,872, p <0.001) when compared to the non-obese patients admitted with A-COPD. CONCLUSIONS: Obesity has been associated with improved survival in patients with existing chronic diseases —a phenomenon referred to as “obesity paradox” (4). A postulated hypothesis suggests that higher metabolic reserves may be beneficial in acute illnesses. In this study, the reduced in-hospital mortality in obese patients with A-COPD support the “obesity paradox”. CLINICAL IMPLICATIONS: Obese patients have improved in-hospital mortality rates when compared to non-obese patients presenting with A-COPD. Additional research is needed to elucidate the physiological rationale for improved survival in obese patients presenting with sepsis and septic shock. DISCLOSURES: No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by James Salonia, source=Web Response No relevant relationships by Jacqueline Sheehan, source=Web Response No relevant relationships by Lingling Wu, source=Web Response