Main Article Content
Introduction: COPD affects 12 million Americans and is one of the leading causes of death worldwide. The national data on COPD readmission rate is about 20% in the U.S. Patients are usually admitted for acute exacerbation with acute or chronic respiratory failure, albeit many were admitted with other comorbidities rather than COPD acute exacerbation. The purpose of this study was to identify high index comorbidities that contribute to COPD hospital readmissions.
Method: Retrospective analysis of a large database on COPD patients who were admitted from 01/01/2013 to 12/31/2015 to a major university health care system in the Southeastern United States was used for this study. Information on patient demographics, medical problems, medications, COPD admissions and readmissions was collected. The Charlson Comorbidity Index (CCI) was used for identifying comorbidities.
Results: The common comorbidities identified in patients who were admitted and re-admitted included congestive heart failure (41.5%), diabetes without complications (33.6%), and renal disease (31.4%). Higher hemoglobin and albumin levels were inversely related to 30-day readmission.
Conclusion: Patients admitted with COPD exacerbation had co-morbidities which included heart failure, diabetes, renal disease, and other diseases sharing the pathophysiology of chronic inflammatory processes. Therefore, we recommend that COPD management should be comprehensive in monitoring chronic inflammatory processes and optimizing management of co-morbidities in addition to the improvement of pulmonary function and lung health.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Richardson A, Tolley E, Hartmann J, et al. Evaluation of Chronic Obstructive Pulmonary Disease (COPD) and reduced ejection fraction heart failure (HRrEF) discharge medication prescribing: Is drug therapy concordant with national guidelines associated with a reduction in 30-day readmissions? Respiratory medicine. 2016;119:135-140.
3. Rinne ST, Elwy AR, Bastian LA, Wong ES, Wiener RS, Liu CF. Impact of Multisystem Health Care on Readmission and Follow-up Among Veterans Hospitalized for Chronic Obstructive Pulmonary Disease. Medical care. 2017.
4. Alonso-Moran E, Nuno-Solinis R, Onder G, Tonnara G. Multimorbidity in risk stratification tools to predict negative outcomes in adult population. Eur J Intern Med. 2015;26(3):182-189.
5. Walsh J. COPD: What yuou don't know can kill you. 2007; http://www.vietnow.com/veterans-health-copd/. Accessed Nov. 18, 2015, 2015.
6. Cavailles A, Brinchault-Rabin G, Dixmier A, et al. Comorbidities of COPD. European respiratory review : an official journal of the European Respiratory Society. 2013;22(130): 454-475.
7. Lenartova P, Kopcekova J, Gazarova M, Mrazova J, Wyka J. Biochemical parameters as monitoring markers of the inflammatory reaction by patients with chronic obstructive pulmonary disease (COPD). Roczniki Panstwowego Zakladu Higieny. 2017;68(2):185-190.
8. Brown DW, Croft JB, Greenlund KJ, Giles WH. Trends in hospitalization with chronic obstructive pulmonary disease-United States, 1990-2005. Copd. 2010;7(1):59-62.
9. Logue E, Smucker W, Regan C. Admission Data Predict High Hospital Readmission Risk. J Am Board Fam Med. 2016;29(1):50-59.
10. Blum A, Simsolo C, Sirchan R, Haiek S. "Obesity paradox" in chronic obstructive pulmonary disease. The Israel Medical Association journal : IMAJ. 2011;13(11):672-675.
11. Onishi K. Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease. J Cardiol. 2017;70(2):128-134.
12. Glaser JB, El-Haddad H. Exploring Novel Medicare Readmission Risk Variables in Chronic Obstructive Pulmonary Disease Patients at High Risk of Readmission within 30 Days of Hospital Discharge. Annals of the American Thoracic Society. 2015;12(9):1288-1293.
13. Yang CJ, Liao WI, Tang ZC, et al. Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2017;12:1923-1932.
14. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease (ICD-9 Codes 490-492, 494, 496). cdc.gov1998.
15. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care. 2005;43(11):1130-1139.
16. Glaser S, Kruger S, Merkel M, Bramlage P, Herth FJ. Chronic obstructive pulmonary disease and diabetes mellitus: a systematic review of the literature. Respiration. 2015;89(3):253-264.
17. Kinney GL, Black-Shinn JL, Wan ES, et al. Pulmonary function reduction in diabetes with and without chronic obstructive pulmonary disease. Diabetes Care. 2014;37(2):389-395.
18. Corsonello A, Aucella F, Pedone C, Antonelli-Incalzi R. Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int. 2017.
19. Lam CW. 2. Inflammation, Cytokines and Chemokines in Chronic Kidney Disease. Ejifcc. 2009;20(1):12-20.
20. Laribi S, Pemberton CJ, Kirwan L, et al. Mortality and acute exacerbation of COPD: a pilot study on the influence of myocardial injury. The European respiratory journal. 2017;49(6).
21. Kubota Y, London SJ, Cushman M, et al. Lung function, respiratory symptoms and venous thrombo-embolism risk: the Atherosclerosis Risk in Communities Study. J Thromb Haemost. 2016;14(12):2394-2401.
22. Kim V, Goel N, Gangar J, et al. Risk Factors for Venous Thrombo-embolism in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis. 2014;1(2):239-249.
23. Di Napoli M, Behrouz R, Topel CH, et al. Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage. Journal of critical care. 2017;41:247-253.
24. Freeman CM, Martinez CH, Todt JC, et al. Acute exacerbations of chronic obstructive pulmonary disease are associated with decreased CD4+ & CD8+ T cells and increased growth & differentiation factor-15 (GDF-15) in peripheral blood. Respir Res. 2015; 16:94.
25. Chen C, Deng Y, Chen H, et al. Decreased concentration of IL-35 in plasma of patients with asthma and COPD. Asian Pacific journal of allergy and immunology. 2014;32(3):211-217.
26. Huang AX, Lu LW, Liu WJ, Huang M. Plasma Inflammatory Cytokine IL-4, IL-8, IL-10, and TNF-alpha Levels Correlate with Pulmonary Function in Patients with Asthma-Chronic Obstructive Pulmonary Disease (COPD) Overlap Syndrome. Medical science monitor: inter-national medical journal of experi-mental and clinical research. 2016;22:2800-2808.
27. Long H, Luo H, Chen P, Li Y. [Correlation among the levels of C-reactive protein and interleukin-18, quality of life, and lung function in patients with chronic obstructive pulmonary disease]. Zhong nan da xue xue bao Yi xue ban = Journal of Central South University Medical sciences. 2011;36(11):1090-1096.
28. Kohli P, Pinto-Plata V, Divo M, et al. Functional capacity, health status, and inflammatory biomarker profile in a cohort of patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2015;35(5):348-355.
29. Panetta NL, Krachman S, Chatila WM. Chronic obstructive pulmonary disease and its comorbidities. Panminerva medica. 2009;51(2):115-123.