Role of Comorbidities in Treatment and Outcomes after Chronic Obstructive Pulmonary Disease Exacerbations.
Ann Am Thorac Soc. 2018 Aug 04;:
Authors: Spece LJ, Epler EM, Donovan LM, Griffith MF, Collins MP, Feemster LC, Au DH
RATIONALE: Hospital readmissions are an important cause of morbidity and mortality among patients with COPD. While comorbidities are associated with outcomes in COPD, it is unknown how they affect treatment choices.
OBJECTIVE: We sought to examine whether comorbidity was associated with readmission, mortality, and delivery of in-hospital treatment for COPD exacerbations.
METHODS: We performed a cohort study of veterans hospitalized with a COPD exacerbation to six Veterans Affairs hospitals between 2005-2011. We collected comorbidities in the year prior to hospitalization. We defined our primary outcome as readmission and/or mortality within 30 days of discharge, and treatment quality as receipt of systemic corticosteroids and respiratory antibiotics during the index hospitalization.
RESULTS: A total of 2,391 patients were included. Each one-point increase in Charlson index was associated with a greater odds of readmission or death (aOR 1.24; 95% CI 1.18 - 1.30), and a reduced odds of receiving treatment with steroids and antibiotics (aOR 0.90; 95% CI 0.85 - 0.95), in adjusted analyses. Patients with comorbid congestive heart failure (aOR 0.64; 95% CI 0.52 - 0.79), coronary artery disease (aOR 0.73; 95% CI 0.60 - 0.89), and chronic kidney disease (aOR 0.74; 95% CI 0.55 - 0.99) were less likely to receive corticosteroids and antibiotic treatment than patients without those comorbidities. We did not identify any comorbidity was associated with an increased odds of receiving appropriate therapies.
CONCLUSIONS: Comorbidity was associated with 30-day readmission and mortality, and with delivery of fewer treatments known to be beneficial among patients with COPD exacerbation.
PMID: 30079748 [PubMed - as supplied by publisher]