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. 2023 Aug;10(1):e001759.
doi: 10.1136/bmjresp-2023-001759.

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Ye Wang  1 , Ruoxi He  1   2 , Fen Dong  3   4   5   6 , Dongyan Liu  7 , Xiaoxia Ren #  8   4   5   9 , Ting Yang #  8   4   5   9 , Chen Wang  1   3   4   5   9
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Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Ye Wang et al. BMJ Open Respir Res. 2023 Aug.

Abstract

Background: Exacerbation of chronic obstructive pulmonary disease (ECOPD) is a complex phenomenon, with marked heterogeneity in the aetiology, pathophysiology and clinical manifestations. This study aimed to evaluate the clinical characteristics and long-term outcomes of patients with 30-day exacerbation among those hospitalised with ECOPD in China.

Methods: Data from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry were used in this study. The patients were divided into re-event and non-event groups based on the incidence of re-exacerbation within 30 days of discharge. Exacerbation, severe exacerbation and all-cause readmissions in the following 12 months were the outcomes of interest. The cumulative incidence rates and incidence densities were calculated. Multivariate hazard function models were used to determine the association between 30-day re-exacerbation and the long-term outcomes after accounting for the competing risk of death.

Results: Re-exacerbation within 30 days of discharge was observed in 4.9% (n=242) of the patients (n=4963). The cumulative incidence rates and incidence densities of exacerbation, severe exacerbation and all-cause readmissions in the event group were significantly higher than those in the non-event group. After adjustment, re-exacerbation within 30 days of discharge was associated with increased risks of exacerbation, severe exacerbation and all-cause readmissions in the following 12 months (adjusted HR: 3.85 (95% CI: 3.09 to 4.80), 3.46 (2.66 to 4.50) and 3.28 (2.52 to 4.25) accordingly).

Conclusion: Re-exacerbation of COPD within 30 days of discharge is a significant predictor of long-term prognosis. In clinical practice, short-term re-exacerbation is a significant clinical phenotype of ECOPD that requires careful management at the earliest.

Keywords: COPD exacerbations; clinical epidemiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of the process of participant enrolment. ACURE, Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry; AECOPD, acute exacerbation of chronic obstructive pulmonary disease.
Figure 2
Figure 2
Cumulative incidences of (A) exacerbation, (B) severe exacerbation and (C) all-cause readmission during the 1-year follow-up since the 31st day after discharge. Event: re-exacerbation within 30 days of discharge; non-event: no re-exacerbation within 30 days of discharge.
Figure 3
Figure 3
Incidence densities of exacerbation, severe exacerbation and all-cause readmission during the 1-year follow-up since the 31st day of discharge. Event: re-exacerbation within 30 days of discharge; non-event, no re-exacerbation within 30 days of discharge. *P<0.05 compared to non-event group.
Figure 4
Figure 4
Risk factors for exacerbation, severe exacerbation and all-cause readmission during the 1-year follow-up after discharge. Event: re-exacerbation within 30 days of discharge; BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease.
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