Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 26;10(1):00838-2023.
doi: 10.1183/23120541.00838-2023. eCollection 2024 Jan.

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

Kiki Waeijen-Smit  1   2 , Mieke Crutsen  3 , Spencer Keene  1   4   5 , Marc Miravitlles  6 , Ernesto Crisafulli  7 , Antoni Torres  8 , Christian Mueller  9 , Philipp Schuetz  10 , Thomas J Ringbæk  11 , Fabio Fabbian  12 , Evgeni Mekov  13 , Timothy H Harries  14 , Chung-Tat Lun  15 , Begum Ergan  16 , Cristóbal Esteban  17   18   19 , Jose M Quintana Lopez  19   20 , José Luis López-Campos  21   22 , Catherina L Chang  23 , Robert J Hancox  23   24 , Eskandarain Shafuddin  23 , Hollie Ellis  23 , Christer Janson  25 , Charlotte Suppli Ulrik  11 , Gunnar Gudmundsson  26   27 , Danny Epstein  28 , José Dominguez  29 , Alicia Lacoma  29 , Christian Osadnik  30 , Inmaculada Alia  31 , Francesco Spannella  32   33 , Zuhal Karakurt  34 , Hossein Mehravaran  35 , Cecile Utens  36 , Martijn D de Kruif  37 , Fanny Wai San Ko  38 , Samuel P Trethewey  39   40 , Alice M Turner  41   42 , Dragos Bumbacea  43 , Patrick B Murphy  44   45 , Kristina Vermeersch  46 , Shani Zilberman-Itskovich  47   48 , John Steer  49   50 , Carlos Echevarria  49   51 , Stephen C Bourke  49   50 , Nicholas Lane  49   51 , Jordi de Batlle  52   53 , Roy T M Sprooten  54 , Richard Russell  55 , Paola Faverio  56 , Jane L Cross  57 , Hendrik J Prins  58   59   60 , Martijn A Spruit  1   2 , Sami O Simons  2 , Sarah Houben-Wilke  1 , Frits M E Franssen  1   2
Affiliations

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

Kiki Waeijen-Smit et al. ERJ Open Res. .

Abstract

Background: Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design.

Methods: A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement.

Results: Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event.

Conclusions: This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: K. Waeijen-Smit, M. Crutsen, S. Keene, T.J. Ringbæk, F. Fabbian, C-t. Lun, B. Ergan, C. Estebam, J.M. Quintana Lopez, C.L. Chang, R.J. Hancox, E. Shafuddin, H. Ellis, C. Janson, G. Gudmundsson, D. Epstein, A. Lacoma, C. Osadnik, I. Alia, F. Spannella, Z. Karakurt, H. Mehravaran, C. Utens, M.D. de Kruif, F.W.S. Ko, S.P. Trethewey, K. Vermeersch, S. Zilberman-Itskovich, C. Echevarria, R.T.M. Sprooten, P. Faverio, H.J. Prins and S. Houben-Wilke have no grants or personal fees to report. Conflict of interest: M. Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Kamada, Takeda, Zambon, CSL Behring, Specialty Therapeutics, Janssen, Grifols and Novartis, consulting fees from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, CSL Behring, Inhibrx, Ferrer, Menarini, Mereo Biopharma, Spin Therapeutics, ONO Pharma, Palobiofarma SL, Takeda, Novartis, Novo Nordisk, Sanofi and Grifols and research grants from Grifols. Conflict of interest: E. Crisafulli has received honoraria for lecturing, scientific advisory boards and participation in clinical studies for AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Novartis, Qbgroup and Sanofi. Conflict of interest: A. Torres reports speaker/consulting honoraria from Pfizer, MSD, Janssen and Biomerieux. Conflict of interest: C. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the University of Basel, the University Hospital Basel, the KTI, Abbott, Beckman Coulter, BRAHMS, Idorsia, LSI-Medience, Ortho Diagnostics, Novartis, Roche, Siemens, SpinChip and Singulex, as well as speaker/consulting honoraria from Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Idorsia, Novartis, Osler, Roche, SpinChip and Sanofi, all outside the submitted work. Conflict of interest: P. Schuetz has received grants from Nestle, Abbot, bioMerieux and Thermofisher outside the submitted work. Conflict of interest: E. Mekov has received grants and personal fees from Chiesi, and speaker or consulting fees from AstraZeneca and Chiesi. Conflict of interest: T.H. Harries is supported by a National Institute for Health and Care Research Academic Clinical Lectureship. Conflict of interest: J.L. López-Campos has received honoraria during the last 3 years for lecturing, scientific advice, participation in clinical studies or writing for publications for (alphabetical order): AstraZeneca, Bial, Boehringer, Chiesi, CSL Behring, Faes, Ferrer, Gebro, Grifols, GSK, Megalabs, Menarini and Novartis. Conflict of interest: C.S. Ulrik has received personal fees and grants from AstraZeneca, Chiesi, Boehringer Ingelheim, GSK, Novartis, Sanofi, Menarini, TEVA, ALK-Abello, Takeda, Orion Pharma, TFF Pharmaceuticals and Covis Pharma outside the submitted work. Conflict of interest: J. Dominguez has received honoraria for lectures from Oxford Immunotec (UK) and received payments for license transference from GenID (Germany), and grants from La Fundació La Marató TV3, Instituto de Salud Carlos III (CP03/00112), Catalan Pulmonology Society (SOCAP), Catalan Pulmonology Foundation (FUCAP) and Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Conflict of interest: A.M. Turner reports research grants outside the submitted work from AstraZeneca, Resmed, Phillips, Chiesi, Grifols, CSL Behring and NIHR, and honoraria from GSK and Boehringer Ingelheim. Conflict of interest: D. Bumbacea has received grants and personal fees in the last 3 years from AstraZeneca, Eli Lilly, Novartis, Sanofi and Synairgen outside of the submitted work. Conflict of interest: PBM has received grants and personal fees from Philips, ResMed, Breas, Chiesi, Fischer & Paykel and, Sanofi outside the submitted work. Conflict of interest: J. Steer has received grants and honoraria, outside the submitted work, from Chiesi, Menarini Group, AstraZeneca and Pfizer. Conflict of interest: S.C. Bourke has received research grants from GSK (BEC COPD IRAS 285200), and additional support from Radiometer for an NIHR-funded study (NIVOW IRAS 313485), Philips, ResMed, and Pfizer Open Air, took part in clinical advisory boards with Philips and AstraZeneca, and has received honoraria from Boehringer Ingelheim, Chiesi, GSK, and AstraZeneca. Conflict of interest: N. Lane reports research grants from Bright Northumbria and The ResMed Foundation; and nonfinancial support from Chiesi and BREAS outside the submitted work. Conflict of interest: J. de Batlle acknowledges receiving financial support from Instituto de Salud Carlos III (Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund, “Investing in your future”. Conflict of interest: R. Russell has received personal fees, outside of the submitted work, from AstraZeneca, Chiesi, Covis, GlaxoSmithKline and Boehringer Ingelheim. Conflict of interest: J.L. Cross has received grants from National Institute of Health Research. Conflict of interest: M.A. Spruit has received grants from the Netherlands Lung Foundation, Stichting Asthma Bestrijding, AstraZeneca, Boehringer Ingeheim, TEVA and CHIESI outside the submitted work. Conflict of interest: S.O. Simons has received grants and personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Chiesi outside the submitted work. Conflict of interest: F.M.E. Franssen has received grants and personal fees from AstraZeneca, Chiesi, Boehringer Ingelheim, Glaxosmithkline, Novartis and MSD outside the submitted work. Conflict of interest: All authors declare no conflicts of interest in relation to the present study.

Figures

FIGURE 1
FIGURE 1
Countries included in the current individual patient data meta-analysis (IPDMA). Note: countries included in the IPDMA with IPD of n<90 (i.e. Mexico, Colombia, USA and Slovakia) are not coloured blue.
FIGURE 2
FIGURE 2
In-hospital mortality rates (%) by day for severe exacerbations of chronic obstructive pulmonary disease (n=1346).
FIGURE 3
FIGURE 3
Pooled and stratified median length of hospital stay (left) and in-hospital mortality rates (right) during the index event per country. Relative percentages are displayed. Total number of patients included per country (percentage of the pooled population): China n=191 (0.3%), Romania n=718 (1.2%), Australia n=90 (0.1%), Belgium n=814 (1.3%), Hong Kong n=401 (0.6%), Ireland n=237 (0.4%), New Zealand n=1126 (1.8%), Poland n=734 (1.2%), Iran n=507 (0.8%), Spain n=8859 (14.3%), Greece n=1133 (1.8%), Austria n=822 (1.3%), Israel n=67 (0.1%), Denmark n=405 (0.7%), Switzerland n=295 (0.5%), Malta n=112 (0.2%), UK n=35 707 (57.6%), The Netherlands n=662 (1.1%), Italy n=7234 (11.7%), Croatia n=445 (0.7%), Turkey n=1421 (2.3%).
FIGURE 4
FIGURE 4
Forest plot displaying Cox proportional hazard ratios for in-hospital mortality in the pooled data subset. *p<0.05. Details are provided in supplementary table S4. FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ECOPD: exacerbations of COPD; NIMV: noninvasive mechanical ventilation; IMV: invasive mechanical ventilation; ICU: intensive care unit.
FIGURE 5
FIGURE 5
Pooled and stratified 30-day, 90-day and 365-day post-discharge mortality rates per country. Relative percentages are displayed. Total number of patients included per country (percentage of the pooled population): Norway n=99 (0.3%), Finland n=60 (0.2%), China n=189 (0.6%), Greece n=1088 (3.6%), Romania n=683 (2.2%), Belgium n=773 (2.5%), Poland n=708 (2.3%), Croatia n=405 (1.3%), Israel n=603 (2.0%), Austria n=788 (2.6%), Spain n=8934 (29.2%), Malta n=105 (0.3%), Ireland n=230 (0.8%), Australia n=87 (0.3%), Bulgaria n=151 (0.5%), Hong Kong n=819 (2.7%), UK n=8731 (28.5%), Iran n=488 (1.6%), Italy n=38 (0.1%), The Netherlands n=1357 (4.4%), Turkey n=1206 (3.9%), New Zealand n=1086 (3.5%), Switzerland n=1290 (4.2%), Denmark n=471 (1.5%), Sweden n=87 (0.3%), Iceland n=81 (0.3%).
FIGURE 6
FIGURE 6
Forest plot displaying Cox proportional hazard ratios for post-discharge mortality in the pooled data subset. *p<0.05. Details are provided in supplementary table S6. FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ECOPD: exacerbations of COPD; mMRC: modified Medical Research Council; NIMV: noninvasive mechanical ventilation; IMV: invasive mechanical ventilation; ICU: intensive care unit.
FIGURE 7
FIGURE 7
Pooled and stratified 30-day, 90-day and 365-day post-discharge hospital readmission rates per country. Relative percentages are displayed. Total number of patients included per country (percentage of the pooled population): China n=189 (0.4%), Israel n=539 (1.2%), Spain n=8770 (18.9%), Switzerland n=279 (0.6%), Malta n=105 (0.2%), Greece n=1088 (2.4%), Austria n=788 (1.7%), Croatia n=405 (0.9%), Turkey n=592 (1.3%), Ireland n=230 (0.5%), UK n=27 839 (60.1%), Poland n=708 (1.5%), Italy n=38 (0.1%), Belgium n=773 (1.7%), Hong Kong n=819 (1.8%), Sweden n=87 (0.2%), The Netherlands n=1127 (2.4%), Australia n=88 (0.2%), Finland n=60 (0.1%), Romania n=683 (1.5%), Denmark n=88 (0.2%), New Zealand n=782 (1.7%), Norway n=99 (0.2%), Iceland n=81 (0.2%).
FIGURE 8
FIGURE 8
Forest plot displaying Cox proportional hazard ratios for hospital readmission in the pooled data subset. *p<0.05. Details are provided in supplementary table S8. FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ECOPD: exacerbations of COPD; mMRC: modified Medical Research Council; NIMV: noninvasive mechanical ventilation; IMV: invasive mechanical ventilation; ICU: intensive care unit.
See this image and copyright information in PMC

References

    1. May SM, Li JT, eds. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc 2015; 36: 4–10. - PMC - PubMed
    1. Pasquale MK, Sun SX, Song F, et al. . Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis 2012; 7: 757–764. doi:10.2147/COPD.S36997 - DOI - PMC - PubMed
    1. Hurst JR, Skolnik N, Hansen GJ, et al. . Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med 2020; 73: 1–6. doi:10.1016/j.ejim.2019.12.014 - DOI - PubMed
    1. Demeyer H, Costilla-Frias M, Louvaris Z, et al. . Both moderate and severe exacerbations accelerate physical activity decline in COPD patients. Eur Respir J 2018; 51: 1702110), doi:10.1183/13993003.02110-2017 - DOI - PubMed
    1. Spruit MA, Gosselink R, Troosters T, et al. . Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax 2003; 58: 752–756. doi:10.1136/thorax.58.9.752 - DOI - PMC - PubMed

LinkOut - more resources