Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 13 , ISSUE 2 ( April-June, 2024 ) > List of Articles

Original Article

Prognostic Indicators for Prolonged Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study

Manju Bala, Akhlesh Rajpoot, Dinesh C Punera, Suyash S Rathore

Keywords : Acute respiratory failure, Chronic obstructive pulmonary disease, Noninvasive ventilation, Steroid therapy

Citation Information : Bala M, Rajpoot A, Punera DC, Rathore SS. Prognostic Indicators for Prolonged Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study. Indian J Respir Care 2024; 13 (2):101-106.

DOI: 10.5005/jp-journals-11010-1117

License: CC BY-NC 4.0

Published Online: 18-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aims and background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is recognized as a major event in the natural history of COPD. Besides hurting lung function, survival, risk of readmission, and quality of life, it tremendously increases healthcare costs associated with hospitalization. Information on the time course and recovery from AECOPD is important in standardizing the length of treatment, planning appropriate follow-up, and decreasing the loss of working days of the patient. Hence, this study aimed to identify predictive parameters for length of hospitalization in AECOPD patients. Materials and methods: It was a prospective and longitudinal clinical-based descriptive study conducted at a tertiary care center in northern India. After applying the exclusion criteria and obtaining informed consent, 200 consecutive AECOPD patients were enrolled over 1 year. The Rome Proposal classifies AECOPD severity as mild, moderate, or severe, and the term prolonged length of hospital stay (LHS) refers to a stay lasting for 7 or more days. Results: The mean age of the 200 AECOPD patients was 63.9 ± 8.2 years, the mean LHS was 10.9 ± 5.2 days, and prolonged LHS (≥7 days) was seen in 140 (70%) patients. Advanced age, previous hospitalizations for AECOPD, arterial hypoxemia, the need for noninvasive ventilation (NIV), and severe AECOPD upon admission were found to be significantly correlated with the LHS (p < 0.05). However, only severe AECOPD upon admission was identified as an independent factor predicting prolonged hospitalization (p < 0.05). Conclusion: Older patients with a prior hospitalization for AECOPD, arterial hypoxemia, severe exacerbation of COPD, and need for NIV at the time of admission are more likely to have a longer hospitalization.


PDF Share
  1. Celli B, Fabbri L, Criner G, et al. Definition and nomenclature of chronic obstructive pulmonary disease: time for its revision. Am J Respir Crit Care Med 2022;206(11):1317–1325. DOI: 10.1164/rccm.202204-0671PP
  2. Agusti A, Melen E, DeMeo DL, et al. Pathogenesis of chronic obstructive pulmonary disease: understanding the contributions of gene-environment interactions across the lifespan. Lancet Respir Med 2022;10(5):512–524. DOI: 10.1016/S2213-2600(21)00555-5
  3. Halpin DMG, Celli BR, Criner GJ, et al. The GOLD summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuber Lung Dis 2019;23(11):1131–1141. DOI: 10.5588/ijtld.19.0397
  4. Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Res Crit Care Med 1998;157(5):1418–1422. DOI: 10.1164/ajrccm.157.5.9709032
  5. Celli BR, Fabbri LM, Aaron SD, et al. An updated definition and severity classification of chronic obstructive pulmonary disease exacerbations: the Rome proposal. Am J Respir Crit Care Med 2021;204(11):1251–1258. DOI: 10.1164/rccm.202108-1819PP
  6. Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest 2000;117(2 Suppl):5S–9S. DOI: 10.1378/chest.117.2_suppl.5s
  7. De la Iglesia F, Valino P, Pita S, et al. Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Med 2002;251(6):500–507. DOI: 10.1046/j.1365-2796.2002.00989.x
  8. Nowiński A, Kamiński D, Korzybski D, et al. The impact of comorbidities on the length of hospital treatment in patients with chronic obstructive pulmonary disease. Resp Med 2011;79(6):388–396. DOI: 10.5603/ARM.27622
  9. Diamantea F, Kostikas K, Bartziokas K, et al. Prediction of hospitalization stay in COPD exacerbations: the AECOPD-F score. Resp Care 2014;59(11):1679–1686. DOI: 10.4187/respcare.03171
  10. Quintana JM, Unzurrunzaga A, Garcia-Gutierrez S, et al. Predictors of hospital length of stay in patients with exacerbations of COPD: a cohort study. JGIM 2015;30(6):824–831. DOI: 10.1007/s11606-014-3129-x
  11. Mushlin AI, Black ER, Connolly AC, et al. The necessary length of hospital stay for chronic pulmonary disease. JAMA 1991;266(1):80–83. DOI: 10.1001/jama.1991.03470010084035
  12. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD 2023. www.goldcopd.org (last accessed on February 20, 2024).
  13. Daniel RA, Aggarwal P, Kalaivani M, et al. Prevalence of chronic obstructive pulmonary disease in India: a systematic review and meta-analysis. Lung India 2021;38(6):506–513. DOI: 10.4103/lungindia.lungindia_159_21
  14. Sinha B, Vibha, Singla R, et al. An epidemiological profile of chronic obstructive pulmonary disease: a community–based study in Delhi. J Postgrad Med 2017;63(1):29–35. DOI: 10.4103/0022-3859.194200
  15. Kostikas K, Clemens A, Patalano F. Prediction and prevention of exacerbations and mortality in patients with COPD. Expert Rev Resp Med 2016;10(7):739–753. DOI: 10.1080/17476348.2016.1185371
  16. Li M, Wang F, Chen R, et al. Factors contributing to hospitalization costs for patients with COPD in China: a retrospective analysis of medical record data. Int J Chron Obstruct Pulmon Dis 2018;13:3349–3357. DOI: 10.2147/COPD.S175143
  17. Agboado G, Peters J, Donkin L, et al. Factors influencing the length of hospital stay among patients resident in blackpool admitted with COPD: a cross-sectional study. BMJ Open 2012;2(5):e000869. DOI: 10.1136/bmjopen-2012-000869
  18. García-Sanz MT, González-Barcala FJ, Cánive-Gómez JC, et al. Prolonged stay predictors in patients admitted with chronic obstructive pulmonary disease acute exacerbation. Lung India 2018;35(4):316–320. DOI: 10.4103/lungindia.lungindia_469_17
  19. Perera PN, Armstrong EP, Sherrill DL, et al. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. Chronic Obstr Pulm Dis 2012;9(2):131–141. DOI: 10.3109/15412555.2011.650239
  20. Ruparel M, López-Campos JL, Castro-Acosta A, et al. Understanding variation in the length of hospital stay for COPD exacerbation: European COPD audit. ERJ Open Res 2016;2(1):00034–2015. DOI: 10.1183/23120541.00034-2015
  21. Connolly MJ, Lowe D, Anstey K, et al. Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: effect of age-related factors and service organization. Thorax 2006;61(10):843–848. DOI: 10.1136/thx.2005.054924
  22. George PM, Stone RA, Buckingham RJ, et al. Changes in NHS organization of care and management of hospital admissions with COPD exacerbations between the national COPD audits of 2003 and 2008. QJM 2011;104(10):859–866. DOI: 10.1093/qjmed/hcr083
  23. Crisafulli E, Ielpo A, Barbeta E, et al. Clinical variables predicting the risk of a hospital stay for longer than 7 days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study. Respir Res 2018;19(1):261. DOI: 10.1186/s12931-018-0951-4
  24. Wang Y, Stavem K, Dahl FA, et al. Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Int J Chron Obstruct Pulmon Dis 2014;9:99–105. DOI: 10.2147/COPD.S51467
  25. Lüthi-Corridori G, Boesing M, Ottensarendt, N, et al. Predictors of length of stay, mortality and rehospitalization in COPD patients: a retrospective cohort study. J Clin Med 2023;12(16):5322. DOI: 10.3390/jcm12165322
  26. Li M, Cheng K, Ku K, et al. Factors influencing the length of hospital stay among patients with chronic obstructive pulmonary disease (COPD) in Macao population: a retrospective study of in-patient health record. Int J Chronic Obstr Pulm Dis 2021;16:1677–1685. DOI: 10.2147/COPD.S307164
  27. Alqahtani JS, Njoku CM, Bereznicki B, et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020;29(156):190166. DOI: 10.1183/16000617.0166-2019
  28. Kessler R, Faller M, Fourgaut G, et al. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159(1):158–164. DOI: 10.1164/ajrccm.159.1.9803117
  29. Jo YS, Kim YH, Lee JY, et al. Impact of BMI on exacerbation and medical care expenses in subjects with mild to moderate airflow obstruction. Int J Chron Obstruct Pulmon Dis 2018;13:2261–2269. DOI: 10.2147/COPD.S163000
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.