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Kim, Lee, Kim, Park, Jeon, Kim, Lee, and Park: Risk Factors Associated with Frequent Hospital Readmissions for Exacerbation of COPD
Original Article

Tuberc Respir Dis 2010;69(4):243-249.

Published online: 19 October 2010

DOI: https://doi.org/10.4046/trd.2010.69.4.243

Risk Factors Associated with Frequent Hospital Readmissions for Exacerbation of COPD

Mi Hyun Kim, M.D., Kwangha Lee, M.D., Ki Uk Kim, M.D., Hye-Kyung Park, M.D., Doo Soo Jeon, M.D., Yun Seong Kim, M.D., Min Ki Lee, M.D., Soon Kew Park, M.D.

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

Address for correspondence: Min Ki Lee, M.D. Department of Internal Medicine, Pusan National University School of Medicine, 1-10 Ami-dong, Seo-gu, Busan 602-739, Korea Phone: 82-51-240-7216, Fax: 82-51-254-3127 E-mail: leemk@pusan.ac.kr

Received 28 June 2010       Accepted 15 September 2010

Copyright © 2010 The Korean Academy of Tuberculosis and Respiratory Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea.

Methods:

A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge.

Results:

During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) ＜18.5 kg/m2, duration ＞36 months, forced expiratory volume in 1 second (FEV1) ＜50% predicted, arterial CO2 partial pressure (PaCO2) ＞40 mm Hg, and arterial oxygen saturation (SaO2) ＜95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI ＜18.5 kg/m2, PaCO2 ＞40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD.

Conclusion:

Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

Keywords: Pulmonary Disease, Chronic Obstructive, Exacerbation, Patient Readmission, Body Mass Index, Hypercapnia

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Table 1.
Baseline characteristics of COPD patients with frequent and non-frequent readmissions
Variables All (n=77) Frequent (n=35) Non-frequent (n=42) p-value
Sex
  Male 64 (83.1) 30 (85.7) 34 (81) 0.546
  Female 13 (16.9) 5 (14.3) 8 (29.0)  
Age, years±SD 69.2±9.4 68.2±9.9 70.1±9.1  
  ≥65 55 (71.4) 24 (68.6) 31 (73.8) 0.466
  ＜65 22 (28.6) 11 (31.4) 11 (26.2)  
Smoking (Pack-year) 44.8±25.6 42.1±26.5 47.2±24.9  
  Non-smoker 14 (18.2) 7 (20.0) 7 (16.6) 0.619
  Ex&current smoker 63 (81.2) 28 (80.0) 35 (83.4)  
BMI, kg/m2
  ≥18.5 25 (32.5) 6 (17.2) 22 (52.4) ＜0.001
  ＜18.5 52 (67.5) 29 (82.8) 20 (47.6)  
Anxiety or depression        
  Yes 9 (11.9) 7 (20.0) 2 (4.8) 0.072
  No 68 (88.3) 28 (80.0) 40 (95.2)  
Previous steroid therapy
  Yes 25 (32.5) 18 (54.3) 7 (16.7) 0.053
  No 46 (59.7) 16 (45.7) 30 (71.4)  
  Unknown 6 (7.8) 1 (0.0) 5 (11.9)  

Data are presented as number (%).

COPD: chronic obstructive pulmonary disease; BMI: body mass index.

Table 2.
Respiratory function of COPD patients with frequent and non-frequent readmissions
Variables All (n=77) Frequent (n=35) Non-frequent (n=42) p-value
Duration of COPD, months±SD 62.38±92.07 83.97±112.44 43.56±65.60  
  ≥36 40 (51.9) 23 (65.7) 17 (40.5) 0.010
  ＜36 37 (48.1) 12 (34.3) 25 (59.5)  
COPD severity
  Mild & moderate 34 (44.1) 11 (31.4) 23 (54.8) 0.051
  Severe & very severe 43 (55.9) 24 (68.6) 19 (45.2)  
FEV1% predicted
  ≥50 23 (29.9) 6 (17.1) 17 (40.5) ＜0.001
  ＜50 54 (80.1) 29 (82.9) 25 (59.5)  
SaO2 at discharge
  ≥95% 29 (37.7) 13 (37.1) 16 (38.1) 0.022
  ＜95% 48 (62.3) 22 (62.9) 26 (61.9)  
PaCO2 at discharge
  ≥40 mm Hg 33 (42.9) 24 (68.6) 9 (21.4) ＜0.001
  ＜40 mm Hg 44 (57.1) 11 (31.4) 33 (78.6)  

Data are presented as number (%).

COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in 1 second; SaO2: arterial oxygen saturation; PaCO2 arterial CO2 partial pressure.

Table 3.
Associated factors of frequent readmission in COPD (univariate analysis)
Variables OR 95% CI p-value
Duration of COPD (≥36 months) 3.409 1.318∼8.817 0.010
BMI (kg/m2) ＜18.5 4.912 1.648∼14.638 ＜0.001
FEV1 ＜50% predicted 4.765 1.745∼13.007 ＜0.001
SaO2 at discharge ＜95% 2.933 1.152∼7.471 0.022
PaCO2 at discharge ＞40 mm Hg 7.758 2.776∼21.679 ＜0.001

COPD: chronic obstructive pulmonary disease; OR: odds ratio; CI: confidence interval; BMI: body mass index; FEV1: forced expiratory volume in 1 second; SaO2: arterial O2 saturation; PaCO2: arterial CO2 partial pressure.

Table 4.
Multiple logistic regression analysis of the association with frequent readmission in COPD
Significant independent predictors OR 95% CI p-value
BMI (kg/m2) ＜18.5 5.306 1.254~22.454 0.023
PaCO2 at discharge 4.213 1.193~14.880 0.025
＞40 mm Hg      

COPD: chronic obstructive pulmonary disease; OR: odds ratio; CI: confidence interval; BMI: body mass index; PaCO2: arterial CO2 partial pressure.

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