Predictors of hospitalization in patients presenting to emergency department with an acute exacerbation of COPD – a single-center study in Turkey
DOI:
https://doi.org/10.15584/ejcem.2023.3.23Keywords:
chronic obstructive pulmonary disease, emergency department, hospitalizationAbstract
Introduction and aim. In this study, we evaluated parameters that might be associated with hospitalization in patients admitted to the emergency department (ED) with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Material and methods. Patients with COPD who presented to ED due to AECOPD between January 1, 2020 and December 31, 2021 were included in the study. Patient data were obtained from the hospital database. Univariable and multivariable logistic regression methods were used to identify the relationship between hospitalization and clinical parameters.
Results. The study included 237 patients divided into two groups: inpatients (n=124) and outpatients (n=113). We found significant differences between the two groups in terms of temperature, oxygen saturation, respiratory rate, C-reactive protein, white blood cell count, procalcitonin, albumin, arterial blood pH, pCO2 , and non-invasive mechanical ventilation (NIMV) requirement. Multivariable logistic regression analysis showed that body temperature [odds ratio (OR):1.62;95% confidence interval (CI):1.21–4.91; p<0.001], oxygen saturation (OR:0.73, 95% CI:0.39-0.94, p<0.001), respiratory rate (OR:1.96; 95% CI: 1.07–6.14; p<0.001), albumin (OR:0.71; 95% CI:0.41–0.93; p=0.042), procalcitonin (OR:2.93; 95% CI:1.22–4.84; p<0.001), arterial blood pH (OR:0.78; 95% CI:0.29-0.91; p=0.038), pCO2 (OR:2.45; 95% CI:1.24–4.65; p<0.001), and NIMV requirement (OR:2.31; 95% CI:1.41– 5.13; p<0.001) were the independent predictors of hospitalization.
Conclusion. Our findings may help identify patients who will require hospitalization at an early stage.
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References
Hurst JR, Han MK, Singh B, et al. Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review. Respir Res. 2022;23(1):213. doi: 10.1186/s12931-022-02123-5
Halpin D, Celli B, Criner G, et al. The GOLD Summit on chronic obstructive pulmonary disease in low-and middle-income countries. Int J Tuberc Lung Dis. 2019;23(11):1131-1141. doi: 10.5588/ijtld.19.0397
Erhabor G, Adeniyi B, Arawomo A, et al. Acute Exacerbation of COPD: Clinical Perspectives and Literature Review. West Afr J Med. 2021;38(11):1129-1142.
Çolak Y, Afzal S, Marott JL, et al. Prognosis of COPD depends on severity of exacerbation history: a population-based analysis. Respir Med. 2019;155:141-147.doi: 10.1016/j.rmed.2019.07.021
Global Initiative for Chronic Obstructive Lung Disease. 2022 GOLD Report. Global strategy for the diagnosis, management and prevention of COPD. 2022. https://goldcopd.org/2022-gold-reports-2/. Accessed February 2, 2022.
Westerik JA, Metting EI, van Boven JF, Tiersma W, Kocks JW, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res. 2017;18(1):31. doi: 10.1186/s12931-017-0512-2
Younus M, Farooq F, Anwar S, Nasir Y, Sciences H. Frequency of Hypomagnesaemia in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Pakistan J Medical Health Sci. 2022;16(07):441.
Gong C, Yang Y, Chen M, Xie Z. Effect of procalcitonin on the prognosis of patients with COPD. Biomed Rep. 2020;12(6):313-318. doi: 10.3892/br.2020.1298
Goto T, Yoshida K, Faridi MK, Camargo CA, Hasegawa K. Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation. BMC Pulm Med. 2020;20(1): 107. doi:10.1186/s12890-020-1136-8
Zysman M, Raherison-Semjen C. Women's COPD. Front Med. 2021;8:600107. doi:10.3389/fmed.2021.600107
DeMeo DL, Ramagopalan S, Kavati A, et al. Women manifest more severe COPD symptoms across the life course. Int J Chron Obstruct Pulmon Dis. 2018;13:3021-3029. doi: 10.2147/COPD.S160270
Antonela SA, Carone M. Hospitalizations for chronic obstructive pulmonary disease exacerbations and their impact on disease and subsequent morbidity and mortality. Expert Rev Pharmacoecon Outcomes Res. 2013;13(2):187-189. doi: 10.1586/erp.13.9
Kırhan İ, Üzer F. Bir üniversite hastanesine KOAH alevlenme ile yatan hastaların genel özelliklerinin incelenmesi. J Harran Univ Med Fac. 2018;15(3):230-205.
Montagnani A, Mathieu G, Pomero F, et al. Hospitalization and mortality for acute exacerbation of chronic obstructive pulmonary disease (COPD): an Italian population-based study. Eur Rev Med Pharmacol Sci. 2020;24(12):6899-6907. doi: 10.26355/eurrev_202006_21681
Kırkıl G, Deveci F, Turgut T, Muz MH, Türkoğlu S. Factors Related with Duration of Hospital Stay in Patients with COPD. Firat Med J. 2013;18(3):171-175.
Agboado G, Peters J, Donkin L. 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
Lieberman D, Shmarkov O, Gelfer Y, Varshavsky R, Lieberman DV. Prevalence and clinical significance of fever in acute exacerbations of chronic obstructive pulmonary disease. Eur J Clin Microbiol Infect Dis. 2003;22(2):75-78. doi: 10.1007/s10096-002-0872-4
MacLeod M, Papi A, Contoli M, et al. Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact. Respirology. 2021;26(6):532-551. doi: 10.1111/resp.14041
Sheng F, Chen L, Lin H, Wu H. Systematic review and meta-analysis: value of venous blood gas in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease in Emergency Department. Ann Palliat Med. 2022;11(4):1473-1481. doi: 10.21037/apm-22-336
Elvekjaer M, Aasvang EK, Olsen RM, et al. WARD-Project Group. Physiological abnormalities in patients admitted with acute exacerbation of COPD: an observational study with continuous monitoring. J Clin Monit Comput. 2020;34:1051-1060. doi: 10.1007/s10877-019-00415-8
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
Tseng CY, Chang JCY, Chen YC, et al. Changes of heart rate variability predicting patients with acute exacerbation of chronic obstructive pulmonary disease requiring hospitalization after emergency department treatment. J Chin Med Assoc. 2018;81:47-52. doi: 10.1016/j.jcma.2017.10.003
Raherison C, Ouaalaya E-H, Bernady A, et al. Comorbidities and COPD severity in a clinic-based cohort. BMC Pulm Med. 2018;18(1):117. doi: 10.1186/s12890-018-0684-7
Hakamy A, McKeever TM, Steiner MC, Roberts CM, Singh SJ, Bolton CE. The use of the practice walk test in pulmonary rehabilitation program: National COPD Audit Pulmonary Rehabilitation Workstream. Int J Chron Obstruct Pulmon Dis. 2017;12:2681-2686. doi: 10.2147/COPD.S141620
Daubin C, Parienti JJ, Vabret A, et al. Procalcitonin levels in acute exacerbation of COPD admitted in ICU: A prospective cohort study. BMC Infect Dis. 2008;8:145. doi: 10.1186/1471-2334-8-145
Simon L, Gauvin F, Amre D, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-217. doi: 10.1086/421997
Lacoma A, Prat C, Andreo F, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:157-169. doi: 10.2147/COPD.S16070
Zinellu E, Fois AG, Sotgiu E, et al. Serum albumin concentrations in stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Clin Med. 2021;10(2):269. doi: 10.3390/jcm10020269
Steriade AT, Johari S, Sargarovschi N, et al. Predictors of outcome of noninvasive ventilation in severe COPD exacerbation. BMC Pulm Med. 2019;19(1):131. doi: 10.1186/s12890-019-0892-9
Crisafulli E, Barbeta E, Ielpo A, Torres A. Management of severe acute exacerbations of COPD: an updated narrative review. Multidiscip Respir Med. 2018;13:36. doi: 10.1186/s40248-018-0149-0
Ahmed SM, Athar M. Mechanical ventilation in patients with chronic obstructive pulmonary disease and bronchial asthma. Indian J Anaesth. 2015;59(9):589-598. doi: 10.4103/0019-5049.165856
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