Readmission risk factors after hospitalization for acute exacerbation of chronic pulmonary disease

Exacerbations of chronic obstructive pulmonary disease (COPD) are a leading cause of admission to hospital and have a great impact on health care expenditure, although the factors causing exacerbations are largely unknown. ΑΙΜ The aim of this study was to determine predictive factors for readmission to hospital after an initial hospitalization for acute exacerbation of COPD. MATERΙAL-METΗΟD This study was a prospective collection of data between October 2003 and April 2005 in patients with COPD. Seventy two (72) patients were included in this study. The patients were hospitalised for an acute exacerbation of COPD at the Pneumonology Clinic of an Athens General Hospital after a first evaluation at the Emergency Department of the Hospital. Information on potential risk factors including the health related quality of life (HRQOL) measured by St George’s respiratory questionnaire (SGRQ) scores, standard clinical measurements as spirometry and arterial blood gases (ABG’s) and patient characteristics was collected at the admission and first follow up visit. Results: All the patients that were included in the study completed the follow up visits. During the 6 months follow up period 65 exacerbations were recorded, 28 patients (39%) needed hospitalization due to acute COPD exacerbation, Anthonisen type I, and 6 patients (8,5%) died. Multivariate logistic regression showed that lower SGRQ total score is a risk factor for readmission to hospital after an initial hospitalization due to acute COPD exacerbation (OR=1.06, 95% CI=1.01–1.11, R=0.039). Age and admissions in the previous year were significantly related with readmissions in the simple logistic regression but did not remain in the final multiple regression models. On the other hand, surprisingly, factors quite important for the clinical management of COPD patients such as smoking habit, and clinical measurements such as FEV₁, PO₂ and PCO₂ were not related with the risk of readmission. CONCLUSIONS The usual clinical measurements for the evaluation of a COPD patient are not associated with the risk of readmission to hospital. On the other hand, the assessment of health related quality of life seems to be a valid prognostic indicator of future COPD exacerbations and hospitalizations.