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Predictors of 30- and 90-Day COPD Exacerbation Readmission: A Prospective Cohort Study

Alqahtani, JS; Aldabayan, YS; Aldhahir, AM; Al Rajeh, AM; Mandal, S; Hurst, JR; (2021) Predictors of 30- and 90-Day COPD Exacerbation Readmission: A Prospective Cohort Study. International Journal of Chronic Obstructive Pulmonary Disease , 2021 (16) pp. 2769-2781. 10.2147/copd.s328030. Green open access

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Abstract

Background: Readmission following COPD exacerbation is a common and challenging clinical problem. New approaches to predicting readmissions are required to help mitigate risk and develop novel interventions. Methods: We conducted a prospective cohort study in 82 COPD patients admitted due to an exacerbation of COPD. Lung function measures [spirometry, forced oscillation technique (FOT) indices and peak inspiratory flow rate (PIFR)], inflammatory biomarkers and patient-reported outcomes including previous exacerbation history, breathlessness, quality of life and frailty were measured at admission and discharge. We prospectively followed patients for 30 and 90 days to identify predictors for readmission. Results: The readmission rate within 30 days was 38%, and 56% within 90 days. Previous exacerbations, higher COPD Assessment Test score at discharge, frailty, reduced PIFR and increased length of stay were significantly associated with 30-day readmission. PIFR at discharge and frailty had the highest predictive ability for 30-day readmission using area under receiver operating characteristic curves (AUC 0.86, 95% CI 0.78– 0.95, p < 0.001 and AUC 0.81, 95% CI 0.71– 0.90, p < 0.001, respectively). Ninety-day readmissions were significantly associated with previous exacerbations and hospitalisations, higher CAT score at discharge, frailty, depression, lower PIFR and greater expiratory flow limitation (EFL) in the supine position. The best predictive variable in multivariable analysis for both 30- and 90-day readmission was PIFR at discharge. Conclusion: PIFR, CAT score, frailty, and EFL were found to be associated with 30- and 90-day readmission following COPD exacerbation. These findings help identify those at highest risk and to optimise care prior to discharge.

Type: Article
Title: Predictors of 30- and 90-Day COPD Exacerbation Readmission: A Prospective Cohort Study
Open access status: An open access version is available from UCL Discovery
DOI: 10.2147/copd.s328030
Publisher version: https://doi.org/10.2147/copd.s328030
Language: English
Additional information: © 2021 Alqahtani et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/ terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php)
Keywords: COPD, exacerbation, admission, readmission, predictor, risk factor, PIFR, frailty, EFL
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10136694
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