Pulmonary Hypertension May Increase In-Hospital Mortality in Acute COPD Exacerbations

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

Pulmonary hypertension (PH) was associated with higher in-hospital mortality, morbidity, length of stay, and health care utilization in patients admitted to the hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), according to research presented at the 2020 CHEST Annual Meeting, held virtually October 18 to 21.

In this retrospective study, patients admitted with AECOPD and PH were identified from the 2016 and 2017 National Readmission Database. Of the 821,468 patients with AECOPD, up to 8.33% (n= 68,429) had a PH diagnosis.

In-hospital mortality during the index admission was the primary outcome in this analysis. Additional secondary outcomes included 30-day readmission, resource utilization, and morbidity. Researchers also reported rates of intubation, prolonged invasive mechanical ventilation (PIMV; >96 h), tracheostomy, chest tube placement, and bronchoscopy during the index admission.

Approximately 61.1% of patients with PH were women and 79.5% of patients were Medicare recipients. The mean age of the population was 70 years. Compared with patients without PH, patients with PH had a significantly greater in-hospital mortality (adjusted odds ratio [aOR], 1.89; 95% CI, 1.73- 2.07; P <.01) and higher 30-day readmission (aOR, -1.24; 95% CI, -1.21 to 1.28; P <.001).

Patients with PH were also associated with significantly higher morbidity, including higher rates of intubation (aOR, 1.99; 95% CI, 1.85-2.14; P <.01), PIMV (aOR, 2.12; 95% CI, 1.89-2.38; P <.001), tracheostomy (aOR, -2.15; 95% CI, -1.53 to 2.9; P <.001), bronchoscopy (aOR, -1.46; 95% CI, -1.11 to1.94; P <.007), and chest tube placement (aOR, -1.39; 95% CI, -1.11 to 1.74; P <.004). In addition, having a PH diagnosis correlated with greater resource utilization with total hospitalization cost (aMD, $2785; 95% CI, $2602-$2967; P <.01) and length of hospital stay (aMD, -1.09; 95% CI, -1.02 to 1.15; P <.001).

Independent predictive variables of higher 30-day readmissions included being 30 to 50 years of age and having a hospital length of stay of more than 3 days. Additional independent predictors included being a Medicare recipient, having a higher Charlson Comorbidity burden, opioid and cocaine dependency, and being of a higher hospital volume quintile for AECOPD. Independent predictive variables for lower 30-day readmissions included female sex, having private insurance, having higher household income, and residing in a small metropolitan area during the index admission.

Based on their findings, the researchers concluded that early identification “and appropriate treatment of PH, close follow up, and early referral to lung transplant will be beneficial to” patients with PH and AECOPD.

Visit Pulmonology Advisor‘s conference section for continuous coverage from CHEST 2020.

Reference

Patel P, Wang Y, Li S, Patel P, Jiyani R. Impact of having pulmonary hypertension in patients admitted with acute exacerbation of COPD in their healthcare utilization and readmission: a US population cohort study. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 1661.