Background: Hospital readmissions for acute exacerbation of chronic obstructive pulmonary disease (COPD) are one of the leading causes of healthcare expenditures worldwide. Objectives: To identify risk factors for hospital readmission in COPD patients. Methods: We prospectively evaluated 129 consecutive patients hospitalized for acute exacerbation of COPD. Clinical, spirometric and arterial blood gas variables were measured during hospitalization. Socioeconomic characteristics, comorbidity, dyspnea, functional dependence, depression, social support and quality of life were also analyzed. Readmission was defined as one or more hospitalizations in the following year. Results: During the follow-up period, 75 (58.5%) patients were readmitted. In bivariate analysis, readmission was associated with previous hospitalization for COPD in the past year, dyspnea scale, PaCO2 at discharge, depression, cor pulmonale, chronic domiciliary oxygen and quality of life measured by the St. George’s Respiratory Questionnaire. In multivariate analysis, the best predictor of readmission was the combination of hospitalization for COPD in the previous year (odds ratio, OR: 4.27; 95% confidence interval, CI: 1.5–12), the total score of the St. George’s Respiratory Questionnaire ≧50 points (OR: 2.36; 95% CI: 1.03–5.04) and PaCO2 at discharge ≧45 mm Hg (OR: 2.18; 95% CI: 0.84–5.06). With this model, the probability of readmission for patients without any of these variables was 7%, while it was 70% for the patients with all three variables present. Conclusion: The combination of quality of life, hospitalization for COPD in the previous year and hypercapnia at discharge are useful predictors of readmission at 1 year.

1.
Sullivan SD, Ramsey SD, Lee TA: The economic burden of COPD. Chest 2000;117:5S–9S.
2.
Strassels SA, Smith DH, Sullivan SD, Mahajan PS: The cost of treating COPD in the United States. Chest 2001;119:344–352.
3.
Murata GH, Gorby MS, Kapsner CO, Chick TW, Halperin AK: A multivariate model for the prediction of relapse after outpatient treatment of decompensated chronic obstructive pulmonary disease. Arch Intern Med 1992;152:73–77.
4.
Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG: Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax2002;57:137–141.
5.
Garcia-Aymerich J, Farrero E, Felez MA, Izquierdo J, Marrades RM, Anto JM: Risk factors of readmission to hospital for a COPD exacerbation: A prospective study. Thorax2003;58:100–105.
6.
Lau AC, Yam LY, Poon E: Hospital re-admission in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2001;95:876–884.
7.
Vega Reyes JA, Montero Perez-Barquero M, Sanchez Guijo P: Assessing COPD-associated morbidity: factors of prognosis. Med Clin (Barc) 2004;122:293–297.
8.
Connors AF Jr, Dawson NV, Thomas C, et al: Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Respir Crit Care Med 1996;154:959–967.
9.
Cydulka RK, McFadden ER Jr, Emerman CL, Sivinski LD, Pisanelli W, Rimm AA: Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;156:1807–1812.
10.
Stehr DE, Klein BJ, Murata GH: Emergency department return visits in chronic obstructive pulmonary disease: the importance of psychosocial factors. Ann Emerg Med 1991;20:1113–1116.
11.
Osman IM, Godden DJ, Friend JA, et al: Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997;52:67–71.
12.
Tsoumakidou M, Tzanakis N, Voulgaraki O, et al: Is there any correlation between the ATS, BTS, ERS and GOLD COPD’s severity scales and the frequency of hospital admissions? Respir Med 2004;98:178–183.
13.
Almagro P, Calbo E, Ochoa de Echagüen A, et al: Mortality after hospitalization for COPD. Chest 2002;121:1441–1448.
14.
Siafakas NM, Vermeire P, Pride NB, et al: Optimal assessment and management of chronic obstructive pulmonary disease. Eur Respir J 1995;8:1398–1420.
15.
Hosmer DW, Lemewshow S: Applied Logistic Regression. New York, Wiley, 1989.
16.
Davies L, Wilkinson M, Bonner S, Calverley PM, Angus RM: ‘Hospital at home’ versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial. BMJ 2000;321:1265–1268.
17.
Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E: Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:158–164.
18.
Costello R, Deegan P, Fitzpatrick M, McNicholas WT: Reversible hypercapnia in chronic obstructive pulmonary disease: a distinct pattern of respiratory failure with a favorable prognosis. Am J Med 1997;102:239–244.
19.
Haidl P, Clement C, Wiese C, Dellweg D, Kohler D: Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia. Respiration 2004;71:342–347.
20.
Vestbo J, Rasmussen FV: Respiratory symptoms and FEV1 as predictors of hospitalization and medication in the following 12 years due to respiratory disease. Eur Respir J 1989;2:710–715.
21.
Emerman CL, Effron D, Lukens TW: Spirometric criteria for hospital admission of patients with acute exacerbation of COPD. Chest 1991;99:595–599.
22.
Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR: Prevalence of depression and anxiety in patients with COPD. Relationship to functional capacity. Chest 1985;87:35–38.
23.
van Manen JG, Bindels PJ, Dekker FW, Ijzermans CJ, van der Zee JS, Schade E: Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax 2002;57:412–416.
24.
Bula CJ, Wietlisbach V, Burnand B, Yersin B: Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients. Arch Intern Med 2001;161:2609–2615.
25.
Hajiro T, Nishimura K, Tsukino M, Ikeda A, Koyama H, Izumi T: Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:785–790.
26.
Jones PW: Issues concerning health-related quality of life in COPD. Chest 1995;107 (suppl):187S–193S.
27.
Jones PW, Quirk FH, Baveystock CM, et al: A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Am Rev Respir Dis 1992;145:1321–1330.
28.
Hajiro T, Nishimura K, Tsukino M, Ikeda A, Oga T: Stages of disease severity and factors that affect the health status of patients with chronic obstructive pulmonary disease. Respir Med 2000;94:841–846.
29.
Lorenzi CM, Cilione C, Rizzardi R, Furino V, Bellantone T, Lugli D, Clini E: Occupational therapy and pulmonary rehabilitation of disabled COPD patients. Respiration 2004;71:246–251.
30.
Bourbeau J, Julien M, Maltais F, et al: Reduction of hospital utilization in patients with chronic obstructive pulmonary disease. Arch Intern Med 2003;163:585–591.
31.
Pascual-Pape T, Badia JR, Marrades RM, et al: Results of a preventive program and assisted hospital discharge for COPD exacerbation. A feasibility study. Med Clin (Barc) 2003;120:408–411.
32.
Puente-Maestu L, SantaCruz A, Vargas T, Martinez-Abad Y, Whipp BJ: Effects of training on the tolerance to high-intensity exercise in patients with severe COPD. Respiration 2003;70:367–370.
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