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Predictors of short-term COPD readmission

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Abstract

COPD readmissions have a great impact on patients’ quality of life and mortality. Our goal was to identify factors related to 60-day readmission. We conducted a prospective observational cohort study with a nested case–control study, with 60 days of follow-up after the index admission. Patients readmitted were matched, by age, baseline forced expiratory volume in 1 s and month at admission, with patients admitted in the same period but not readmitted at 2 months. Data were collected on sociodemographic and clinical characteristics and health-related quality of life data at the index admission and events from discharge to readmission within 60 days. Conditional logistic (60-day readmission) and Cox (days to readmission) regression models were constructed. Both multivariable analyses identified the following as predictors: any admission in the preceding 2 months (OR: 2.366; HR: 1.918), hematocrit at ED arrival ≤ 35% (OR: 2.949; HR: 1.570), pre-existing cardiovascular disease (valvular disease or myocardial infarction) (OR: 1.878; HR: 1.490); NIMV at discharge (OR: 0.547; HR: 0.70); no appointment with a specialist after discharge (OR: 5.785; HR: 3.373) and patient-reported need for help at home (OR: 2.978; HR: 2.061). The AUC for the logistic model was 0.845 and the c-index for the Cox model was 0.707. EuroQol EQ-5D score before the admission was correlated with a lower risk of readmission (OR: 0.383; HR: 0.670). As conclusions, we have identified factors related to 60-day readmission and summarized the findings in easy-to-use scoring scales that could be incorporated into the daily clinical routine and may help establish preventive measures to reduce future readmissions.

Registration: Clinical Trial Registration NCT03227211.

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Acknowledgements

This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund (PI15/00016); the Departments of Health of the Basque Government (2017111080) and the thematic network—REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas)—of the Instituto de Salud Carlos III. We are grateful for the collaboration of all hospitals and patients who participated in the study and to the reviewers Amaia Gonzalez, Mariam Valverde, Soraya Estebanez, Jose Rafael, and Yolanda Marrero. The authors also would like to thank Ideas Need Communicating Language Services for improving the use of English in the manuscript.

ReEPOC-REDISSEC group

Cristóbal Esteban, Amaia Aramburu, Myriam Aburto, Ane Villanueva, Ane Anton, Miren Orive, Jose M Quintana (hospital de Galdakao); Milagros Iriberri, Eva Tabernero (hospital de Cruces); Patricia Sobradillo (hospital de Txagorritxu); Monica Rayon (hospital Donostia), Raquel Sánchez (hospital de Basurto); Lorena López Roldan (hospital de Santa Marina); Jose Joaquín Cebrián, Alberto Jiménez-Puente, Maria Padilla (hospital Costa del Sol); Javier de-Miguel-Díez, José Terán (hospital Gregorio Marañón); Ignacio García-Talavera (hospital Nuestra Señora de la Candelaria).

Funding

This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund (PI15/00016); the Departments of Health of the Basque Government (2017111080) and the thematic network–REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas)–of the Instituto de Salud Carlos III. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the projects "RD16/0001/0001" and RD21CIII/0003/0017 and co-funded by the European Union.

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Authors and Affiliations

  1. Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga S/N, 48960, Galdakao, Vizcaya, Spain

    Jose M. Quintana & Ane Anton-Ladislao

  2. Departamento Psicología Social, Facultad Farmacia, UPV/EHU, Vitoria-Gasteiz, Spain

    Miren Orive

  3. Servicio de Respiratorio, Hospital Universitario Galdakao-Usansolo, Galdakao, Spain

    Amaia Aramburu & Cristobal Esteban

  4. Servicio de Respiratorio, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain

    Milagros Iriberri

  5. Servicio de Respiratorio, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain

    Raquel Sánchez

  6. Unidad de Evaluación, Hospital Costa del Sol, Marbella, Málaga, Spain

    Alberto Jiménez-Puente

  7. Servicio de Respiratorio, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

    Javier de-Miguel-Díez

  8. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Barakaldo, Vizcaya, Spain

    Jose M. Quintana, Ane Anton-Ladislao, Miren Orive & Cristobal Esteban

  9. Instituto Kronikgune, Barakaldo, Vizcaya, Spain

    Jose M. Quintana, Ane Anton-Ladislao & Miren Orive

  10. Instituto BioCruces-Bizkaia, Barakaldo, Vizcaya, Spain

    Amaia Aramburu, Milagros Iriberri & Cristobal Esteban

  11. Universidad Complutense de Madrid, Madrid, Spain

    Javier de-Miguel-Díez

Authors
  1. Jose M. Quintana
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  2. Ane Anton-Ladislao
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Consortia

the ReEPOC-REDISSEC group

Contributions

Drs Quintana, Anton-Ladislao, and Esteban had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Quintana, Esteban, Orive, Aramburu, Iriberri, Sánchez, Jiménez-Puente, de-Miguel-Díez, and Esteban. Acquisition, analysis, or interpretation of data: Quintana, Orive, and the whole ReEPOC-REDISSEC group. Drafting of the manuscript: Quintana, Esteban, and Anton-Ladislao. Critical revision of the manuscript for important intellectual content: all the authors. Statistical analysis: Quintana, Esteban and Anton-Ladislao. Obtained funding: Quintana. Administrative, technical, or material support: the whole ReEPOC-REDISSEC group.

Corresponding author

Correspondence to Jose M. Quintana.

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No financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest exist for any of the authors of this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee of the Basque Country (reference PI2015124).

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All patients were required to provide written informed consent to participate in the study.

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Quintana, J.M., Anton-Ladislao, A., Orive, M. et al. Predictors of short-term COPD readmission. Intern Emerg Med 17, 1481–1490 (2022). https://doi.org/10.1007/s11739-022-02948-4

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