UCL Respiratory, University College London, London, UK
Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
Eur Respir Rev. 2020 Jun 3;29(156). doi: 10.1183/16000617.0166-2019. Print 2020 Jun 30.
Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.
We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.
In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)).
Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
慢性阻塞性肺疾病（COPD）加重住院后的再入院率高得令人无法接受，但其相关因素仍知之甚少。我们的目的是总结和评估与 COPD 加重住院后 30 天和 90 天全因再入院相关的因素。
我们系统地检索了从创建到 2019 年 11 月 5 日的电子数据库。两名作者按照系统评价和荟萃分析的首选报告项目（PRISMA）指南提取数据。使用纽卡斯尔-渥太华量表的改良版评估研究质量。我们从合格研究中进行了叙述性综合，并在可能的情况下使用随机效应模型进行了荟萃分析。
共筛选了 3533 篇摘要，回顾了 208 篇全文文献。共有 32 篇文章符合纳入标准，其中 14 篇文章纳入荟萃分析。30 天的再入院率为 8.8%-26.0%，90 天的再入院率为 17.5%-39.0%。我们的叙述性综合表明，合并症、既往加重和住院次数以及初始住院时间的延长是 30 天和 90 天再入院的主要危险因素。汇总调整后的优势比（95%置信区间）显示，心力衰竭（1.29（1.22-1.37））、肾衰竭（1.26（1.19-1.33））、抑郁症（1.19（1.05-1.34））和酒精使用（1.11（1.07-1.16））均与 30 天全因再入院风险增加相关，而女性则是一个保护因素（0.91（0.88-0.94））。
合并症、既往加重和住院次数以及住院时间的延长是 COPD 加重住院后 30 天和 90 天全因再入院的重要危险因素。
