Simpson Matthew, Kapfumvuti Rumbidzai, Niranjan Sitara, Sherman Matthew, Hassan Abdulahi, Mutabi Erasmus, Daniel Tyrell, Ranganatha Ravishankar, Awuah Kojo-Frimpong, Paul Haris, Yin Yue, Hoffman Brandon, Venkat Divya
Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA.
Department of Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
J Thorac Dis. 2024 Dec 31;16(12):8538-8549. doi: 10.21037/jtd-24-932. Epub 2024 Dec 28.
Chronic obstructive pulmonary disease (COPD) exacerbations often lead to hospitalizations and subsequent readmissions. Steroid therapy is a common approach in managing COPD exacerbations, yet a considerable proportion of patients experience readmissions within a short timeframe, highlighting the persistent and complex nature of COPD exacerbations. The aim of this retrospective study is to investigate risk factors for all-cause hospital readmissions in COPD patients discharged on steroid tapers following exacerbations, emphasizing the need for personalized management strategies to reduce readmission rates.
Patient demographics and treatment histories were collected in a retrospective study of electronic medical records for patients in our hospital system for the calendar year 2023. Descriptive statistics were calculated, and univariate logistic regression were conducted for potential predictors.
Data analysis revealed that higher exacerbation frequency significantly increased the likelihood of readmission within a year, with patients experiencing three or more exacerbations facing 11 times and 25 times greater risks compared to those with 0 exacerbations. Early re-exacerbations within 30 days of discharge also emerged as strong predictors of long-term prognosis.
Existing prognostic tools lack specificity for predicting short-term readmissions, highlighting the need for comprehensive risk assessment tools tailored to individual patient needs. Proactive monitoring of exacerbation frequency and personalized management strategies are essential for optimizing care delivery and reducing readmission rates in COPD patients. Targeted interventions aimed at mitigating identified risk factors and optimizing post-discharge management can enhance patient outcomes and alleviate the overall burden of COPD on patients and healthcare systems. Further research is warranted to address limitations and refine risk assessment tools to support personalized COPD care.
慢性阻塞性肺疾病（COPD）急性加重常常导致住院及随后的再次入院。类固醇疗法是管理COPD急性加重的常用方法，但相当一部分患者在短时间内再次入院，这凸显了COPD急性加重的持续性和复杂性。这项回顾性研究的目的是调查在急性加重后接受类固醇逐渐减量治疗出院的COPD患者全因再次入院的风险因素，强调需要个性化管理策略以降低再入院率。
在一项对我院系统2023年全年电子病历的回顾性研究中收集患者人口统计学和治疗史。计算描述性统计量，并对潜在预测因素进行单因素逻辑回归分析。
数据分析显示，较高的急性加重频率显著增加了一年内再次入院的可能性，与无急性加重的患者相比，经历三次或更多次急性加重的患者面临的风险分别高11倍和25倍。出院后30天内的早期再次急性加重也是长期预后的有力预测因素。
现有的预后工具在预测短期再次入院方面缺乏特异性，这凸显了需要针对个体患者需求定制全面的风险评估工具。积极监测急性加重频率和个性化管理策略对于优化护理提供和降低COPD患者再入院率至关重要。旨在减轻已识别风险因素并优化出院后管理的针对性干预措施可以改善患者结局并减轻COPD对患者和医疗系统的总体负担。有必要进行进一步研究以解决局限性并完善风险评估工具，以支持个性化的COPD护理。
