scholarly journals Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Russell G. Buhr ◽  
Nicholas J. Jackson ◽  
Gerald F. Kominski ◽  
Steven M. Dubinett ◽  
Michael K. Ong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Standard Deviation ◽  
Pulmonary Disease ◽  
Model Fit ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Model Parameters ◽  
Standard Deviation Increase ◽  
Obstructive Pulmonary Disease ◽  
Comorbidity Index

Abstract Background Readmissions following exacerbations of chronic obstructive pulmonary disease (COPD) are prevalent and costly. Multimorbidity is common in COPD and understanding how comorbidity influences readmission risk will enable health systems to manage these complex patients. Objectives We compared two commonly used comorbidity indices published by Charlson and Elixhauser regarding their ability to estimate readmission odds in COPD and determine which one provided a superior model. Methods We analyzed discharge records for COPD from the Nationwide Readmissions Database spanning 2010 to 2016. Inclusion and readmission criteria from the Hospital Readmissions Reduction Program were utilized. Elixhauser and Charlson Comorbidity Index scores were calculated from published methodology. A mixed-effects logistic regression model with random intercepts for hospital clusters was fit for each comorbidity index, including year, patient-level, and hospital-level covariates to estimate odds of thirty-day readmissions. Sensitivity analyses included testing age inclusion thresholds and model stability across time. Results In analysis of 1.6 million COPD discharges, readmission odds increased by 9% for each half standard deviation increase of Charlson Index scores and 13% per half standard deviation increase of Elixhauser Index scores. Model fit was slightly better for the Elixhauser Index using information criteria. Model parameters were stable in our sensitivity analyses. Conclusions Both comorbidity indices provide meaningful information in prediction readmission odds in COPD with slightly better model fit in the Elixhauser model. Incorporation of comorbidity information into risk prediction models and hospital discharge planning may be informative to mitigate readmissions.

Day-to-day variability of forced oscillatory mechanics for early detection of acute exacerbations in COPD

2020 ◽  
Vol 56 (3) ◽  
pp. 1901739 ◽  
Author(s):  
Sabine C. Zimmermann ◽  
Jacqueline Huvanandana ◽  
Chinh D. Nguyen ◽  
Amy Bertolin ◽  
Joanna C. Watts ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Standard Deviation ◽  
Early Detection ◽  
Pulmonary Disease ◽  
Repeated Measures ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
The Relationship

BackgroundTelemonitoring trials for early detection of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have provided mixed results. Day-to-day variations in lung function measured by the forced oscillation technique (FOT) may yield greater insight. We evaluated the clinical utility of home telemonitoring of variability in FOT measures in terms of 1) the relationship with symptoms and quality of life (QoL); and 2) the timing of variability of FOT measures and symptom changes prior to AECOPD.MethodsDaily FOT parameters at 5 Hz (resistance (R) and reactance (X); Resmon Pro Diary, Restech Srl, Milan, Italy), daily symptoms (COPD Assessment Test (CAT)) and 4-weekly QoL data (St George's Respiratory Questionnaire (SGRQ)) were recorded over 8–9 months from chronic obstructive pulmonary disease (COPD) patients. Variability of R and X was calculated as the standard deviation (sd) over 7-day running windows and we also examined the effect of varying window size. The relationship of FOT versus CAT and SGRQ was assessed using linear mixed modelling, daily changes in FOT variability and CAT prior to AECOPD using one-way repeated measures ANOVA.ResultsFifteen participants with a mean±sd age of 69±10 years and a % predicted forced expiratory volume in 1 s (FEV1) of 39±10% had a median (interquartile range (IQR)) adherence of 95.4% (79.0–98.8%). Variability of the inspiratory component of X (indicated by the standard deviation of inspiratory reactance (SDXinsp)) related to CAT and weakly to SGRQ (fixed effect estimates 1.57, 95% CI 0.65–2.49 (p=0.001) and 4.41, 95% CI −0.06 to 8.89 (p=0.05), respectively). SDXinsp changed significantly on the same day as CAT (1 day before AECOPD, both p=0.02) and earlier when using shorter running windows (3 days before AECOPD, p=0.01; accuracy=0.72 for 5-day windows).ConclusionsSDXinsp from FOT telemonitoring reflects COPD symptoms and may be a sensitive biomarker for early detection of AECOPD.

scholarly journals Stability of blood eosinophils in acute exacerbation of chronic obstructive pulmonary disease and its relationship to clinical outcomes: a prospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanan Cui ◽  
Wenye Zhang ◽  
Yiming Ma ◽  
Zijie Zhan ◽  
Yan Chen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Acute Exacerbation ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
The Stability ◽  
Blood Eosinophils

Abstract Background The clinical value of blood eosinophils and their stability in chronic obstructive pulmonary disease (COPD) remains controversial. There are limited studies on association between the stability of blood eosinophils in acute exacerbation of COPD (AECOPD) and clinical outcomes. This study aimed to evaluate the stability of blood eosinophils in hospitalized AECOPD and its relationship to clinical outcomes. Methods This prospective observational study recruited patients hospitalized with AECOPD from November 2016 to July 2020. The eligible patients were divided into four groups according to their blood eosinophil counts at admission and discharge: persistently < 300 cells/μl (LL), < 300 cells/μl at admission but ≥ 300 cells/µl at discharge (LH), ≥ 300 cells/μl at admission but < 300 cells/µl at discharge (HL), and persistently ≥ 300 cells/μl (HH). Cox hazard analyses were used to study the association between eosinophil changes and exacerbations or mortality. Results In 530 patients included, 90 (17.0%) had a high blood eosinophil count (BEC) ≥ 300 cells/µl at admission but 32 (35.6%) of them showed a decreased BEC at discharge. The proportions and distribution for group LL, LH, HL, and HH were 381 (71.9%), 59 (11.1%), 32 (6.0%), and 58 (10.9%), respectively. During hospitalization, the LH group had a higher C-reactive protein level, higher rate of intensive care unit (ICU) admission, and higher total cost. The length of hospital stay of the LH group was longer compared with group LL, HL, or HH (P = 0.002, 0.017, and 0.001, respectively). During a follow-up of 12 months, the HH group was associated with a higher risk of moderate-to-severe exacerbations compared to the LL group (hazard ratio 2.00, 95% confidence interval 1.30–3.08, P = 0.002). Eosinophil changes had no significant association with mortality at 12 months. Sensitivity analyses in patients without asthma and without use of systemic corticosteroids prior to admission did not alter the results. Conclusions More attention should be paid to the LH group when evaluating the short-term prognosis of AECOPD. A persistently high BEC was a risk factor for long-term exacerbations. Eosinophil changes during hospitalization could help to predict outcomes.

scholarly journals Comprehensive assessment of patients with chronic obstructive pulmonary disease by means of multicomponent ADO index and Charlson comorbidity index

2018 ◽  
pp. 182-184 ◽  
Author(s):  
E. Kochetova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Correlation Coefficient ◽  
Charlson Comorbidity Index ◽  
Comprehensive Assessment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Comorbidity Index

The purpose of this study was to investigate the ADO index, and index of comorbidity of Charlson in patients with chronic obstructive pulmonary disease (COPD). Materials and methods: 207 patients with chronic obstructive pulmonary disease (COPD) were observed. The investigated group was made by the patients having the long experience of smoking. Research of function of external breath was studied with multimodular installation of type «Master-Lab/Jaeger». Patients were determined the index ADO and of comorbidity of Charlson. Results: The index ADO increased with stage of COPD, minimum of level ADO was observed in patients with COPD 2 stage 2,23 ± 0,88, in patients with 3 stage COPD ADO was 5,05 ± 1,19, 4 stages of COPD 7,0 ± 1,0. The correlation coefficient between ADO index and and index of comorbidity Charlson was -0,71, p <0,005. The correlation coefficient between ADO and VC was -0,57, p <0,05, between ADO and ERV was -0,63, p <0,05. 

scholarly journals Endothelial dysfunction in chronic obstructive pulmonary disease: a systematic review and meta-analysis of studies using different functional assessment methods

2021 ◽  
pp. 00983-2020
Author(s):  
Marieta P. Theodorakopoulou ◽  
Maria Eleni Alexandrou ◽  
Dimitra Rafailia Bakaloudi ◽  
Georgia Pitsiou ◽  
Ioannis Stanopoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Pulmonary Disease ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

BackgroundCardiovascular disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Endothelial dysfunction is suggested to be one of the pathogenetic mechanisms involved. This is a systematic review and meta-analysis of studies using any available functional method to examine differences in endothelial function between patients with COPD and individuals without COPD (controls).MethodsLiterature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Subgroup analyses were performed to explore heterogeneity across the studies. Funnel-plots were constructed to evaluate publication bias.ResultsOf the 21 initially identified reports, 19 studies with a total of 968 participants were included in the final meta-analysis. A significantly impaired response in endothelium-dependent (weighted mean between-group difference, WMD: −2.59%, 95%CI [−3.75, −1.42]) and –independent vasodilation (WMD: −3.13, 95%CI [−5.18, −1.09]) was observed in patients with COPD compared to controls. When pooling all studies together, regardless of the technique used for assessment of vascular reactivity, pronounced endothelial dysfunction was observed in COPD compared to controls (standardised-mean-difference, SMD: −1.19, 95%CI [−1.69, −0.68]). Subgroup analysis showed that the difference was larger when patients with COPD were compared with non-smoking controls (SMD: −1.75, 95%CI [−2.58, −0.92]. Sensitivity analyses confirmed the above results.ConclusionsPatients with COPD have significantly impaired endothelial function compared to controls without COPD. Future studies should delineate the importance of endothelial dysfunction towards development of cardiovascular disease in COPD.

scholarly journals Economic Impact of Using an Immunostimulating Agent to Prevent Severe Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

2001 ◽  
Vol 8 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Jean-Paul Collet ◽  
Thierry Ducruet ◽  
Seema Haider ◽  
Stan Shapiro ◽  
Ann Robinson ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Economic Impact ◽  
Pulmonary Disease ◽  
Sensitivity Analyses ◽  
Random Fluctuation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
The Cost

RATIONALE: OM-85 BV, an immunostimulant made from bacterial extracts, has been shown to reduce the risk of hospitalization for acute exacerbation in patients with chronic obstructive pulmonary disease, as well as to reduce the length of stay for all hospitalizations.METHODS: In conjunction with a placebo controlled, randomized clinical trial, a cost effectiveness analysis was carried out to assess the economic impact of using OM-85 BV. In the analysis, effectiveness was defined as the difference in the number of severe acute exacerbations, assessed by the number of hospitalizations for a respiratory problem, between the placebo and OM-85 BV-treated groups.RESULTS: The median cost to prevent one day of hospitalization for a respiratory condition was CDN$45, with a 95% CI of CDN$18 to CDN$210. Bootstrap of the study population and sensitivity analyses showed that the results were robust and not likely due to random fluctuation; 98.8% of the cost effectiveness and 96.8% of the cost-benefit ratios favoured the use of OM-85 BV. Indirect costs, defined as a need for help, were reduced by 36% in the group treated with OM-85 BV: 779 h of help compared with 1212 h in the placebo group. This trend, while not significant, is consistent with other results and suggests a decrease in the severity of exacerbations in the OM-85 BV-treated group.CONCLUSION: Given the high prevalence of chronic obstructive pulmonary disease worldwide and the high cost of acute exacerbations, immunostimulants may become a key element in the improved control of this condition.

scholarly journals Daily Objective Physical Activity and Sedentary Time in Adults with COPD Using Spirometry Data from Canadian Measures Health Survey

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
P. Bernard ◽  
G. Hains-Monfette ◽  
S. Atoui ◽  
G. Moullec
Keyword(s):  
Physical Activity ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Sedentary Time ◽  
Airflow Obstruction ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Chronic Obstructive ◽  
Intensity Level ◽  
Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is expected to be the third leading cause of premature death and disability in Canada and around the world by the year 2020. The study aims to compare objective physical activity (PA) and sedentary time in a population-based sample of adults with chronic obstructive pulmonary disease (COPD) and compare a group, and to investigate whether these behaviors differ according to COPD severity. From the 2007–2013 Canadian Health Measures Survey dataset, accelerometer and prebronchodilator spirometry data were available for 6441 participants, aged 35 to 79. Two weighted analyses of covariance were performed with adjustments for age, sex, body mass index, accelerometer wearing time, season, work, smoking (cotinine), education level, and income. A set of sensitivity analyses were carried out to examine the possible effect of COPD and type of control group. A cross-sectional weighted analysis indicated that 14.6% of study participants had a measured airflow obstruction consistent with COPD. Time in PA (moderate-vigorous and light PA), number of steps, and sedentary duration were not significantly different in participants with COPD, taken together, compared to controls. However, moderate to severe COPD participants (stages ≥2) had a significantly lower daily time spent in PA of moderate and vigorous intensity level compared to controls. Canadian adults with COPD with all disease severity levels combined did not show lower daily duration of light, moderate, and vigorous PA, and number of steps and higher daily sedentary time than those without airflow obstruction. Both groups are extremely sedentary and have low PA duration. Thus, “move more and sit less” public health strategy could equally target adults with or without COPD.

scholarly journals Bias away from the null due to miscounted outcomes? A case study on the TORCH trial

2017 ◽  
Vol 27 (10) ◽  
pp. 3151-3166 ◽  
Author(s):  
Stefanie Muff ◽  
Milo A Puhan ◽  
Leonhard Held
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Treatment Effect ◽  
Negative Binomial ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Model Parameters ◽  
Unexpected Result ◽  
Validation Data ◽  
Obstructive Pulmonary Disease

Count outcomes occur in virtually all disciplines, such as medicine, epidemiology or biology, but they often contain error. Recently, it has been shown that self-reported numbers of exacerbations of Chronic Obstructive Pulmonary Disease patients can be considerably miscounted. Motivated by this result, we reanalysed data from the Towards a Revolution in Chronic Obstructive Pulmonary Disease Health trial, a large randomized controlled trial with the self-reported number of exacerbations of Chronic Obstructive Pulmonary Disease patients as outcome. To adjust for miscounting error in the response of Poisson and (zero-inflated) negative binomial models, we introduce novel, general methodology. The key idea is to formulate a zero-inflated negative binomial model to capture the error mechanism. This parametric approach automatically circumvents drawbacks of previously suggested methodology that treats miscounted outcomes in the misclassification framework. Prior information for the response error model parameters was elicited from validation data of an external study and adaptively weighted to account for potential prior-data conflict. The results of the Bayesian hierarchical modelling approach indicated that the treatment effect has been overestimated in the original study. However, closer inspection revealed that this unexpected result was an artefact of an unaccounted time dependency of the treatment effect.

scholarly journals Risk of Chronic Obstructive Pulmonary Disease Exacerbation in Patients Who Use Methotrexate—A Nationwide Study of 58,580 Outpatients

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 604
Author(s):  
Christina Marisa Bergsøe ◽  
Pradeesh Sivapalan ◽  
Mohamad Isam Saeed ◽  
Josefin Eklöf ◽  
Zaigham Saghir ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Propensity Score ◽  
Pulmonary Disease ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Matched Study

Patients with severe chronic obstructive pulmonary disease (COPD) experience frequent acute exacerbations and require repeated courses of corticosteroid therapy, which may lead to adverse effects. Methotrexate (MTX) has anti-inflammatory properties. The objective of this study was to describe the risk of COPD exacerbation in patients exposed to MTX. In this nationwide cohort study of 58,580 COPD outpatients, we compared the risk of hospitalization-requiring COPD exacerbation or death within 180 days in MTX vs. non-MTX users in a propensity-score matched study population as well as an unmatched cohort, in which we adjusted for confounders. The use of MTX was associated with a reduction in risk of COPD exacerbation in the propensity-score matched population at 180 days follow-up (HR 0.66, CI 0.66–0.66, p < 0.001). Similar results were shown in our sensitivity analyses at 180-day follow-up on unmatched population and 365-day follow-up on matched and unmatched population (HR 0.76 CI 0.59–0.99, HR 0.81 CI 0.81–0.82 and HR 0.92 CI 0.76–1.11, respectively). MTX was associated with a lower risk of COPD exacerbation within the first six months after study entry. The finding seems biologically plausible and could potentially be a part of the management of COPD patients with many exacerbations.

Sign in / Sign up

Export Citation Format

Share Document