scholarly journals Long-Term Outcomes in Patients with Incident Chronic Obstructive Pulmonary Disease after Acute Kidney Injury: A Competing-Risk Analysis of a Nationwide Cohort

2018 ◽  
Vol 7 (9) ◽  
pp. 237 ◽  
Author(s):  
Che-Hsiung Wu ◽  
Huang-Ming Chang ◽  
Cheng-Yi Wang ◽  
Likwang Chen ◽  
Liang-Wen Chen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Kidney Injury ◽  
Risk Analysis ◽  
Pulmonary Disease ◽  
Kidney Injury ◽  
Competing Risk ◽  
Chronic Obstructive ◽  
Competing Risk Analysis ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Both acute kidney injury (AKI) and chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality. However, the incidence of de novo COPD in patients with AKI, and the impact of concurrent COPD on the outcome during post-AKI care is unclear. Patients who recovered from dialysis-requiring AKI (AKI-D) during index hospitalizations between 1998 and 2010 were identified from nationwide administrative registries. A competing risk analysis was conducted to predict the incidence of adverse cardiovascular events and mortality. Among the 14,871 patients who recovered from temporary dialysis, 1535 (10.7%) were identified as having COPD (COPD group) one year after index discharge and matched with 1473 patients without COPD (non-COPD group) using propensity scores. Patients with acute kidney disease superimposed withs COPD were associated with a higher risk of incident ischemic stroke (subdistribution hazard ratio (sHR), 1.52; 95% confidence interval (95% CI), 1.17 to 1.97; p = 0.002) and congestive heart failure (CHF; sHR, 1.61; (95% CI), 1.39 to 1.86; p < 0.001). The risks of incident hemorrhagic stroke, myocardial infarction, end-stage renal disease, and mortality were not statistically different between the COPD and non-COPD groups. This observation adds another dimension to accumulating evidence regarding pulmo-renal consequences after AKI.

Chronic obstructive pulmonary disease mortality, a competing risk analysis

2018 ◽  
Vol 12 (11) ◽  
pp. 2598-2605 ◽  
Author(s):  
Jawad Abukhalaf ◽  
Ross Davidson ◽  
Nicolas Villalobos ◽  
Paula Meek ◽  
Hans Petersen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Risk Analysis ◽  
Pulmonary Disease ◽  
Competing Risk ◽  
Chronic Obstructive ◽  
Competing Risk Analysis ◽  
Obstructive Pulmonary Disease ◽  
Disease Mortality

scholarly journals Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: A population-based study

2020 ◽  
Author(s):  
Atsushi Hirayama ◽  
Tadahiro Goto ◽  
Kohei Hasegawa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Kidney Injury ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Kidney Injury ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background and Aim: Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD. Methods: A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission. Results: We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P<0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32-1.38; P<0.001). These associations remained significant after adjustment for confounders (both P<0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure. Conclusions: Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.

scholarly journals Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: A population-based study

2020 ◽  
Author(s):  
Atsushi Hirayama ◽  
Tadahiro Goto ◽  
Kohei Hasegawa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Kidney Injury ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Kidney Injury ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background and Aim : Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD. Methods : A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission. Results: We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P<0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32-1.38; P<0.001). These associations remained significant after adjustment for confounders (both P<0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure. Conclusions : Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.

scholarly journals The Impact of Diabetes Mellitus in Patients with Chronic Obstructive Pulmonary Disease (COPD) Hospitalization

2021 ◽  
Vol 10 (2) ◽  
pp. 235
Author(s):  
Kulothungan Gunasekaran ◽  
Swetha Murthi ◽  
Kalaimani Elango ◽  
Mandeep Singh Rahi ◽  
Bright Thilagar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Kidney Injury ◽  
The United States ◽  
Chronic Obstructive ◽  
Inpatient Hospitalization ◽  
Obstructive Pulmonary Disease ◽  
Anatomy And Physiology ◽  
The Impact

(1) Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. Diabetes mellitus (DM) has been shown to have adverse inflammatory effects on lung anatomy and physiology. We investigated the impact of DM on COPD patient outcomes during inpatient hospitalization. (2) Methods: We conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) over the years 2002–2014. Three groups, COPD without diabetes, COPD with diabetes but no complication, and COPD with DM and complication, were analyzed. (3) Results: A total of 7,498,577 were COPD hospitalization; of those, 1,799,637 had DM without complications, and 483,467 had DM with complications. After adjusting for clinical, demographic, and comorbidities, the odds of increased LOS in the COPD/DM with complication were 1.37 (confidence interval (CI): 1.326–1.368), and those of DM without complication were 1.061 (1.052–1.070) when compared with COPD alone. The odds of pneumonia, respiratory failure, stroke, and acute kidney injury were also higher in COPD hospitalizations with DM. Both DM with complication (odds ratio (OR): 0.751 (CI 0.727–0.777)) and DM without complication (OR: 0.635 (CI: 0.596–0.675)) have lesser odds of mortality during hospitalization than with COPD alone. (4) Conclusions: There is a considerable inpatient burden among COPD patients with DM in the United States.

scholarly journals Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: A population-based study

2019 ◽  
Author(s):  
Atsushi Hirayama ◽  
Tadahiro Goto ◽  
Kohei Hasegawa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Kidney Injury ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Kidney Injury ◽  
Population Based ◽  
Hazard Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Readmission Risk

Abstract Background and Aim Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risk after hospitalization for AECOPD.Methods A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. Additionally, we also identified the primary reason of readmission.Results We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P<0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission compared to those without AKI (hazard ratio 1.35; 95% CI 1.32-1.38; P<0.001). These associations remained significant after adjustment for confounders (both, P<0.05). Additionally, patients with AKI were likely to readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure.Conclusions Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission compared to those without AKI, with non-respiratory reasons.

scholarly journals Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: A population-based study

2020 ◽  
Author(s):  
Atsushi Hirayama ◽  
Tadahiro Goto ◽  
Kohei Hasegawa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Kidney Injury ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Kidney Injury ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background and Aim : Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD. Methods : A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission. Results: We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P<0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32-1.38; P<0.001). These associations remained significant after adjustment for confounders (both P<0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure. Conclusions : Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.

scholarly journals ‘I’m fine!’: Assertions of lack of support need among patients with chronic obstructive pulmonary disease: A mixed-methods study

2021 ◽  
pp. 174239532110003
Author(s):  
A Carole Gardener ◽  
Caroline Moore ◽  
Morag Farquhar ◽  
Gail Ewing ◽  
Efthalia Massou ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Mixed Method ◽  
Self Report ◽  
Design Stage ◽  
Chronic Obstructive ◽  
Support Needs ◽  
Obstructive Pulmonary Disease ◽  
Stage 1 ◽  
The Impact

Objectives To understand how people with Chronic Obstructive Pulmonary Disease (COPD) disavow their support needs and the impact on care. Methods Two stage mixed-method design. Stage 1 involved sub-analyses of data from a mixed-method population-based longitudinal study exploring the needs of patients with advanced COPD. Using adapted criteria from mental health research, we identified 21 patients who disavowed their needs from the 235 patient cohort. Qualitative interview transcripts and self-report measures were analysed to compare these patients with the remaining cohort. In stage 2 focus groups (n = 2) with primary healthcare practitioners (n = 9) explored the implications of Stage 1 findings. Results Patients who disavowed their support needs described non-compliance with symptom management and avoidance of future care planning (qualitative data). Analysis of self-report measures of mental and physical health found this group reported fewer needs than the remaining sample yet wanted more GP contact. The link between risk factors and healthcare professional involvement present in the rest of the sample was missing for these patients. Focus group data suggested practitioners found these patients challenging. Discussion This study identified patients with COPD who disavow their support needs, but who also desire more GP contact. GPs report finding these patients challenging to engage.

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