Characteristics, Management and In-Hospital Clinical Outcomes Among Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in China: Results from the Phase I Data of ACURE Study

Figures & data

Figure 1 Flow Chart of Obtaining the Study Population.

Abbreviations: ACURE, acute exacerbation of chronic obstructive pulmonary disease inpatient registry; AECOPD, acute exacerbation of chronic obstructive pulmonary disease.

Table 1 Demographics and Smoking History at Admission of Study Population

Variables	Overall (N=5334)	Tertiary General Hospital (N=4010)	Tertiary TCM Hospital (N=698)	Secondary Hospital (N=626)	P-value
Demographics
Age (years)					<0.001
Median (IQR)	69.0 (63.0, 76.0)	69.0 (63.0, 75.0)	71.0 (64.0, 78.0) ^a	71.0 (64.0, 77.0) ^a
Missing	13	10	1	2
Sex, N (%)					0.16
Female	1133 (21.2)	875 (21.8)	131 (18.8)	127 (20.3)
Male	4201 (78.8)	3135 (78.2)	567 (81.2)	499 (79.7)
Education level, N (%)					<0.001
Primary school or below	2591 (48.6)	1937 (48.3)	274 (39.3) ^a	380 (60.7) ^a,b
Junior high school	1754 (32.9)	1356 (33.8)	220 (31.5)	178 (28.4)
Senior high school	766 (14.4)	558 (13.9)	148 (21.2)	60 (9.6)
Undergraduate or above	223 (4.2)	159 (4.0)	56 (8.0)	8 (1.3)
Body mass index (kg/m^2)					0.068
Median (IQR)	22.0 (19.5, 24.2)	21.9 (19.5, 24.2)	22.2 (19.8, 24.6)	21.8 (19.4, 24.2)
Smoking history
Smoking status, N (%)					0.068
Current	1259 (23.6)	949 (23.7)	168 (24.1)	142 (22.7)
Former	2360 (44.2)	1812 (45.2)	285 (40.8)	263 (42.0)
Never	1715 (32.2)	1249 (31.1)	245 (35.1)	221 (35.3)
Smoking beginning age (years)					0.002
Median (IQR)	21.0 (20.0, 29.0)	21.0 (20.0, 28.0)	23.0 (20.0, 30.0) ^a	20.0 (19.0, 27.0) ^b
Missing	1	1	0	0
Average number of cigarettes smoked per day (cigarettes/day)					0.33
Median (IQR)	20.0 (15.0, 21.0)	20.0 (15.0, 20.0)	20.0 (12.0, 30.0)	20.0 (15.0, 20.0)
Missing	1	1	0	0
Intensity of cigarette smoking (pack-years)					0.47
Median (IQR)	39.0 (22.5, 52.0)	38.0 (22.5, 51.0)	40.0 (20.5, 54.0)	40.0 (25.0, 52.2)
Missing	113	94	10	9

Notes: Median and IQR were displayed for skewed continuous variables; P-value was calculated by Kruskal–Wallis test for skewed continuous variables, and Pearson’s chi-squared test for categorical variables. ^aBonferroni-adjusted P-value<0.05 vs tertiary general hospital. ^bBonferroni-adjusted P-value<0.05 vs tertiary TCM hospital.

Abbreviations: IQR, interquartile range; TCM, traditional Chinese medicine.

Table 2 Medical History and Laboratory Finding of Study Population

Variables	Overall (N=5334)	Tertiary General Hospital (N=4010)	Tertiary TCM Hospital (N=698)	Secondary Hospital (N=626)	P-value
Medical history
Age at COPD diagnosis (years)					0.099
Median (IQR)	64.0 (57.0, 71.0)	64.0 (57.0, 71.0)	65.0 (58.0, 73.0)	64.0 (57.0, 72.0)
Missing	75	62	8	5
Frequency of hospitalization due to AECOPD in past year (times), N (%)					0.99
<2	3785 (71.0)	2844 (70.9)	497 (71.2)	444 (70.9)
≥2	1549 (29.0)	1166 (29.1)	201 (28.8)	182 (29.1)
Frequency of emergency room visiting due to AECOPD in past year (times), N (%)					<0.001
<2	4032 (75.7)	3080 (76.9)	534 (76.5)	418 (66.8) ^a,b
≥2	1295 (24.3)	923 (23.1)	164 (23.5)	208 (33.2)
Missing	7	7	0	0
CAT score					<0.001
Median (IQR)	20.0 (16.0, 25.0)	20.0 (15.0, 25.0)	21.0 (17.0, 26.0) ^a	22.0 (16.0, 27.0) ^a
CAT score category, N (%)					<0.001
0–10	505 (9.5)	382 (9.5)	46 (6.6) ^a	77 (12.3) ^a,b
11–20	2253 (42.2)	1794 (44.7)	270 (38.7)	189 (30.2)
21–30	2220 (41.6)	1587 (39.6)	328 (47.0)	305 (48.7)
31–40	356 (6.7)	247 (6.2)	54 (7.7)	55 (8.8)
FEV1 (L)					0.005
Median (IQR)	0.9 (0.7, 1.3)	0.9 (0.7, 1.3)	1.0 (0.7, 1.3)	0.9 (0.6, 1.3) ^a,b
Missing	1007	770	135	102
FEV1% predicted (%)					<0.001
Median (IQR)	39.3 (27.6, 54.5)	39.4 (27.8, 55.0)	40.6 (28.8, 55.6)	36.6 (23.6, 51.7) ^a,b
Missing	1081	827	147	107
Post-bronchodilator FEV1/FVC					<0.001
Median (IQR)	0.5 (0.4, 0.6)	0.5 (0.4, 0.6)	0.5 (0.4, 0.6) ^a	0.5 (0.4, 0.6) ^b
Missing	1350	998	179	173
GOLD grade, N (%)					0.78
GOLD 1 (FEV1% predicted≥80)	189 (4.9)	144 (4.9)	25 (5.0)	20 (4.5)
GOLD 2 (50≤FEV1% predicted<80)	1176 (30.3)	890 (30.4)	162 (32.2)	124 (27.7)
GOLD 3 (30≤FEV1% predicted<50)	1611 (41.5)	1207 (41.2)	207 (41.2)	197 (44.0)
GOLD 4 (FEV1% predicted<30)	906 (23.3)	690 (23.5)	109 (21.7)	107 (23.9)
Missing	1452	1079	195	178
Any comorbidity, N (%)					0.028
Yes	4733 (88.7)	3579 (89.3)	618 (88.5)	536 (85.6) ^a
No	601 (11.3)	431 (10.7)	80 (11.5)	90 (14.4)
Pulmonary comorbidity, N (%)					<0.001
Yes	3592 (67.3)	2818 (70.3)	385 (55.2) ^a	389 (62.1) ^a,b
No	1742 (32.7)	1192 (29.7)	313 (44.8)	237 (37.9)
Extrapulmonary comorbidity, N (%)					<0.001
Yes	3732 (70.0)	2784 (69.4)	535 (76.6) ^a	413 (66.0) ^b
No	1602 (30.0)	1226 (30.6)	163 (23.4)	213 (34.0)
Laboratory finding
Blood eosinophil count (cells/μL), N (%)					0.74
<100	1722 (45.1)	1299 (45.1)	212 (44.9)	211 (45.0)
100–300	1435 (37.5)	1071 (37.2)	178 (37.7)	186 (39.7)
>300	665 (17.4)	511 (17.7)	82 (17.4)	72 (15.4)
Missing	1512	1129	226	157
pH					0.025
Median (IQR)	7.4 (7.4, 7.4)	7.4 (7.4, 7.4)	7.4 (7.4, 7.4) ^a	7.4 (7.4, 7.4)
Missing	2996	2223	407	366
PaO2 (mmHg)					<0.001
Median (IQR)	69.5 (59.7, 80.0)	69.0 (58.2, 79.0)	71.2 (63.0, 86.0) ^a	71.3 (62.0, 80.0)
Missing	2996	2223	407	366
PaCO2 (mmHg)					0.003
Median (IQR)	42.0 (37.0, 47.3)	42.0 (37.4, 47.9)	41.3 (37.0, 46.0)	40.1 (36.0, 46.0) ^a
Missing	2996	2223	407	366
PaCO2≥50 mmHg, N (%)					0.21
Yes	441 (18.9)	351 (19.6)	46 (15.8)	44 (16.9)
No	1897 (81.1)	1436 (80.4)	245 (84.2)	216 (83.1)
Missing	2996	2223	407	366

Notes: Median and IQR were displayed for skewed continuous variables; P-value was calculated by Kruskal–Wallis test for skewed continuous variables, and Pearson’s chi-squared test for categorical variables. ^aBonferroni-adjusted P-value<0.05 vs tertiary general hospital. ^bBonferroni-adjusted P-value<0.05 vs tertiary TCM hospital.

Abbreviations: AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, global initiative for chronic obstructive lung disease; IQR, interquartile range; PaCO₂, arterial partial pressure of carbon dioxide; PaO₂, arterial partial pressure of oxygen; TCM, traditional Chinese medicine.

Table 3 Usage of Treatment During Stable Period and Hospitalization of Study Population

Variables	Overall (N=5334)	Tertiary General Hospital (N=4010)	Tertiary TCM Hospital (N=698)	Secondary Hospital (N=626)	P-value
Usage of treatment during stable period
Pharmacological treatment, N (%)					<0.001
Yes	3036 (56.9)	2221 (55.4)	447 (64.0) ^a	368 (58.8)
No	2298 (43.1)	1789 (44.6)	251 (36.0)	258 (41.2)
Inhaled bronchodilator, N (%)					0.016
Yes	878 (16.5)	627 (15.6)	129 (18.5)	122 (19.5) ^a
No	4456 (83.5)	3383 (84.4)	569 (81.5)	504 (80.5)
Inhaled corticosteroids, N (%)					0.061
Yes	318 (6.0)	222 (5.5)	48 (6.9)	48 (7.7)
No	5016 (94.0)	3788 (94.5)	650 (93.1)	578 (92.3)
LABA/LAMA or ICS/LABA/LAMA, N (%)					0.40
Yes	1762 (33.0)	1323 (33.0)	243 (34.8)	196 (31.3)
No	3572 (67.0)	2687 (67.0)	455 (65.2)	430 (68.7)
Oral corticosteroids, N (%)					0.003
Yes	159 (3.0)	113 (2.8)	34 (4.9) ^a	12 (1.9) ^b
No	5175 (97.0)	3897 (97.2)	664 (95.1)	614 (98.1)
Methylxanthines, N (%)					<0.001
Yes	958 (18.0)	656 (16.4)	121 (17.3)	181 (28.9) ^a,b
No	4376 (82.0)	3354 (83.6)	577 (82.7)	445 (71.1)
Expectorant, N (%)					<0.001
Yes	812 (15.2)	524 (13.1)	172 (24.6) ^a	116 (18.5) ^a,b
No	4522 (84.8)	3486 (86.9)	526 (75.4)	510 (81.5)
Influenza vaccination, N (%)					0.14
Yes	153 (2.9)	125 (3.1)	13 (1.9)	15 (2.4)
No	5179 (97.1)	3883 (96.9)	685 (98.1)	611 (97.6)
Missing	2	2	0	0
Usage of treatment during hospitalization
Pharmacological treatment during hospitalization, N (%)					0.12 ^c
Yes	5303 (99.5)	3981 (99.4)	696 (99.7)	626 (100.0)
No	25 (0.5)	23 (0.6)	2 (0.3)	0 (0.0)
Missing	6	6	0	0
Short-acting bronchodilator therapy, N (%)					<0.001
Yes	3877 (72.7)	2960 (73.8)	421 (60.3) ^a	496 (79.2) ^a,b
No	1457 (27.3)	1050 (26.2)	277 (39.7)	130 (20.8)
Corticosteroids, N (%)					<0.001
Yes	4196 (78.8)	3215 (80.3)	505 (72.3) ^a	476 (76.0) ^a
No	1132 (21.2)	789 (19.7)	193 (27.7)	150 (24.0)
Missing	6	6	0	0
Antibiotics, N (%)					0.37
Yes	4842 (90.9)	3649 (91.2)	633 (90.7)	560 (89.5)
No	484 (9.1)	353 (8.8)	65 (9.3)	66 (10.5)
Missing	8	8	0	0
Methylxanthines, N (%)					<0.001
Yes	3880 (72.7)	2895 (72.2)	491 (70.3) ^a	494 (78.9) ^a,b
No	1454 (27.3)	1115 (27.8)	207 (29.7)	132 (21.1)
ICS, N (%)					<0.001
Yes	3531 (66.3)	2722 (68.0)	404 (57.9) ^a	405 (64.7) ^b
No	1797 (33.7)	1282 (32.0)	294 (42.1)	221 (35.3)
Missing	6	6	0	0
Systemic corticosteroids, N (%)					0.002
Yes	1964 (36.9)	1488 (37.2)	281 (40.3)	195 (31.2) ^a,b
No	3364 (63.1)	2516 (62.8)	417 (59.7)	431 (68.8)
Missing	6	6	0	0
Daily dosage of systemic corticosteroids during hospitalization (mg) ^d					<0.001
Median (IQR)	50.0 (50.0, 50.0)	50.0 (50.0, 50.0)	50.0 (38.3, 50.0) ^a	50.0 (50.0, 50.0) ^b
Missing	818	688	70	60
Total dosage of systemic corticosteroids during hospitalization (mg) ^d					0.007
Median (IQR)	266.7 (175.0, 400.0)	300.0 (200.0, 400.0)	300.0 (160.0, 450.0)	200.0 (150.0, 350.0) ^a,b
Missing	818	688	70	60
Respiratory support, N (%)					<0.001 ^c
Oxygen therapy (conventional or high flow)	4034 (75.6)	3112 (77.6)	444 (63.6) ^a	478 (76.4) ^a,b
Noninvasive positive-pressure ventilation	363 (6.8)	309 (7.7)	33 (4.7)	21 (3.4)
Invasive positive-pressure ventilation	16 (0.3)	13 (0.3)	1 (0.1)	2 (0.3)
None	921 (17.3)	576 (14.4)	220 (31.5)	125 (20.0)

Notes: Median and IQR were displayed for skewed continuous variables; P-value was calculated by Kruskal–Wallis test for skewed continuous variables, and Pearson’s chi-squared test for categorical variables unless otherwise specified. ^aBonferroni-adjusted P-value<0.05 vs tertiary general hospital. ^bBonferroni-adjusted P-value<0.05 vs tertiary TCM hospital. ^cFisher’s exact test. ^dStandardized to the dosage of prednisone.

Abbreviations: LABA, long-acting beta₂-agonist; LAMA, long-acting muscarinic antagonist; ICS: inhaled corticosteroids; IQR, interquartile range; TCM, traditional Chinese medicine.

Table 4 In-Hospital Clinical Outcomes of Study Population

Variables	Overall (N=5334)	Tertiary General Hospital (N=4010)	Tertiary TCM Hospital (N=698)	Secondary Hospital (N=626)	P-value
All-cause death during hospitalization, N (%)					>0.999 ^c
Yes	8 (0.1)	6 (0.1)	1 (0.1)	1 (0.2)
No	5326 (99.9)	4004 (99.9)	697 (99.9)	625 (99.8)
Length of hospital stay category (days), N (%)					<0.001
≤10	2886 (54.3)	2256 (56.4)	319 (46.1) ^a	311 (49.8) ^a
>10	2429 (45.7)	1742 (43.6)	373 (53.9)	314 (50.2)
Missing	19	12	6	1
Intensive care unit admission, N (%)					0.048
Yes	83 (1.6)	72 (1.8)	6 (0.9)	5 (0.8)
No	5251 (98.4)	3938 (98.2)	692 (99.1)	621 (99.2)
Total direct cost of hospitalization (US dollars)					<0.001
Median (IQR)	1424.3 (1027.3, 2013.0)	1396.5 (1027.8, 1963.2)	1867.6 (1355.5, 2356.3) ^a	1147.5 (834.7, 1650.6) ^a,b
Missing	19	17	2	0
CAT score at discharge					0.043
Median (IQR)	12.0 (8.0, 16.0)	12.0 (8.0, 16.0)	11.0 (8.0, 16.0)	11.0 (8.0, 16.0) ^a
Missing	14	12	1	1
CAT score category at discharge, N (%)					0.026 ^c
0–10	2242 (42.1)	1653 (41.3)	296 (42.5)	293 (46.9) ^a
11–20	2527 (47.5)	1914 (47.9)	323 (46.3)	290 (46.4)
21–30	522 (9.8)	408 (10.2)	74 (10.6)	40 (6.4)
31–40	29 (0.5)	23 (0.6)	4 (0.6)	2 (0.3)
Missing	14	12	1	1
Change of CAT scores at discharge compared to admission					<0.001
Median (IQR)	−7.0 (−12.0, −3.0)	−7.0 (−11.0, −3.0)	−9.0 (−13.0, −4.0) ^a	−9.0 (−14.0, −4.0) ^a
Missing	14	12	1	1

Notes: Median and IQR were displayed for skewed continuous variables; P-value was calculated by Kruskal–Wallis test for skewed continuous variables, and Pearson’s chi-squared test for categorical variables unless otherwise specified. ^aBonferroni-adjusted P-value<0.05 vs tertiary general hospital. ^bBonferroni-adjusted P-value<0.05 vs tertiary TCM hospital. ^cFisher’s exact test.

Abbreviations: CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; IQR, interquartile range; TCM, traditional Chinese medicine; US, United States.