Co-morbidities and 90-day Outcomes in Hospitalized COPD Exacerbations

Figures & data

Table 1  Prevalence of significant other medical conditions recorded in the patient's medical records

		% (of 9608)	Patients with condition
Ischemic Heart Disease		25.4	2439
Other cardiovascular disease		19.4	1862
Diabetes		11.8	1130
Locomotor problems		11.3	1090
Cardiac arrhythmia e.g. AF		10.0	961
Other gastro-intestinal condition		8.8	844
Psychiatric condition		7.4	708
Left Ventricular Failure (LVF)		6.7	645
Stroke		6.4	619
Other malignant disease		6.3	602
Neurological condition		5.5	528
Other endocrine disorder		4.9	467
Corpulmonale		3.3	319
Thromboembolic Disease—pulmonary embolism, DVT		3.3	313
Alcohol-related condition		2.6	250
Visual impairment		2.3	218
Lung cancer		1.9	180
Number of conditions	0	22.6	2169
	1	32.4	3117
	2	25.6	2457
	3–8	19.4	1865

*Presence or otherwise of other medical conditions in patient notes was known for 9608 of the 9716 patients.

Table 2  Patient characteristics at admission and number of significant other medical conditions recorded in the patient's medical records

	Number of significant medical conditions
	None (N = 2169)		One (N = 3117)		Two (N = 2457)		≥Three (N = 1865)
	%	N	%	N	%	N	%	N
Male	49	1059	50	1559	52	1265	52	976
Aged <65	31	673	23	715	18	442	14	268
Aged 65–74	34	739	31	977	29	709	27	504
Aged 75–84	28	597	34	1075	38	945	41	772
Aged 85+	7	160	11	350	15	361	17	321
Performance status:
Normal activity	13	254/1955	10	280/2781	7	165/2220	6	97/1711
Strenuous activity limited	19	363/1955	16	451/2781	14	304/2220	11	191/1711
Limited activity but self-care	47	928/1955	48	1335/2781	50	1101/2220	47	804/1711
Limited self-care	17	339/1955	20	546/2781	22	484/2220	26	449/1711
Bed/chair bound –no self care	4	71/1955	6	169/2781	7	166/2220	10	170/1711
Paid or unpaid care	29	615/2142	37	1144/3088	43	1040/2415	51	937/1837
Current smoker	38	789/2071	34	992/2912	32	728/2302	29	506/1741
Ex-smoker	60	1245/2071	63	1826/2912	65	1490/2302	68	1182/1741
Life-long non-smoker	2	37/2071	3	94/2912	4	84/2302	3	53/1741
<20 pack years	8	90/1189	7	114/1550	8	95/1180	10	88/884
20–39 pack years	30	355/1189	29	451/1550	31	361/1180	26	227/884
40+ pack years	63	744/1189	64	985/1550	61	724/1180	64	569/884
Sputum volume increase	66	1161/1756	66	1647/2477	65	1248/1925	65	927/1420
Sputum colour change	61	1106/1803	60	1527/2525	62	1218/1980	60	878/1462
Increased breathlessness	98	2086/2132	97	2971/3051	98	2368/2423	97	1779/1827
Peripheral Edema	21	328/1590	28	641/2319	35	648/1833	46	674/1481
	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Age (n = 9608)	73	63–78	73	65–80	75	68–82	77	69–82
Respiratory rate (n = 8948)	24	20–28	24	20–28	24	20–28	24	20–28
FEV1 (n = 5316)	0.80	0.51–1.06	0.84	0.63–1.20	0.91	0.66–1.24	0.91	0.70–1.26
		N = 1291		N = 1717		N = 1312		N = 996
FEV1%predicted (n = 5222)	31	22–47	38	28–50	40	30–54	41	30–56
Serum albumin g/dl (n = 7072)	40	36–42	39	35–42	38	35–41	38	34–41
Blood Urea mmol/l (n = 8845)	5.4	4.1–7.2	6.1	4.4–8.2	6.6	4.8–9.1	7.4	5.2–10.3
Blood Creatinine (n = 9199)	78	64–93	81	66–101	86	70–109	93	74–122
pH (n = 8124)	7.40	7.35–7.44	7.41	7.36–7.45	7.41	7.36–7.45	7.41	7.36–7.45
BIC mmol/l (n = 7743)	26	24–29	26	24–30	26	24–30	26	24–30
PCO2 kPa (n = 8138)	5.9	5.0–7.3	5.8	4.9–7.2	5.7	4.9–7.1	5.7	4.9–7.1
mmHg	44.3	37.5–54.8	43.5	36.8–54.0	42.8	36.8–53.3	42.8	36.8–53.3
PO2 kPa (n = 8140)	8.8	7.5–11.3	8.9	7.5–11.3	9.1	7.6–11.4	8.9	7.6–11.1
mmHg	66.0	56.3–84.8	66.8	56.3–84.8	68.3	57.0–85.5	66.8	57.0–83.3

IQR: Inter-QuartileRange.

Table 3  Co-morbidity and in-patient mortality

		% died	Patients	Risk ratio	95% CI for risk ratio	P-Value
		7.6	734/9608
Cor pulmonale		17.9	57/319	2.45	1.93–3.11	<0.001
Left Ventricular failure (LVF)		12.7	82/645	1.75	1.41–2.16	<0.001
Other malignant disease		12.1	73/602	1.65	1.32–2.06	<0.001
Neurological condition		11.7	62/528	1.59	1.24–2.03	<0.001
Lung cancer		11.1	20/180	1.47	0.96–2.25	0.08
Cardiac arrhythmia e.g. AF		9.7	93/961	1.31	1.05–1.62	0.02
Visual impairment		9.6	21/218	1.27	0.86–1.87	0.23
Stroke		9.5	59/619	1.27	0.99–1.62	0.06
Psychiatric condition		8.3	59/708	1.10	0.86–1.41	0.45
Locomotor problems		7.9	86/1090	1.04	0.84–1.28	0.73
Ischemic Heart Disease		7.5	184/2439	0.98	0.83–1.16	0.84
Other cardiovascular disease		7.3	136/1862	0.95	0.80–1.12	0.52
Diabetes		6.9	78/1130	0.89	0.70–1.14	0.36
Other gastro-intestinal condition		6.6	56/844	0.86	0.66–1.11	0.24
Other endocrine disorder		6.2	29/467	0.81	0.57–1.14	0.23
Thromboembolic Disease—pulmonary embolism, DVT		6.1	19/313	0.79	0.50–1.25	0.32
Alcohol-related condition		6.0	15/250	0.78	0.49–1.25	0.30
Number of conditions**	0	5.9	127/2169	reference	reference	reference
	1	7.8	244/3117	1.34	1.08–1.65	0.007
	2	7.9	195/2457	1.36	1.09–1.68	0.006
	3–8	9.0	168/1865	1.54	1.23–1.92	<0.001

*Risk ratios are given relative to cases without the specified co-morbidity.

**Where number of conditions = 0 this is the reference population.

Table 4  Co-morbidity and 90-day mortality

		% died	Patients**	Risk ratio	95% CI for risk ratio	P-Value
All Cases		13.8	1272/9201
Lung cancer		31.5	53/168	2.34	1.86–2.94	<0.001
Cor pulmonale		30.0	93/310	2.26	1.92–2.66	<0.001
Left Ventricular failure (LVF)		21.4	131/612	1.61	1.37–1.89	<0.001
Neurological condition		20.8	105/504	1.55	1.30–1.86	<0.001
Other malignant disease		19.6	113/578	1.45	1.20–1.76	<0.001
Visual impairment		18.7	39/209	1.36	1.05–1.76	0.02
Cardiac arrhythmia, e.g., AF		18.0	165/915	1.35	1.17–1.55	<0.001
Stroke		17.0	101/594	1.25	1.03–1.51	0.02
Locomotor problems		14.3	149/1045	1.04	0.88–1.22	0.67
Psychiatric condition		14.3	95/665	1.04	0.85–1.26	0.73
Other gastro-intestinal condition		14.0	113/809	1.01	0.84–1.21	0.90
Alcohol-related condition		13.5	32/237	0.98	0.73–1.30	0.87
Ischemic Heart Disease		13.4	314/2338	0.96	0.85–1.08	0.53
Other cardiovascular disease		13.0	232/1791	0.92	0.81–1.05	0.24
Diabetes		12.7	136/1075	0.90	0.76–1.08	0.26
Thromboembolic Disease—pulmonary embolism, DVT		11.3	34/300	0.81	0.58–1.15	0.24
Other endocrine disorder		10.8	48/446	0.77	0.60–0.99	0.04
Number of conditions***	0	10.2	212/2081	reference	reference	reference
	1	14.5	433/2985	1.42	1.21–1.68	<0.001
	2	14.2	335/2356	1.40	1.18–1.65	<0.001
	3–8	16.4	292/1779	1.61	1.36–1.91	<0.001

*Risk ratios are given relative to cases without the specified co-morbidity.

**90-day mortality was not known for 407 patients.

***Where number of conditions = 0 this is the reference population.

Table 5  Co-morbidity and length of stay (LOS)

		Median LOS	Mean LOS	% LOS of 7 or more days	Discharged Patients	Risk ratio	95% CI for risk ratio	P-Value
All Cases		5	8.87	42	3695/8869
Cor pulmonale		7	11.45	60	157/262	1.46	1.30–1.64	<0.001
Visual impairment		5	11.20	43	84/197	1.02	0.87–1.20	0.77
Stroke		7	10.53	50	280/560	1.22	1.12–1.32	<0.001
Left Ventricular Failure (LVF)		7	10.42	51	289/562	1.25	1.15–1.36	<0.001
Cardiac arrhythmia e.g. AF		7	10.32	51	445/867	1.26	1.17–1.36	<0.001
Other malignant disease		6	9.64	48	252/528	1.16	1.06–1.27	0.002
Thromboembolic Disease		7	9.44	50	147/294	1.21	1.09–1.34	<0.001
Neurological condition		6	9.34	44	204/465	1.06	0.94–1.18	0.34
Locomotor problems		6	9.06	45	450/1003	1.09	1.01–1.17	0.03
Diabetes		5	8.99	43	447/1050	1.02	0.95–1.10	0.52
Other cardiovascular disease		5	8.91	43	736/1725	1.03	0.96–1.10	0.40
Alcohol-related condition		6	8.86	43	101/235	1.03	0.89–1.20	0.68
Other endocrine disorder		6	8.75	43	188/438	1.03	0.92–1.16	0.59
Psychiatric condition		5	8.58	42	271/649	1.00	0.91–1.11	0.96
Ischemic Heart Disease		5	8.57	42	952/2253	1.02	0.96–1.08	0.54
Lung cancer		6	8.41	41	66/160	0.99	0.82–1.19	0.91
Other gastro-intestinal condition		5	8.36	40	316/787	0.96	0.88–1.05	0.35
Number of conditions	0	5	8.08	35	712/2040	reference	reference	reference
	1	5	8.84	41	1191/2873	1.19	1.09–1.29	<0.001
	2	6	9.05	44	997/2262	1.26	1.15–1.38	<0.001
	3–8	6	9.62	47	795/1694	1.34	1.23–1.47	<0.001

*Risk ratios (for LOS of at least 7 days) are given relative to cases without the specified co-morbidity.

Where number of conditions = 0 this is the reference population.

Table 6  Co-morbidity and 90 day re-admission (since index admission) for discharged patients

		% Re-admitted	Discharged Patients	Risk ratio	95% CI for risk ratio	P-Value
All Cases		34	2937/8586
Cor pulmonale		46	117/257	1.34	1.18–1.54	<0.001
Lung cancer		44	69/156	1.30	1.08–1.56	0.005
Neurological condition		42	187/450	1.23	1.09–1.39	0.001
Left Ventricular Failure (LVF)		41	222/539	1.22	1.10–1.35	<0.001
Alcohol-related condition		41	93/229	1.19	1.02–1.40	0.03
Ischemic Heart Disease		39	849/2179	1.20	1.12–1.27	<0.001
Cardiac arrhythmia, e.g., AF		37	310/841	1.09	0.99–1.19	0.08
Diabetes		37	381/1019	1.11	1.01–1.21	0.02
Psychiatric condition		37	228/624	1.07	0.96–1.20	0.22
Thrombo-embolic Disease		37	104/282	1.08	0.90–1.30	0.40
Locomotor problems		36	349/976	1.05	0.96–1.15	0.28
Stroke		36	196/537	1.07	0.95–1.20	0.24
Other gastro-intestinal condition		35	266/766	1.02	0.93–1.12	0.73
Visual impairment		33	64/193	0.97	0.80–1.18	0.75
Other malignant disease		33	170/514	0.96	0.85–1.10	0.60
Other cardiovascular disease		32	529/1676	0.91	0.84–0.98	0.01
Other endocrine disorder		32	135/425	0.93	0.81–1.06	0.27
Number of conditions	0	30	596/1977	reference	reference	reference
	1	34	938/2775	1.12	1.02–1.23	0.02
	2	36	779/2189	1.18	1.08–1.29	<0.001
	3–8	38	624/1645	1.26	1.14–1.39	<0.001

*Risk ratios are given relative to cases without the specified co-morbidity.

Where number of conditions = 0 this is the reference population.