Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia

Figures & data

Table 1. ICD-9 codes used in this study.

Comorbidity	ICD-9 codes
Coronary artery disease	414.0^*, 414.2, 414.3, 414.4, 414.8, 414.9, 410.^* & 413.^*
Stroke	1st listed inpatient diagnosis of 433–436
Hypertensive disease	410–414
Heart failure	428.0, 428.1, 428.9, 428.22, 428.30, 428.32, 428.40, 428.42
MI	1st listed inpatient diagnosis of 410, 411.1, 411.81, 411.89
Hyperlipidemia	272.2, 272.4
Diabetes	250
Acute heart failure	428.21, 428.23, 428.31, 428.33, 428.41, 428.43
Acute cor pulmonale	415.0
Acute cardiac ischemia	410.^* & 413.^*
Atrial fibrillation/flutter/supraventricular arrhythmias	427.0 & 427.3
Lung malignancy	162.^**
Pulmonary thromboembolism	DVT is 453.4^*; acutePE is 415.1, chronic PE 416.2
Pleural effusion	511.1, 511.8, and 511.9
COPD	491, 492, 494, or 496
Acute renal failure	584
Acute liver failure	570
Chronic cor pulmonale	416 excluding 416.2
Chronic renal failure	585 and 586
Chronic liver disease	571 and 573
Advanced neurological disorders	331.1, 331.2, 331.7, 331.8, 331.9, 332.^**, 333.^**, 334.^**, 340.^** and 341.^**, 345.^**, 346.^**

DVT, Deep vein thrombosis; PE, Pulmonary embolism.

Table 2. Demographic and baseline characteristics of three study cohorts^**.

Variables	AECOPD	PNA	PCOPD	p-value
Number of patients	7,154	4,433	3,478
Age at inception: mean (SD)	68.8 (10.4) ^*	69.3 (12.6)	70.4 (10.6 ) ^#	<0.0001
Female sex	200 (2.8%)	126 (2.8%)	74 (2.1%)	>0.05
BMI: mean(SD)	26 (8) ^*	25 (7)	25 (7) ^#	<0.0001
Race				<0.0001
White	5,678 (79.4%)	3,342(75.4%)	2,890(83.1%)
Black	1,165(16.3%)	869 (19.6%)	426 (12.2%)
Other	120 (1.7%)	94 (2.1%)	57 (1.6%)
Unknown	191 (2.7%)	128 (2.9%)	105 (3.0%)
Smokers	3,212(44.9%)^*	2,200(49.6%)^+	1,894(54.5%)^#	<0.0001
Charlson comorbidity index	2.4 (1.4)	2.4 (1.7)	2.9 (1.6)	<0.0001
Home O2 preinception	1,140(15.9%)^*	572 (12.9%)^+	890 (25.6%)^#	<0.0001
Influenza vaccination (past 12 months preinception)	2,777(38.8%)^*	2,217 (50%)	1,774(51.0%)^#	<0.0001
Pneumococcal vaccination (past 5 years preinception)	2,361(33.0%)^*	1,769(39.7%)^+	1,520(43.7%)^#	<0.0001
Heart failure	2,471 (34.5%)^*	1,425 (32.1%)^+	1,414 (40.7%)^#	<0.0001
CAD	3,603 (50.4%)	2,237 (50.5%)^+	1,944 (55.9%)^#	<0.0001
Chronic cor pulmonale	434 (6.1%)^*	143 (3.2%)^+	196 (5.6%)	<0.0001
Atrial arrhythmias	1,224 (17.1%)^*	934 (21.1%)^+	914 (26.3%)^#	<0.0001
Lung malignancy	462 (6.5%)^*	442 (10.0%)^+	490 (14.1%)^#	<0.0001
Pulmonary thromboembolism	151 (2.1%)^*	217 (4.9%)	205 (5.9%)^#	<0.0001
Pleural effusion	370 (5.2%)^*	630 (14.2%)	484 (13.9%)^#	<0.0001
Chronic renal failure	641 (9.0%)^*	918 (20.7%)^+	631 (18.1%)^#	<0.0001
Chronic liver disease	309 (4.3%)^*	323 (7.3%)	249 (7.2%)^#	<0.0001
Advance neurological diseases	582 (8.1%)^*	654 (14.8%)	476 (13.7%)^#	<0.0001
Statin	2,970(41.5%)^*	2,554 (57.6%)	2,004 (57.6%)^#	<0.0001
Beta-blocker	2,455 (34.3%)^*	2,273 (51.3%)	1,780 (51.2%)^#	<0.0001
ICS	1,337 (18.7%)^*	698 (15.7%)^+	875 (25.2%)^#	<0.0001
LAMA	328 (4.6%)	215 (4.8%)^+	463 (13.3%)^#	<0.0001
LABA	1,021 (14.3%)^*	481 (10.9%)^+	848 (24.4%)^#	<0.0001

BMI, body mass index; CAD, coronary artery disease; ICS, inhaled corticosteroid; LAMA, long-acting muscarinic agent; LABA: long-acting beta-agonist.

^**Data are presented as means (standard deviation) unless otherwise indicated.

^*Significant difference between AECOPD and PNA group.

⁺Significant difference between PNA and PCOPD group.

^#Significant difference between PCOPD and ACOPD group.

Table 3. Mortality and other clinical outcome measures in the study cohorts.

Outcome	AECOPD	PNA	PCOPD	p-value^#
Total patients	7,154	4,433	3,478
Months in study	46.3 (39.6)	35.3 (28)	30.8 (27.5)	<0.0001
Inpatient mortality	341 (4.8%)	422 (9.5%)	460 (13.2%)	<0.0001
30-day mortality	476 (6.7%)	550 (12.41%)	507 (14.6%)	<0.0001
Long-term mortality^*	4,611 (64.5%)	2,544 (57.4%)	2,303 (66.2%)	<0.0001
Invasive ventilation	64 (0.9%)	90 (2%)	138 (4.0%)	<0.0001
Discharged to a long-term facility	164 (2.3%)	201 (4.5%)	194 (5.6%)	<0.0001

^#Significant comparisons among the three study groups.

^*Long-term mortality is anchored to the inception date which is the first day of inception admission.

Table 4. Predictors of long-term mortality.

N = 12,552	HR	95% CI		p
Age at inception	1.04	1.028	1.033	<0.0001
Female	0.68	0.565	0.808	<0.0001
BMI at inception	0.97	0.966	0.973	<0.0001
Charlson comorbidity index	1.09	1.072	1.115	<0.0001
History of atrial arrhythmia	1.15	1.084	1.217	<0.0001
History of lung cancer	1.27	1.138	1.405	<0.0001
History of heart failure	1.28	1.203	1.355	<0.0001
History of chronic cor pulmonale	1.16	1.052	1.280	<0.005
History of chronic renal failure	1.15	1.076	1.228	<0.0001
History of chronic liver disease	1.13	1.025	1.248	<0.0001
Smoker	1.07	1.020	1.122	<0.01
Preinception prescription: inhaled corticosteroid	0.89	0.838	0.943	<0.0001
Preinception prescription: statin	0.87	0.821	0.913	<0.0001
Preinception prescription: beta-blocker^*COPD	0.91	0.857	0.971	<0.005
Preinception prescription: O2	1.44	1.361	1.532	<0.0001
Presence of COPD	1.12	1.042	1.208	<0.01
Presence of pneumonia	1.35	1.198	1.514	<0.0001
Time varying covariate
Presence of pneumonia	0.87	0.840	0.909	<0.0001

CI, confidence interval; HR, hazard ratio; ICS, inhaled corticosteroid.

Figure 1. Kaplan–Meier survival estimates for the study cohorts.

Table 5. Predictors of mortality during inception admission.

N = 13,377	OR	95% CI		p-value
Age at inception	1.037	1.029	1.044	0.000
BMI at inception	0.967	0.955	0.979	0.000
Charlson comorbidity index	1.158	1.102	1.217	0.000
History of atrial arrhythmia	1.433	1.219	1.685	0.000
History of lung cancer	2.059	1.708	2.482	0.000
History of pulmonary thromboembolism	1.532	1.141	2.058	0.005
History of chronic renal failure	1.375	1.148	1.647	0.001
History of advance neurological condition	1.334	1.094	1.627	0.004
Body T at admission	0.967	0.949	0.986	0.001
Diastolic BP at admission	0.990	0.982	0.997	0.007
systolic BP at admission	0.995	0.990	1.000	0.034
Pulse rate at admission	1.020	1.016	1.024	0.000
Respiratory rate at admission	1.044	1.029	1.060	0.000
Preinception prescription: inhaled corticosteroid	0.749	0.614	0.913	0.004
Preinception prescription: long acting muscarinic agent	0.655	0.478	0.895	0.008
Flue vaccination past 12 months	0.877	0.756	1.018	0.084
Pneumonia vaccination past 5 years	0.747	0.642	0.869	0.000
Need ventilator support	2.906	1.996	4.229	0.000
Presence of COPD	1.43	1.211	1.689	0.000
Presence of pneumonia	2.80	2.296	3.405	0.000

CI, confidence interval; OR, odds ratio.

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