Hospitalizations for COPD Exacerbations: Trends and Determinants of Death

Figures & data

Table 1. Trends in COPD admissions in the Languedoc-Roussillon region between 2007 and 2012

	2007	2008	2009	2010	2011	2012
Number of hospitalizations for COPD (N)	4500	4786	5141	5007	4986	5359
Number of COPD patients (N)	3732	3945	4203	4136	4155	4460
Percentage of total admissions (%)*	0.495	0.521	0.557	0.552	0.529	0.538
Number of deaths among hospitalizations for COPD (N, %)	360 (8)	367 (7.6)	419 (8.2)	434 (8.7)	424 (8.5)	460 (8.6)

*Percentage of hospitalizations for COPD among the total number of hospitalizations.

Table 2. Main characteristics of hospitalizations of COPD

		Total	Mild	Moderate	severe	Very severe	p-value
			(ward-No ARF)	(wardsign of ARF)	(ICU-No MV)	(ICU-MV)
Admissions (N)	2010	5007	3201	1007	249	550
	2011	4986	3086	1184	284	432
	2012	5359	3207	1306	312	534
Patients (N)	2010	4136	2636	823	211	466
	2011	4155	2548	981	241	385
	2012	4460	2642	1062	276	480
Age (years. mean ± sd)	2010	74.9 ± 12.3	74.82 ± 12.29	76.88 ± 12.37	75.72 ± 11.84	71.2 ± 11.62	<0.01
	2011	74.5 ± 12.6	74.7 ± 12.8	75.7 ± 12.5	75.2 ± 12.5	69.8 ± 11.4	<0.01
	2012	75.3 ± 12.5	75.2 ± 12.7	77.2 ± 12.2	75.3 ± 12.3	71.4 ± 11.2	<0.01
Gender (% of Male)	2010	64.39	64.57	63.30	62.09	66.31	0.64
	2011	64.93	64.99	63.4	62.24	70.13	0.10
	2012	63.83	63.93	60.83	62.32	70.83	<0.01
Institution (% of public)	2010	69.08	64.23	75.57	84.74	78.36	<0.01
	2011	70.9	64.31	80.49	86.97	81.25	<0.01
	2012	71.09	64.95	79.94	87.82	76.59	<0.01
Co-morbid conditions / patient (median (IQR))	2010	2 (3)	2 (2)	2 (3)	4 (5)	5 (4)	<0.01
	2011	2 (3)	2 (2)	2 (3)	4 (6)	4 (4)	<0.01
	2012	2 (3)	2 (2)	2 (2)	4 (5)	4 (4.5)	<0.01
Deaths (N(%))	2010	434 (8.67)	127 (3.97)	141 (14.00)	33 (13.25)	133 (24.18)	<0.01
	2011	424 (8.50)	113 (3.66)	167 (14.10)	37 (13.03)	107 (24.77)	<0.01
	2012	460 (8.58)	116 (3.62)	186 (14.24)	45 (14.42)	113 (21.16)	<0.01
Length of stay (days) (median(IQR))	2010	8 (8)	7 (8)	9 (9)	9 (9)	13 (14)	<0.01
	2011	8 (8)	8 (7)	9 (7.5)	10 (9)	14 (15)	<0.01
	2012	8 (8)	7 (7)	9 (8)	10 (8.5)	14 (16)	<0.01

ICU: Intensive Care Unit, MV: Mechanical Ventilation, ARF: Acute Respiratory Failure.

Figure 1. Seasonality of admissions and in-hospital deaths from 2010 to 2012.

Table 3a. Multivariate model of factors predicting in-hospital death among the whole population of COPD admitted because of an exacerbation

Variables	Univariate analysis			Multivariate analysis
	HR	95% CI	p-value	Adjusted HR	95% CI	p-value
Sex			.071
Female	1
Male	1.08	[0.96-1.21]	.20
Age	1.04	[1.04-1.06]	<.01	1.05	[1.04-1.06]	<.01
Number of past hospitalizations	1.01	[1.01-1.02]	.01	1.01	[1.01-1.02]	<.01
Number of co-morbid conditions	0.99	[0.98-1.01]	.58
Institute			<.01			<.01
Public	1
Private	0.63	[0.53-0.73]	<.01	0.68	[0.58-0.79]	<.01
Category			<.01			<.01
mild or moderate (no ICU admission)	1			1
severe or very severe (ICU admission)	1.59	[1.42-1.79]	<.01	2.06	[1.82-2.32]	<.01

Table 3b. Co-morbid conditions independently associated with an increased risk of in-hospital death

	Overall
Co-morbid conditions	HR	CI 95%		p-value
Sepsis	1.84	1.51	2.24	<.01
Lung cancer	2.31	1.84	2.89	<.01
Bedridden	1.62	1.39	1.89	<.01
Heart failure /Valvular defect	1.56	1.39	1.75	<.01
Chronic renal failure	1.20	1.01	1.42	0.04
Dementia	1.24	1.05	1.47	0.01
Obesity	0.68	0.53	0.87	0.01
Diabetes mellitus	0.71	0.61	0.83	<.01
Sleep apnea	0.54	0.39	0.73	<.01
Smoking	0.39	0.29	0.52	<.01
Dependence on respirator	0.74	0.61	0.90	0.01