Pulmonary hypertension may impact in-hospital mortality in acute COPD exacerbations

Pulmonary hypertension is associated with an increase in in-hospital mortality and other adverse outcomes in patients with acute exacerbation of COPD, researchers reported.

Palakkumar Patel, MD, sleep medicine fellow at Nassau University Medical Center at the University of Illinois, Chicago, and colleagues conducted a retrospective analysis to examine the impact of pulmonary hypertension in this patient population. The study included 821,468 patients aged 18 years or older from the 2016-2017 National Readmission Database who were admitted with a primary diagnosis of acute exacerbation of COPD. Of those, 68,429 (8.33%) had a secondary diagnosis of pulmonary hypertension.

Pulmonary hypertension was most common among women (61.1%), older adults (mean age, 70 years), Medicare recipients (79.5%), and those with high Charlson comorbidity burden, lower economic status and who were treated in a large urban teaching hospital.

The primary outcome, in-hospital mortality during index admission, was higher in patients with acute exacerbation of COPD and pulmonary hypertension compared with those without pulmonary hypertension (adjusted OR = 1.89; 95% CI, 1.73-2.07; P < .01).

Pulmonary hypertension was also associated with increased risk for the following secondary outcomes, compared with those without pulmonary hypertension:

• 30-day readmission (aOR = –1.24; 95% CI, –1.21 to 1.28; P < .001);
• intubation (aOR = 1.99; 95% CI, 1.85-2.14; P < .01);
• prolonged invasive mechanical ventilation for longer than 96 hours (aOR = 2.12; 95% CI, 1.89-2.38; P < .001);
• tracheostomy (aOR = –2.15; 95% CI, –1.53 to 2.9; P < .001);
• chest tube placement (aOR = –1.39; 95% CI, –1.11 to 1.74; P < .004);
• bronchoscopy (aOR = –1.46; 95% CI, –1.11 to 1.94; P < .007);
• hospital resource utilization costs (adjusted mean difference [aMD] = $2,785; 95% CI, 2,602-2,967; P < .01); and
• length of stay (aMD = –1.09; 95% CI, –1.02-1.15; P < .001).

Independent predictors of higher 30-day admission rates included age 30 to 50 years, index length of stay of 3 or more days, Medicare insurance, higher Charlson comorbidity burden, higher hospital volume quintile for acute COPD exacerbation, opioid and/or cocaine dependence and nonroutine discharge during index admission. Independent predictors of lower 30-day readmission included female sex, private insurance, higher household income and residence in a small metropolitan areas.

“Early diagnosis and appropriate treatment of pulmonary hypertension, close follow-up and early referral to lung transplant will be beneficial to such patients who [are] found to have pulmonary hypertension in management of acute exacerbation COPD,” Patel said during his presentation at the virtual CHEST Annual Meeting.

Reference:

Patel P, et al. Chest. 2020;doi:10.1016/j.chest.2020.08.1492.