COPD plus GERD reduces mortality, ventilation odds in hospitalized patients
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Key takeaways:
- Having gastroesophageal reflux disease while hospitalized for COPD decreased several adverse outcome odds.
- Remission within 30 days was more likely among patients with GERD compared with patients without GERD.
BOSTON — The odds for mortality, ventilation and septic shock among adults hospitalized with COPD went down if they also had GERD, according to data presented at the CHEST Annual Meeting.
“Initially, when we found that patients with both COPD and GERD had better in-hospital outcomes, it was quite surprising, especially considering the prevailing belief that GERD typically worsens COPD by increasing the frequency of exacerbations,” A B M Nasibul Alam, MD, internal medicine resident at Northwestern Medicine McHenry Hospital, told Healio.
“However, we realized that most of the patients with a GERD diagnosis during hospitalization were likely on acid reflux therapy. This could explain why these patients had better outcomes, as the therapy may have provided some protective effects during their hospital stay,” Alam continued.
In this retrospective analysis, Alam and colleagues evaluated 3,798,952 adults hospitalized with COPD from the 2017 to 2020 National Readmission Database to determine how the presence of associated GERD changes the odds for in-hospital mortality and other outcomes.
This study population included 1,024,665 patients with associated GERD (mean age, 69.46 years; 39.88% men) and 2,774,287 patients without GERD (mean age, 68.24 years; 47.72% men).
Between the two sets of patients, researchers found significantly reduced odds for in-hospital mortality in the GERD group (adjusted OR = 0.717; 95% CI, 0.696-0.737; P < .001) using a demographic and comorbidity-adjusted multivariate logistic regression model.
The likelihood for two ventilation types while hospitalized also significantly went down among those with vs. without GERD: noninvasive mechanical ventilation (aOR = 0.907; 95% CI, 0.89-0.925; P < .001) and 24 hour or longer invasive ventilation (aOR = 0.727; 95% CI, 0.708-0.746; P < .001).
Researchers further reported that the group with vs. without GERD had significantly decreased odds for septic shock (aOR = 0.731; 95% CI, 0.703-0.76), acute heart failure (aOR = 0.762; 95% CI, 0.751-0.773), acute kidney injury (aOR = 0.877; 95% CI, 0.867-0.888) and acute respiratory failure (aOR = 0.915; 95% CI, 0.905-0.925; all P < .001) in the hospital.
“It’s possible that anti-reflux medications helped reduce the risk of lung infections in COPD patients by reducing micro aspiration of gastric contents, which led to reduced rates of septic shock,” Alam told Healio. “It’s something important to keep in mind, and hopefully, future research will provide clearer answers on this connection.”
When asked about the impact of these findings for clinicians, Alam said there are two important implications.
“First, they highlight the potential protective role of acid suppression therapy in patients with both COPD and GERD, as it may improve in-hospital outcomes,” Alam told Healio. “This could encourage more proactive management of GERD in COPD patients, especially those at higher risk for exacerbations or hospitalization.
“Another important consideration is optimizing the dose of anti-reflux therapy, as doing so could potentially enhance these protective effects,” Alam continued.
In contrast to the above findings, remission within 30 days was more likely among patients with GERD compared with patients without GERD (aOR = 1.08; 95% CI, 1.07-1.091; P < .001), according to the abstract.
“[This] higher readmission rate suggests that perhaps this subgroup of patients is inherently more predisposed to COPD exacerbations, and while GERD and anti-reflux medications may help reduce acute complications during hospitalization, they do not provide long-term improvements in lung function,” Alam told Healio.
“As a result, these patients are prone to frequent exacerbations and subsequent readmissions. Future studies should focus on the long-term impact of acid reflux medications in COPD patients, particularly examining their functional status and lung function over time,” Alam said.
Hospitalization duration was slightly extended in the group with GERD by 0.09 day. Lastly, researchers observed that having vs. not having GERD resulted in a $2,824.5996 decrease in total hospital charges.
“Since this was a retrospective study, future research should focus on conducting prospective studies or randomized controlled trials to validate these findings,” Alam told Healio. “We need high-quality trials that evaluate different acid suppression therapies and their dosages, assessing their impacts on COPD patients in both the hospital and outpatient settings. This could help provide clearer guidelines for managing GERD in COPD patients and determine whether certain medications or dosing strategies are more effective in improving outcomes and reducing readmissions.”
For more information:
A B M Nasibul Alam, MD, can be reached at Nasibul.alam@nm.org.