Odds for mortality elevated in COPD exacerbation, COVID-19 hospitalization
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Key takeaways:
- Hospitalization duration for a COPD exacerbation was significantly longer in the with vs. without COVID-19 group.
- The exacerbation plus COVID-19 group also faced an increased likelihood for invasive ventilation.
BOSTON — Having a COPD exacerbation hospitalization in combination with COVID-19 vs. no COVID-19 significantly raised the odds for mortality and invasive ventilation, according to a poster presented at the CHEST Annual Meeting.
“Although we expected a possibility of severe outcomes in patients with COPD exacerbation from COVID-19 infection, the results showed markedly severe outcomes of longer hospital stay, two times higher need for invasive ventilation and five times higher mortality in patients with COPD exacerbation from COVID-19 infection than those without COVID-19 infection,” Antony J. Arumairaj, MD, attending physician at New York City Health and Hospitals Corporation and clinical assistant professor of medicine at New York Medical College, told Healio.
Using the 2020 National Inpatient Sample database, Arumairaj and colleagues assessed 10,833 adults (mean age, 71.9 years; 50.5% men; 72.4% Caucasian; 15.8% African American) admitted to a hospital with COPD exacerbations plus a COVID-19 infection to find out how the odds for hospitalization, invasive ventilation and mortality differed vs. 194,517 adults (mean age, 68.8 years; 46.2% men; 77.8% Caucasian; 13.8% African American) admitted to a hospital with COPD exacerbations and no COVID-19 infection.
“Data regarding the impact of COVID-19 infection on the outcomes of COPD exacerbations have been conflicting, with some clinical studies showing a significant reduction in COPD exacerbations while other clinical studies have demonstrated severe outcomes of COPD exacerbations with COVID-19 infection,” Arumairaj told Healio. “Hence, we decided to do a National Inpatient Sample analysis.”
When divided into insurance types (Medicaid, Medicare, private or uninsured), researchers observed that most patients with COPD exacerbations plus COVID-19 had Medicaid insurance (77.8%), and the same was true for patients with COPD exacerbations without COVID-19 (71.8%).
In terms of income, both those with COVID-19 and those without COVID-19 had similar proportions of patients with a national income of $1 to $38,999 (38.5% vs. 38.9%), $39,000 to $47,999 (29.8% vs. 29.5%), $48,000 to $62,999 (19.9% vs. 19.4%) and greater than $63,000 (11.7% vs. 12%), according to the poster.
Between the two sets of patients, hospitalization duration was significantly longer in the with vs. without COVID-19 group (9.2 days vs. 5.7 days; P < .001).
In a multivariate logistic regression model adjusted for age, sex, race, national income quartile and insurance, researchers reported a significant reduction in the odds for being hospitalized with COPD exacerbation in the group with vs. without a COVID-19 infection (adjusted OR = 0.78; P < .001).
The abstract further noted that when compared with the COPD exacerbation with no COVID-19 group, the COPD exacerbation plus COVID-19 group faced an increased likelihood for invasive ventilation (aOR = 2; P < .001).
Having a COPD exacerbation in combination with COVID-19 vs. no COVID-19 infection also significantly raised the odds for mortality (aOR = 5.62; P < .001), according to researchers.
“Physicians should aim for better outpatient management and control of COPD with inhaled bronchodilators and inhaled steroids,” Arumairaj told Healio. “Given the severe outcomes, patients with COPD must be advised and encouraged to be up-to-date with COVID-19 vaccinations to prevent COVID-19 infection resulting in COPD exacerbations.”
Looking ahead, Arumairaj said studies continuing research on this topic should adjust for additional factors.
“[The] next step will be to adjust the findings based on whether these patients were hospitalized in teaching or nonteaching hospitals, whether patients were hospitalized in tertiary, rural or suburban hospitals, the size of the hospitals — small, medium and large hospitals —and regions — New England, Middle Atlantic, East North Central, West North Central, South Atlantic, South Central, Mountain and Pacific — to determine if any of these factors played a role in the outcome of the findings and served as a confounding factor in the outcome of the study,” Arumairaj told Healio.