Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures

Abstract

Background

Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known.

Objective

To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF.

Methods

Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers).

Results

From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, P<0.01; 12 [6–30] vs 9 [6–18] days, P<0.05; and 50 vs 32.1% deaths, P<0.01, respectively). The risk of dying in the two following years was also higher in VCF patients (odds ratio: 2.11 [1.2–3.6], P<0.01). The validation cohort consisted of 250 patients who showed very similar results. The logistic regression analysis indicated that both VCF and age were factors independently associated with mortality.

Conclusion

Although VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.