Patients who survive a severe exacerbation of COPD are at high risk of rehospitalization
for COPD and death. The objective of this study was to determine predictors of these
events in a large cohort of Veterans Affairs (VA) patients.
We identified 51,353 patients who were discharged after an exacerbation of COPD in
the VA health-care system from 1999 to 2003, and determined the rates of rehospitalization
for COPD and death from all causes. Potential risk factors were assessed with univariate
and multivariate survival analysis.
On average, the cohort was elderly (mean age, 69 years), predominately white (78%
white, 13% black, 3% other, and 6% unknown), and male (97%), consistent with the underlying
VA population. The risk of death was 21% at 1 year, and 55% at 5 years. Independent
risk factors for death were age, male gender, prior hospitalizations, and comorbidities
including weight loss and pulmonary hypertension; nonwhite race and other comorbidities
(asthma, hypertension, and obesity) were associated with decreased mortality. The
risk of rehospitalization for COPD was 25% at 1 year, and 44% at 5 years, and was
increased by age, male gender, prior hospitalizations, and comorbidities including
asthma and pulmonary hypertension. Hispanic ethnicity and other comorbidities (diabetes
and hypertension) were associated with a decreased risk of rehospitalization.
Age, male gender, prior hospitalizations, and certain comorbid conditions were risk
factors for death and rehospitalization in patients discharged after a severe COPD
exacerbation. Nonwhite race and other comorbidities were associated with decreased
risk.