Studies show dementia associated with worsening outcomes in patients with COPD

Recent studies published in International Journal of Chronic Obstructive Pulmonary Disease Patients with dementia were found to be at increased risk of worsening outcomes when hospitalized for chronic obstructive pulmonary disease (COPD) Deterioration.

The purpose of this study was to evaluate the effect of coexistence of dementia on inpatient mortality and length of stay (LOS) in hospitalized COPD patients in US hospitals.

The researchers used the 2011-2015 discharge records from the National Inpatient Sample (NIS) database, which is part of the Medical Expenses and Utilization Project, for analysis. The full payer database contains records of impatient usage, fees, quality, and results. This database lacked the unique details that could identify the patient. That is, all hospitalizations, including readmissions, were treated as separate cases.

Database used both International Classification of Diseases, 9th revision, clinical revision (ICD-9-CM) 2011-2015 and International Classification of Diseases, 10th revision, clinical revision (ICD-10-CM) 2015. The coexistence diagnosis of dementia was classified using these classifications.

The target population for this study was all 41 years and older. Patients who were hospitalized between January 1, 2011 and December 31, 2015 and received a primary diagnosis of acute exacerbation of COPD by the ICD code were included.

The researchers analyzed the resulting measurements, including LOS and inpatient mortality, calculated by subtracting the date of admission from the date of discharge. Some covariates considered included age, gender, comorbidities, race, year of hospitalization, and primary payer.

Comorbidity was analyzed using the Charleson Comorbidity Index. It shows the score if the following conditions are present: COPD, dementia, Rheumatoid arthritis disease, Kidney disease, Diabetes mellitusCongestive heart failure, liver disease, hemiplegia / paraplegia, malignant tumor, AIDS / HIV, Or metastatic solid tumors. In this study, COPD and dementia were excluded from the comorbidity index to avoid over-adjustment.

All continuous variables were represented by median and interquartile range (IQR), while categorical data was represented by frequency and percentage. Logistic regression analysis was used to assess inpatient mortality in patients with dementia with exacerbation of COPD compared to patients without dementia. Cox proportional hazards regression analysis was used to assess the impact of cognitive impairment on impatient death.

A total of 576,381 patients were identified in this study after excluding patients under the age of 40 and / or those with missing values. The prevalence of diagnosed dementia in these inpatients with exacerbation of COPD was 6.1%. The median age (IQR) for patients with COPD with dementia was 82 (76-87) years, compared to 68 (59-77) for patients without dementia.

Patients with COPD and dementia had a higher rate of comorbidity. Patients with COPD with dementia reported less frequent respiratory problems, but there was no significant difference in the performance of non-invasive ventilation (NIV) or mechanical ventilation among those who reported it.

A total of 6413 (1.1%) inpatient deaths from COPD patients occurred during the study period. The total number of inpatient deaths was significantly higher in patients with dementia than in patients without dementia (COPD with dementia and COPD without dementia: 581 (1.6%) vs 5832 (1.1%, respectively). )).

Patients with COPD and dementia in the youngest age category, 41-64 years, had a significantly higher risk of death in inpatients than those without dementia (adjusted odds ratio 1.75; 95% CI 1.04-2.92). ; P = .03). There was no significant difference in the elderly.

Patients with COPD and dementia who were hospitalized for worsening COPD had significantly higher mortality within 4 days compared to patients without dementia (HR, 1.79; 95% CI, 1.58-2.04 vs HR, 1.23; 95% CI, 1.08-1.41). After the 5th, the mortality rate was low. This indicates that patients hospitalized for COPD exacerbations with dementia are less likely to die during the remaining hospital stay (HR, 1.09; 95% CI, 0.98-1.23).

Median LOS in patients with COPD and dementia was longer than in patients without dementia (median) [IQR] LOS with dementia and LOS without dementia: 4 [3-6] vs 3 [2-5]). The discharge rate of patients with dementia was significantly lower.

This study had some limitations. The NIS database did not have a unique identifier for the patient, so readmission could not be investigated. This could mean that the group may have had more readmissions that would be included in the study. Mortality could only be assessed using in-hospital mortality because patients were not followed after discharge. As a result, 30-day mortality cannot be tracked and this study may underestimate mortality. There are also limitations in clinical coding, and it was previously emphasized that dementia is underdiagnosed in patients with COPD.

Using only the ICD classification can lead to misidentification of some acute exacerbations and may underestimate the differences in observed results. Some prognostic factors for COPD, such as smoking, lung function, and severity of dementia, were not available in the database. Excluding cases where values ​​are missing can bias the findings. The association between mortality and LOS could not be tracked due to lack of reliable data on medicines.

Researchers have identified existing dementia in patients with exacerbated COPD and concluded that using preemptive strategies may improve inpatient mortality and LOS.

“Clinicians take care to consider the patient’s specific dementia care needs and the involvement of a team of dementia experts to develop a more coordinated care plan for this subpopulation. We need to, “they write.

reference

Gupta A, McKeever TM, Hutchinson JP, Bolton CE. The effect of coexisting dementia on the outcome of inpatients hospitalized for exacerbation of COPD. Int J Chron Obstruct Pulmon Dis.. 2022; 17: 535-544. doi: 10.2147 / COPD.S345751