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Vol. 40. Issue 11.
Pages 502-507 (November 2004)
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Vol. 40. Issue 11.
Pages 502-507 (November 2004)
Original Articles
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Risk Factors of Readmission in Acute Exacerbation of Moderate-to-Severe Chronic Obstructive Pulmonary Disease
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C. Gonzáleza,
Corresponding author
cruz.gonzalez@uv.es

Correspondence: Dra. C. González. Servicio de Neumología. Hospital Clínico Universitario. Avda. Blasco Ibáñez, 17. 46010 Valencia. España
, E. Serveraa, G. Ferrisa, M.L. Blascob, J. Marína
a Servicio de Neumología, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain
b Unidad Coronaria, Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, Spain
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Objectives

More effective management of chronic obstructive pulmonary disease (COPD) and improved survival of COPD patients requires a better understanding of the risk factors for exacerbation. The aim of this study was to identify factors related to readmission in patients with moderate-to-severe COPD.

Patients and methods

Ninety patients with moderate-to-severe COPD hospitalized consecutively for acute exacerbation were studied prospectively. At discharge, the following potential predictors were assessed: clinical and spirometric variables, arterial blood gases, and respiratory muscle strength determined noninvasively. The patients were followed for a period of 3 months. Readmission for exacerbation and time intervals free of hospitalization were recorded.

Results

Univariate analysis showed that the presence of cor pulmonale (P <.05), long-term oxygen therapy (P <.05), hypercapnia (P <.05), and high inspiratory load—mean inspiratory airway pressure measured at the mouth exceeding 0.40 cm H2O and a pressure-time index greater than 0.25 (P <.05 for both variables)— increased the risk of hospitalization for exacerbation. Multivariate analysis showed that only cor pulmonale (P <.05) and a high pressure-time index (>0.25, P <.05) were independently related to risk of readmission.

Conclusions

Cor pulmonale and a high pressure-time index are independent risk factors for hospitalization for exacerbation of moderate-to-severe COPD.

Key Words:
Chronic obstructive pulmonary disease (COPD)
Exacerbation
Readmission
Inspiratory load
Pressure-time index
Objetivos

Conocer los factores asociados a la exacerba-ción de la enfermedad pulmonar obstructiva (EPOC) es im-portante para mejorar la supervivencia de los pacientes y conseguir mayor efectividad en su tratamiento. El objetivo de este estudio es identificar las variables asociadas con el reingreso hospitalario en la agudización de la EPOC moderada-grave.

Pacientes Y Métodos

Se estudió de forma prospectiva a 90 pacientes con EPOC moderada-grave ingresados de manera consecutiva en nuestro Servicio de Neumología por exacerbación de su enfermedad. En el momento del alta se evaluaron las variables clínicas, espirométricas y gasométri-cas, así como el estado muscular, mediante medidas no in-vasivas. Se realizó un seguimiento de los pacientes durante 3 meses tras el alta. Recogimos las agudizaciones que requi-rieron ingreso hospitalario y el tiempo libre de enfermedad.

Resultados

El análisis univariado mostró que la coexistencia de cor pulmonale (p < 0,05), el uso de oxigenoterapia domi-ciliaria (p < 0,05), la hipercapnia (p < 0,05) y una elevada car-ga inspiratoria —presión media de la vía respiratoria medida en boca > 0,40 cmH2O e índice presión-tiempo > 0,25 (p < 0,05 para ambas)— aumentan el riesgo de ingreso hospitalario tras una agudización. El análisis multivariado mostró como factores predictivos independientes el cor pulmonale (p < 0,05) y un elevado índice presión-tiempo (mayor de 0,25; p < 0,05).

Conclusiones

La coexistencia de cor pulmonale y un elevado índice presión-tiempo son factores predictivos independientes de ingreso hospitalario por agudización en los pacientes con EPOC moderada-grave.

Palabras clave:
EPOC
Agudización
Reingreso
Carga inspiratoria
Índice presión-tiempo
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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