Predictors of early readmission in acute exacerbation of COPD
Dr. Antoni Torres Martí (principal investigator)
Dr. Joaquim Gea
Hospital del Mar
Dr. Roser Coll
Consorci Sanitari Parc Taulí
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major cause of hospitalization. Approximately 22% of these patients require readmission before a month of discharge, being not yet available an accurate description of etiologic or predisposing factors for readmissions. These recurrent hospitalizations have important clinical and economic implications.
Objectives: 1) To determine the clinical factors, inflammatory and microbiological predictors of hospital readmission in patients with COPD exacerbations. 2) To analyze the protective capacity of a rehabilitation program of short duration on the number of readmissions and length of hospital stay.
Design: Prospective, observational and multicenter study.
Methods: all patients with AECOPD which require hospitalization will be included in the 3 participating centers during the recruitment period. Systemic inflammatory response (IL -‐ 6, IL
-‐8 and IL -‐10 ) and biomarkers (CRP, procalcitonin , troponin I and proadrenomedullin), tumour necrosis factor-‐alpha (TNF-‐α) will be determined on admission to the hospital, at day 3 and at discharge. Clinical and outcome variables will be collected at hospital admission, and sputum culture, bronchial microbiome (sputum culture-‐independent techniques), on admission and at discharge. Patients will be followed-‐up for 1 year. Clinical, microbiological, bronchial microbiome and inflammatory variables will be compared between group of patients requiring hospital readmission within 30 days of hospital discharge and the non-‐readmitted group, to determine the risk factors associated with readmission.
Patients with AECOPD, in one of the centers, will be randomizedly enrolled in pulmonary rehabilitation program within 48 hours of hospital discharge. The program will include: aerobic exercise, strength training, pulmonary physiotherapy / breathing exercises, energy saving techniques and health education during 4 weeks.