Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

Kiki Waeijen-Smit, Mieke Crutsen, Spencer Keene, Marc Miravitlles, Ernesto Crisafulli, Antoni Torres, Christian Mueller, Philipp Schuetz, Thomas J. Ringbæk, Fabio Fabbian, Evgeni Mekov, Timothy H. Harries, Chung-tat Lun, Begum Ergan, Cristóbal Esteban, Jose M. Quintana Lopez, José Luis López-Campos, Catherina L. Chang, Robert J. Hancox, Eskandarain ShafuddinHollie Ellis, Christer Janson, Charlotte Suppli Ulrik, Gunnar Gudmundsson, Danny Epstein, José Dominguez, Alicia Lacoma, Christian Osadnik, Inmaculada Alia, Francesco Spannella, Zuhal Karakurt, Hossein Mehravaran, Cecile Utens, Martijn D. de Kruif, Fanny Wai San Ko, Samuel P. Trethewey, Alice M. Turner, Dragos Bumbacea, Patrick B. Murphy, Kristina Vermeersch, Shani Zilberman-Itskovich, John Steer, Carlos Echevarria, Stephen C. Bourke, Nicholas Lane, Jordi de Batlle, Roy T. M. Sprooten, Richard Russell, Paola Faverio, Jane L. Cross, Hendrik J. Prins, Martijn A. Spruit, Sami O. Simons, Sarah Houben-Wilke, Frits M. E. Franssen

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Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design.

Methods A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement.

Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event.

Conclusions This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.
Original languageEnglish
Article number00838-2023
JournalERJ Open Research
Publication statusPublished - 26 Feb 2024

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