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 Shafuddin; Hollie 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

doi:10.1183/23120541.00838-2023

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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Abstract

Please note there is a correction available for this article: https://doi.org/10.1183/23120541.50838-2023

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 language	English
Article number	00838-2023
Journal	ERJ Open Research
Volume	10
Issue number	1
DOIs	https://doi.org/10.1183/23120541.00838-2023
Publication status	Published - 26 Feb 2024

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00838-2023.fullFinal published version, 1.92 MBLicence: CC BY-NC

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Waeijen-Smit, K., Crutsen, M., Keene, S., Miravitlles, M., Crisafulli, E., Torres, A., Mueller, C., Schuetz, P., Ringbæk, T. J., Fabbian, F., Mekov, E., Harries, T. H., Lun, C., Ergan, B., Esteban, C., Quintana Lopez, J. M., López-Campos, J. L., Chang, C. L., Hancox, R. J., ... Franssen, F. M. E. (2024). Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients. ERJ Open Research, 10(1), Article 00838-2023. https://doi.org/10.1183/23120541.00838-2023

@article{bc609b3638dc4ad9ad245fe92b7689d8,

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

abstract = "Please note there is a correction available for this article: https://doi.org/10.1183/23120541.50838-2023 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. ",

author = "Kiki Waeijen-Smit and Mieke Crutsen and Spencer Keene and Marc Miravitlles and Ernesto Crisafulli and Antoni Torres and Christian Mueller and Philipp Schuetz and Ringb{\ae}k, {Thomas J.} and Fabio Fabbian and Evgeni Mekov and Harries, {Timothy H.} and Chung-tat Lun and Begum Ergan and Crist{\'o}bal Esteban and {Quintana Lopez}, {Jose M.} and L{\'o}pez-Campos, {Jos{\'e} Luis} and Chang, {Catherina L.} and Hancox, {Robert J.} and Eskandarain Shafuddin and Hollie Ellis and Christer Janson and {Suppli Ulrik}, Charlotte and Gunnar Gudmundsson and Danny Epstein and Jos{\'e} Dominguez and Alicia Lacoma and Christian Osadnik and Inmaculada Alia and Francesco Spannella and Zuhal Karakurt and Hossein Mehravaran and Cecile Utens and {de Kruif}, {Martijn D.} and Ko, {Fanny Wai San} and Trethewey, {Samuel P.} and Turner, {Alice M.} and Dragos Bumbacea and Murphy, {Patrick B.} and Kristina Vermeersch and Shani Zilberman-Itskovich and John Steer and Carlos Echevarria and Bourke, {Stephen C.} and Nicholas Lane and {de Batlle}, Jordi and Sprooten, {Roy T. M.} and Richard Russell and Paola Faverio and Cross, {Jane L.} and Prins, {Hendrik J.} and Spruit, {Martijn A.} and Simons, {Sami O.} and Sarah Houben-Wilke and Franssen, {Frits M. E.}",

note = "This article has a correction (see : ERJ Open Research 2024 10(6): 50838-2023; DOI: https://doi.org/10.1183/23120541.50838-2023) In the originally published version of this article there was an error in the follow-up time and total number of readmissions in two datasets of the hospital readmission data subset. This concerned the datasets of Quintana et al. [1] and Lopez-Campos et al. [2]. Instead of a follow-up time of 365 days, the correct follow-up times were 60 and 90 days, respectively. In addition, instead of total readmission rates of 19.5% and 26.6%, the correct readmission rates were 26.0% and 35.1%, respectively. As a result, the median follow-up time in the hospital readmission data subset changed from 365 days to 90 days, whereas the overall readmission rate changed from 15 195 (32.8%, 95% CI 32.4–33.3%) to 16 646 (36.0%, 95% CI 35.5–36.4%). Corrections have been made accordingly to the Results, including table S7 and figure S8, and to the Discussion. In addition, there was an error in the coding for the 30-, 90- and 365-day categories related to post-discharge mortality and hospital readmission. The initial coding failed to capture all possible conditional statements needed to accurately capture outcome statuses based on follow-up times. This was particularly relevant in studies where the exact time until the event was not known, and was instead represented by the predetermined, or set, study follow-up period. These corrections altered the pooled 30-, 90- and 365-day post-discharge mortality and hospital readmission rates from 1.8% to 2.0%, from 5.5% to 6.4%, from 10.9% to 12.2%, and from 7.1% to 11.8%, from 12.6% to 26.5% and from 32.1% to 38.2%, respectively. Corrections have been made accordingly to the Abstract, Results (including figures 5 and 7), and to the Discussion. Figures S3 and S7 have been aligned to display only the percentages of patients with a known time of event, categorised by time intervals during follow-up after hospital discharge from the index event. Importantly, the corrections do not change the scientific conclusions drawn in the article. // Data sharing statement: Access to the extracted data, and/or the codes developed for this analysis, are possible upon reasonable request. Such queries may be directed towards the senior author. ",

year = "2024",

month = feb,

day = "26",

doi = "10.1183/23120541.00838-2023",

language = "English",

volume = "10",

journal = "ERJ Open Research",

issn = "2312-0541",

publisher = "European Respiratory Society",

number = "1",

}

Waeijen-Smit, K, Crutsen, M, Keene, S, Miravitlles, M, Crisafulli, E, Torres, A, Mueller, C, Schuetz, P, Ringbæk, TJ, Fabbian, F, Mekov, E, Harries, TH, Lun, C, Ergan, B, Esteban, C, Quintana Lopez, JM, López-Campos, JL, Chang, CL, Hancox, RJ, Shafuddin, E, Ellis, H, Janson, C, Suppli Ulrik, C, Gudmundsson, G, Epstein, D, Dominguez, J, Lacoma, A, Osadnik, C, Alia, I, Spannella, F, Karakurt, Z, Mehravaran, H, Utens, C, de Kruif, MD, Ko, FWS, Trethewey, SP, Turner, AM, Bumbacea, D, Murphy, PB, Vermeersch, K, Zilberman-Itskovich, S, Steer, J, Echevarria, C, Bourke, SC, Lane, N, de Batlle, J, Sprooten, RTM, Russell, R, Faverio, P, Cross, JL, Prins, HJ, Spruit, MA, Simons, SO, Houben-Wilke, S & Franssen, FME 2024, 'Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients', ERJ Open Research, vol. 10, no. 1, 00838-2023. https://doi.org/10.1183/23120541.00838-2023

TY - JOUR

T1 - Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

AU - Waeijen-Smit, Kiki

AU - Crutsen, Mieke

AU - Keene, Spencer

AU - Miravitlles, Marc

AU - Crisafulli, Ernesto

AU - Torres, Antoni

AU - Mueller, Christian

AU - Schuetz, Philipp

AU - Ringbæk, Thomas J.

AU - Fabbian, Fabio

AU - Mekov, Evgeni

AU - Harries, Timothy H.

AU - Lun, Chung-tat

AU - Ergan, Begum

AU - Esteban, Cristóbal

AU - Quintana Lopez, Jose M.

AU - López-Campos, José Luis

AU - Chang, Catherina L.

AU - Hancox, Robert J.

AU - Shafuddin, Eskandarain

AU - Ellis, Hollie

AU - Janson, Christer

AU - Suppli Ulrik, Charlotte

AU - Gudmundsson, Gunnar

AU - Epstein, Danny

AU - Dominguez, José

AU - Lacoma, Alicia

AU - Osadnik, Christian

AU - Alia, Inmaculada

AU - Spannella, Francesco

AU - Karakurt, Zuhal

AU - Mehravaran, Hossein

AU - Utens, Cecile

AU - de Kruif, Martijn D.

AU - Ko, Fanny Wai San

AU - Trethewey, Samuel P.

AU - Turner, Alice M.

AU - Bumbacea, Dragos

AU - Murphy, Patrick B.

AU - Vermeersch, Kristina

AU - Zilberman-Itskovich, Shani

AU - Steer, John

AU - Echevarria, Carlos

AU - Bourke, Stephen C.

AU - Lane, Nicholas

AU - de Batlle, Jordi

AU - Sprooten, Roy T. M.

AU - Russell, Richard

AU - Faverio, Paola

AU - Cross, Jane L.

AU - Prins, Hendrik J.

AU - Spruit, Martijn A.

AU - Simons, Sami O.

AU - Houben-Wilke, Sarah

AU - Franssen, Frits M. E.

N1 - This article has a correction (see : ERJ Open Research 2024 10(6): 50838-2023; DOI: https://doi.org/10.1183/23120541.50838-2023) In the originally published version of this article there was an error in the follow-up time and total number of readmissions in two datasets of the hospital readmission data subset. This concerned the datasets of Quintana et al. [1] and Lopez-Campos et al. [2]. Instead of a follow-up time of 365 days, the correct follow-up times were 60 and 90 days, respectively. In addition, instead of total readmission rates of 19.5% and 26.6%, the correct readmission rates were 26.0% and 35.1%, respectively. As a result, the median follow-up time in the hospital readmission data subset changed from 365 days to 90 days, whereas the overall readmission rate changed from 15 195 (32.8%, 95% CI 32.4–33.3%) to 16 646 (36.0%, 95% CI 35.5–36.4%). Corrections have been made accordingly to the Results, including table S7 and figure S8, and to the Discussion. In addition, there was an error in the coding for the 30-, 90- and 365-day categories related to post-discharge mortality and hospital readmission. The initial coding failed to capture all possible conditional statements needed to accurately capture outcome statuses based on follow-up times. This was particularly relevant in studies where the exact time until the event was not known, and was instead represented by the predetermined, or set, study follow-up period. These corrections altered the pooled 30-, 90- and 365-day post-discharge mortality and hospital readmission rates from 1.8% to 2.0%, from 5.5% to 6.4%, from 10.9% to 12.2%, and from 7.1% to 11.8%, from 12.6% to 26.5% and from 32.1% to 38.2%, respectively. Corrections have been made accordingly to the Abstract, Results (including figures 5 and 7), and to the Discussion. Figures S3 and S7 have been aligned to display only the percentages of patients with a known time of event, categorised by time intervals during follow-up after hospital discharge from the index event. Importantly, the corrections do not change the scientific conclusions drawn in the article. // Data sharing statement: Access to the extracted data, and/or the codes developed for this analysis, are possible upon reasonable request. Such queries may be directed towards the senior author.

PY - 2024/2/26

Y1 - 2024/2/26

N2 - Please note there is a correction available for this article: https://doi.org/10.1183/23120541.50838-2023 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.

AB - Please note there is a correction available for this article: https://doi.org/10.1183/23120541.50838-2023 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.

UR - http://www.scopus.com/inward/record.url?scp=85188618068&partnerID=8YFLogxK

U2 - 10.1183/23120541.00838-2023

DO - 10.1183/23120541.00838-2023

M3 - Article

SN - 2312-0541

VL - 10

JO - ERJ Open Research

JF - ERJ Open Research

IS - 1

M1 - 00838-2023

ER -

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

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