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Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation
Ayushman Gupta1, Tricia M McKeever1,2, John P Hutchinson3
1NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Insights
Dementia significantly increases inpatient death risk and length of stay for COPD exacerbation patients. This highlights the critical impact of cognitive impairment on respiratory illness outcomes.
Area of Science:
- Medical research
- Pulmonology
- Geriatrics
Background:
- Chronic Obstructive Pulmonary Disease (COPD) patients face higher cognitive dysfunction risks.
- The impact of co-existing dementia in COPD exacerbation hospitalizations is not well understood.
Purpose of the Study:
- Assess dementia's impact on inpatient mortality and length of stay (LOS) in COPD exacerbation patients.
- Utilize the National Inpatient Sample database for United States-based analysis.
Main Methods:
- Included patients aged over 40 with primary COPD exacerbation diagnosis (2011-2015).
- Grouped patients into those with and without dementia.
- Employed multivariable logistic regression and Cox regression for mortality analysis, and competing risk analysis for discharge rates.
Main Results:
- 6.1% of 576,381 patients had dementia.
- Dementia increased inpatient death odds in younger patients (41-64 years) [OR 1.75].
- Dementia cases showed higher early mortality [HR 1.23] and longer LOS [sub-hazard ratio 0.93].
Conclusions:
- Dementia is a significant comorbidity associated with adverse outcomes in COPD exacerbation hospitalizations.
- Patients with dementia experience increased inpatient mortality and extended length of stay.
Purpose:
People with COPD are at a higher risk of cognitive dysfunction than the general population. However, the additional impact of dementia amongst such patients is not well understood, particularly in those admitted with a COPD exacerbation. We assessed the impact of coexisting dementia on inpatient mortality and length of stay (LOS) in patients admitted to hospital with a COPD exacerbation, using the United States based National Inpatient Sample database.
Patients And Methods:
Patients aged over 40 years and hospitalised with a primary diagnosis of COPD exacerbation from 2011 to 2015 were included. Cases were grouped into patients with and without dementia. Multivariable logistic regression analysis, stratified by age, was used to assess risk of inpatient deaths. Cox regression was carried out to compare death rates and competing risk analysis gave estimates of discharge rates with time to death a competing variable.
Results:
A total of 576,381 patients were included into the analysis, of which 35,372 (6.1%) had co-existent dementia. There were 6413 (1.1%) deaths recorded. The odds of inpatient death were significantly greater in younger patients with dementia (41-64 years) [OR (95% CI) dementia vs without: 1.75 (1.04-2.92), p=0.03]. Cases with dementia also had a higher inpatient mortality rate in the first 4 days [HR (95% CI) dementia vs without: 1.23 (1.08-1.41), p=0.002] and a longer LOS [sub-hazard ratio (95% CI) dementia vs without: 0.93 (0.92-0.94), p<0.001].
Conclusion:
Dementia as a comorbidity is associated with worse outcomes based on inpatient deaths and LOS in patients admitted with COPD exacerbations.
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