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Emphysema Phenotype and 1‑Year Readmission Risk After Acute Exacerbation of COPD: A Real-World Study Using Propensity
Chengfeng Fu1,2, Yanling Wu1, Aixia Huang1
1Respiratory and Critical Care Medicine, The Second People's Hospital of Banan District, Chongqing, 400054, People's Republic of China.
Background:
The association between emphysema phenotype and readmission risk after acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains unclear. This real‑world study evaluated this association with rigorous confounding control.
Methods:
This retrospective cohort study included patients hospitalized for AECOPD (2023). Emphysema was diagnosed by chest CT. The outcome was 1‑year acute exacerbation‑related readmission. Propensity score matching (PSM), multiple-weighting methods, doubly robust analysis, Schoenfeld residuals test, Kaplan‑Meier curves, and subgroup analyses were used.
Results:
Among 875 patients, PSM yielded 171 matched pairs. Emphysema was associated with higher readmission risk in adjusted analysis (HR=1.64, 95% CI:1.17-2.32, p=0.005), and after PSM (HR=1.81, 95% CI:1.22-2.68, p=0.003). Results were consistent across all weighting methods. The Schoenfeld test satisfied the proportional hazards assumption. Kaplan‑Meier curves showed significantly lower readmission‑free survival in the emphysema group. Subgroup analyses revealed a stronger association in patients not using inhaled corticosteroids.
Conclusion:
Emphysema was associated with a higher risk of 1‑year readmission after AECOPD. The emphysema phenotype may aid risk stratification and guide individualized therapy, though these findings should be interpreted cautiously.
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