ABSTRACT
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 <12â
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.