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March 26, 2026

985: Comparing Outcomes of Patients With Copd Exacerbation in the Presence of Adrenal Insufficiency

Key Points

To characterize the outcomes of patients treated for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in the presence of adrenal insufficiency.
Conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2022.
Extracted patients with AECOPD and categorized them based on the presence of adrenal insufficiency.
Performed propensity score matching considering age, gender, and Elixhauser index using the Van Walraven algorithm.
Stratified analyses by race.
No significant increase in in-hospital mortality associated with adrenal insufficiency (OR 1.07, p = 0.618).
Significantly longer length of stay by an average of 0.83 days (p = 0.002).
Total hospital costs increased by 73.5% (p < 0.001).
Largest increases in length of stay and costs were observed in Black (3.25 days, 71.2% increase) and Hispanic patients (5.58 days, 229% increase).

Abstract

Introduction: Corticosteroids remain one of the pillars of treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Prior studies have shown the precipitation of adrenal insufficiency (AI) due to suppression of the hypothalamic-pituitary-adrenal axis but impacts on hospital outcomes and healthcare utilization has not been studied extensively. The aim of this project is to characterize outcomes of patients being treated for AECOPD in the presence of AI. We hypothesize that patients with AI would experience higher in-patient mortality, longer length of stay (LOS), and higher total charges. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2022, extracting patients with AECOPD (International Classification of Diseases, Tenth Revision code J44.1). Groups were assigned based on presence of AI, which also includes patients with previous diagnosis of AI. Primary outcomes included in-hospital mortality, LOS, and total charges. Propensity score matching was done with age, gender, and the Elixhauser index calculated with Van Walraven algorithm. Analyses were also stratified by race. Results: After matching, 4,250 total patients (2,125 with AI and 2,125 controls) were included in the study. The presence of adrenal insufficiency was not associated with increased in-hospital mortality (OR 1.07, 95% CI 0.81-1.42, p = 0.618), bur results showed significant associations with longer LOS (0.83 days on average, 95% CI 0.30-1.37, p = 0.002) and higher hospital costs (73.5% increase, 95% CI 0.495–0.607; p < 0.001). In race-stratified models the largest increases in LOS were seen in Blacks (3.25 days, 95% CI 1.00–5.51, p=0.005) and Hispanics (5.58 days, 95% CI 2.74–8.42, p< 0.001). These populations also witnessed the largest increase in cost (71.2% in Black, 229% in Hispanic). Conclusions: Although having AI did not significantly increase mortality, it was associated with longer LOS and higher costs. This suggests that adrenal suppression from high dose steroids given in AECOPD complicates the hospital course, requiring more resource utilization. This burden was further shown to be disproportionate in Black and Hispanic populations. Future studies may explore alternative treatments or dose adjustments, especially in vulnerable populations.

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Cite This Study

Gupta et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cd49fdc3bde44891971a https://doi.org/https://doi.org/10.1097/01.ccm.0001185936.30856.2e

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