Key result
Reduced erector spinae muscle cross-sectional area on admission CT, older age, long-term oxygen therapy, and elevated D-dimer were significantly associated with in-hospital death and severe ADL dependence.
Why the study?
COPD exacerbations requiring hospitalization carry increased risks of in-hospital death and impaired activities of daily living, but predictors of these poor outcomes needed identification.
What are the predictors of poor clinical outcomes in patients hospitalized with exacerbation of COPD?
Cohort (n=207)
No
What are the predictors of poor clinical outcomes in patients hospitalized with exacerbation of COPD?
Reduced erector spinae muscle cross-sectional area on admission CT, along with older age, long-term oxygen therapy, and elevated D-dimer, predicts in-hospital death and severe ADL dependence in COPD exacerbations.
Highlights potential predictors of death and ADL loss in COPD hospitalizations; leaves open validation in prospective cohorts before guiding care.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. Many patients with COPD experience exacerbations that require hospitalization, which is associated with an increased risk of in-hospital death and impaired ability to perform activities of daily living (ADL). Declining ability to perform ADL is a critical issue for these patients. Objectives: To identify predictors of poor clinical outcomes, including in-hospital death and low ability to perform ADL at discharge, in patients who are hospitalized with exacerbation of COPD. Design: This retrospective study involved a cohort of patients with exacerbation of COPD who were admitted to Iwata City Hospital in Japan between July 2015 and October 2019. Methods: We collected clinical data, measured the cross-sectional area of the erector spinae muscles (ESM CSA ) on computed tomography (CT) scans at admission, and investigated the associations of poor clinical outcomes (in-hospital death and severe dependence when performing ADL, defined as a Barthel Index (BI) of ⩽40 at discharge) with clinical parameters. Results: Overall, 207 patients were hospitalized for exacerbation of COPD during the study period. The incidence of poor clinical outcomes was 21.3%, and the in-hospital mortality rate was 6.3%. Multivariate logistic regression analyses showed that older age, long-term oxygen therapy, an elevated D-dimer concentration, and a reduced ESM CSA on chest CT at admission were significantly associated with poor clinical outcomes (in-hospital death and a BI of ⩽40). Conclusion: Hospitalization for exacerbation of COPD was associated with high rates of in-hospital mortality and a BI of ⩽40 at discharge, which may be predicted by assessment of ESM CSA .
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Murakami et al. (2023) conducted a cohort in exacerbation of chronic obstructive pulmonary disease (COPD) (n=207). Reduced erector spinae muscle cross-sectional area (ESM CSA) on chest CT was evaluated on Poor clinical outcomes (in-hospital death and severe dependence when performing ADL, defined as a Barthel Index of ⩽40 at discharge). Reduced erector spinae muscle cross-sectional area on admission CT, older age, long-term oxygen therapy, and elevated D-dimer were significantly associated with in-hospital death and severe ADL dependence.
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