Predictive factors of chronic obstructive pulmonary disease on emergency ward visits
, 2, 2, 1
Abstract
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the most prominent diseases in pulmonology due to its high incidence, preventable nature, and in cases where exposure to irritants had continued, an increased overall morbidity and mortality. This study was performed to evaluate if local risk factors exist for COPD patients that affect emergency ward visits and to investigate if enough data may be gathered to create a model for risk assessment.
MATERIAL AND METHODS: The study was conducted as a retrospective, single-center cohort in a tertiary training and research hospital. The study evaluated patients between January 1, 2015, and January 31, 2020, with the collaboration of the Emergency Medicine and Pulmonary Medicine departments. Patients who had a confirmed COPD diagnosis, an emergency admission, and a pulmonary medicine consultation were included in the study, while those leaving against medical advice, transferred to other departments, and with incomplete consultation notes were excluded. The patient’s demographic data, symptom presence, known comorbidities, drug history, medical treatment given in the emergency ward, respiratory risk factors, auscultation findings, vitals at admission, routine laboratory results, and radiological findings were recorded. Descriptive statistics were used to summarize data, presented as means with standard deviations or medians with percentiles as appropriate. Parametric distribution was assessed via quantile–quantile (Q–Q) plots. Significant variables were tested by binomial regression analysis.
RESULTS: A total of 306 patients were evaluated. Change in phlegm and chest pain were the symptoms positively correlated with repeated emergency admission. Hypertension, coronary heart disease, and arrhythmia were the comorbidities with a correlation. Treatment-wise, bilevel pressure support device requirement, lipid-lowering regimen, and anticoagulant use were found to correlate with repeated emergency ward admission. The regression model showed that chest pain, hypertension, coronary arterial disease, arrhythmia, anti-lipid regimen requirement, desaturation at admission, presence of infection in imaging modalities, and hospital admission within a week were independent predictive factors for repeated emergency ward admission.
CONCLUSIONS: Cardiac-related symptoms and treatment history, desaturation, presence of pulmonary infection, and former hospital admission history are independent risk factors affecting repeated emergency ward admission for COPD patients. These observations correlate with the available literature, especially in terms of the correlation between repeated admission and cardiac comorbidities.
Keywords: chronic obstructive pulmonary diseasecoronary heart diseaseemergency ward
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