Examination of the general characteristics of patients hospitalized with acute COPD exacerbation in a university hospital

Yıl 2018, Cilt: 15 Sayı: 3, 230 - 235, 12.12.2018

İdris Kırhan , Fatih Üzer

Öz

Background: Chronic Obstructive Pulmonary Disease (COPD) is an important cause of morbidity and mortality. Admission at the hospital is thought to be related to parameters indicating the severity of the disease. The aim of this study is to investigate the general characteristics of the patients who are hospitalized with acute exacerbation of COPD and to determine the factors affecting the lenght of hospitalization.

Material and Methods: Patients with acute COPD exacerbation at the Harran University Medical Faculty Hospital between 2015 and 2018 were studied retrospectively. Sociodemographic data, disease stages, hemogram, biochemistry, c-reactive protein levels and lenght of stay were recorded in the data of patients with COPD acute exacerbation. Exclusion criteria were asthma, other obstructive lung diseases such as bronchiectasis, and patients who were discharged on their own voluntarily, while the study inclusion criteria were COPD patients over 40 years of age. Based on the guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for COPD diagnosis and staging.

Results: A total of 119 patients (29.3%) were female and 90 (75.6%) were male, whose mean age was 68.1 ± 10.7 years. Of the patients included in the study, 81 (68.0%) were over 65 years old and 38 (31.9%) patients were under 65 years old. The mean duration of stay at the hospital was 9.3 ± 6.0 days, 9.8 ± 4.9 days for women and 9.2 ± 6.3 days for men. Elderly patients (≥65 years) were in the hospital for 9.8 ± 6.5 days and younger patients (<65 years) were in the hospital for 8.2 ± 4.6 days (p: 0.175). The most frequent symptom was dsypnea (80.6%). Of the patients included in the study, 10 (8.4%) were group A, 54 (45.3%) were from group B, 28 (23.5%) were from group C and 27 (22.6%) were from group D.nAs the severity of the disease increased, there was a statistically significant decrease in FEV1 (p: 0.000), FVC (p: 0.000) and FEV1 / FVC (p: 0.000) levels. The level of eosinophil (p:0.006) in group A and the level of alanine aminotransferase (p:0.021) and urea (p:0.026) in group C were statistically significantly higher than the other groups.

Conclusion: Most of the patients hospitalized with acute exacerbation of COPD are elderly male patients. As COPD progression and blood urea levels increase, the length of stay in the hospital increases.

Anahtar Kelimeler

COPD, exacerbation, hospitalization charge

Bir üniversite hastanesine KOAH alevlenme ile yatan hastaların genel özelliklerinin incelenmesi

Öz

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) önemli bir morbidite ve mortalite nedenidir. Hastanede yatışların, hastalığın ağırlığını gösteren parametreler ile ilişkili olduğu bilinmektedir. Çalışmamızın amacı üniversite hastanesine KOAH akut atağı ile hastane yatışı gereken hastaların genel özelliklerinin incelenmesi ve hastane yatış süresine etki eden faktörlerin saptanmasıdır.

Materyal ve Metod: Çalışmamızda 2015-2018 yıllarında Harran Üniversitesi Tıp Fakültesi Hastanesine KOAH akut atağı ile yatan hastalar retrospektif olarak incelendi. Bu hastaların sosyodemografik verileri, hastalık evreleri, hemogram, biyokimya, c-reaktif protein düzeyleri ile hastanede yatış süreleri veri formuna kaydedildi. Çalışmaya dahil edilme kriterleri, 40 yaş üstü KOAH tanılı hastalar iken, çalışmadan dışlama kriterleri astım, bronşektazi gibi diğer obstrüktif akciğer hastalıkları, kendi isteği ile taburcu olan hastalar olarak belirlendi. KOAH tanısı ve evrelemesi için Global Initiative for Chronic Obstructive Lung Disease (GOLD) rehberleri temel alındı.

Bulgular: Çalışmamıza ortalama yaşı 68,1±10,7 olan 29 (%24,3) kadın, 90 (%75,6) erkek toplam 119 hasta dahil edildi. Çalışmaya dahil edilen hastaların 81 (%68)’i 65 yaş ve üstündeyken, 38 (%31,9) hasta 65 yaş altına idi. Hastanede ortalama kalış süresi 9,3±6,0 gün, kadınlarda 9,8±4,9 gün erkeklerde 9,2±6,3 gün olarak saptandı. Yaşlı hastalar (≥65 yaş) 9,8±6,5 gün, genç hastalar (<65 yaş) 8,2±4,6 gün hastanede yatmıştı (p:0.175). En sık başvuru nedeni nefes darlığı (%80,6) olarak tespit edildi. Çalışmaya dahil edilen hastaların %8,4 (10) A grubu, %45,3(54) B grubu, %23.5 (28) C grubu ve %22,6 (27) D grubu olduğu gözlendi. A grubundan D grubuna doğru gidildikçe FEV1 (p:0.000), FVC (p:0.000) ve FEV1/FVC (p:0.000) düzeylerinde istatistiki olarak anlamlı düzeyde azalma tespit edildi. A grubunda eozinofil (p:0.006) düzeyinin, C grubunda ise alanin aminotransferaz (p:0.021) ve üre (p:0,026) düzeyinin diğer gruplardan istatistiki olarak anlamlı düzeyde yüksek olduğu tespit edildi.

Sonuç: KOAH akut atağı ile hastaneye yatan hastaların büyük bir bölümü yaşlı erkek hastalardan oluşmaktadır. KOAH evresi ve kan üre düzeyi arttıkça hastanede kalış süresi artmaktadır.

Anahtar Kelimeler

KOAH, Alevlenme, Hastaneye yatış

Kaynakça

• Kaynaklar1. GOLD 2018 Global Strategy for the Diagnosis, Management and Prevention of COPD. www.goldcopd.org, 2018. 2. Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003; 163: 1180–11863. Yamauchi Y, Yasunaga H, Matsui H et al. Comparison of in-hospital mortality in pa-tients with COPD, asthma and asthma–COPD overlap exacerbations. Respirology 2015; 20:940–6.4. Ruchlin HS, Dasbach EJ. An economic overview of chronic obstructive pulmonary disease. Pharmacoeconomics 2001; 19: 623-42.5. Bafadhel M, Pavord ID, Russell REK. Eosinophils in COPD: just another biomarker? Lancet Respir Med 2017; 5: 747–7596. Similowski T, Agusti A, MacNee W, Schonhofer B. The potential impact of anaemia of chronic disease in COPD. Eur Respir J 2006; 27: 390–3967. Nowin´ski A, Kamin´ski D, Korzybski D, Stokłosa A, Górecka D. [The impact of comorbidities on the length of hospital treatment in patients with chronic obstructive pulmonary disease]. Pneumonol Alergol Pol. 2011;79(6):388–396. Polish8. Chen YW, Leung JM, Sin DD. A systematic review of diagnostic biomarkers of COPD exacerbation. PLoS One. 2016;119. Kırkıl G, Deveci F, Turgut T, Muz MH, Türkoğlu S, 2013. KOAH'lı olguların hastanede yatış süresini etkileyen faktörler. Fırat Tıp Dergisi, 18, 3, 171-510. Esatoğlu AZ, Bozat S. Survey on the lenght of stay for the patients with chronic obstructive pulmonary disease: an application on Atatürk Chest Disease Hospital. J Ank Med Sch 2002; 24: 165-76.11. Yağlı NV, Sağlam M, İnca Dİ, Topeli A, Kütükçü EÇ, Arık H. Kronik Obstrüktif Akciğer Hastalığı Akut Atağında Cinsiyetin Fiziksel, Fizyolojik ve Klinik Özelliklere Etkisi. Yoğun Bakım Derg 2015; 6: 27-33 12. Mawajdeh S, Hayajdeh Y, Al-Qutob R. The effect of type of hospital and health ınsurance on hospital length of stay in Irbid, North Jordan. Health Policy and Planning. Irbid Jordan 1997; 12: 166-72.13. Alnajashi MA, Almasoud MA, Aldaham SA, Acuna JM, Zevallos JC. Association of gender and length of stay among Puerto Ricans hospitalized with decompensated heart failure. Medicine 2016; 95:29 14. Butterworth J, James R, Prielipp R, Cerese J, Livingston J, Burnett D. Female gender associates with increased duration of intubation and length of stay after coronary artery surgery. CABG Clinical Benchmarking Database Participants. Anesthesıology 2000; 92:414 –2415. Agboado G, Peters J, Donkin L. Factors influencing the length of hospital stay among patients resident in Blackpool admitted with COPD: a cross-sectional study. BMJ Open. 2012;2(5):e00086916. Madani Y, Saigal A, Sunny J, Morris L, Johns RH. Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study. Turk Thorac J 2017; 18: 119-2417. Göçmen H, Ediger D, Uzaslan E, Ege E. Stabil KOAH’lı hastalarda hastanede yatış anamnezi ile spirometrik değerler ve amfizem paterni arasındaki ilişki. Fırat Tıp Dergisi 2009; 14: 254-59. 18. Esteban C, Quintana JM, Aburto M, et al. Predictors of mortality in patients with stable COPD. J Gen Intern Med 2008; 11: 1829-34.19. Groenewegen KH. Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest 2003; 124: 459-67.20. Ruparel M, Lopez-Campos JL, Castro-Acosta A, Hartl S, Pozo-Rodriguez F, Roberts CM. Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit. ERJ Open Res 2016;2:00034-2015.21. Parappil A, Depczynski B, Collett P, et al. Effect of comorbid diabetes on length of stay and risk of death in patients with acute exacerbations of COPD. Respirology 2010; 15: 918–922.22. Quintana JM, Unzurrunzaga A, Garcia-Gutierrez S, et al. Predictors of hospital length of stay in patients with exacerbations of COPD: a cohort study. J Gen Intern Med 2015; 30: 824–83123. Limsuwat C, Mankongpaisarnrung C, Dumrongmongcolgul N, Nugent K. Factors influencing the length of hospital stay in patients with acute exacerbations of chronic obstructive pulmonary disease admitted to intensive care units. Qual Manag Health Care. 2014;23:86–93