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Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression

G. Gudmundsson, T. Gislason, C. Janson, E. Lindberg, R. Hallin, C. S. Ulrik, E. Brøndum, M. M. Nieminen, T. Aine, P. Bakke
European Respiratory Journal 2005 26: 414-419; DOI: 10.1183/09031936.05.00078504
G. Gudmundsson
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T. Gislason
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C. Janson
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E. Lindberg
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R. Hallin
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C. S. Ulrik
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E. Brøndum
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M. M. Nieminen
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T. Aine
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P. Bakke
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  • Fig. 1—
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    Fig. 1—

    Health status in relation to patients with (Embedded Image) and without (□) hospital re-admissions. The box plot displays the median, 10, 25, 50, 75 and 90% percentiles. #: p = 0.08; ¶: p<0.0001.

  • Fig. 2—
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    Fig. 2—

    Kaplan-Meier survival curve demonstrating the time until re-admission in patients in relation to chronic obstructive pulmonary disease (COPD) severity defined according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification. –––: GOLD I and II; · · ·: GOLD III; - - -: GOLD IV. p<0.0001.

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    Fig. 3—

    Kaplan-Meier survival curve demonstrating time until re-admission in relation to health status (St George's Respiratory Questionnaire (SGRQ) total score).The patients were divided into quartiles according the SGRQ total score. – · –: 1st quartile <46.4; · · ·: 2nd quartile 46.4–60.4; - - -: 3rd quartile 60.5–70.5; –––: 4th quartile >70.6. p<0.0001.

Tables

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  • Table. 1—

    Characteristics of patients included in the study in relation to re-admission

    AllNo rehospitalisationRehospitalisationp-value
    Subjects n406160246
    Age yrs69.2±10.568.3±12.169.8±9.40.16
    Female51.254.449.20.31
    Hospital stay days8 (6–13)7 (5–12)9 (6–14)0.02
    Smokers36.030.623.00.09
    Pack-yrs35.2±23.333.9±21.236.1±24.60.37
    College education30.730.830.60.96
    Living alone52.148.754.40.28
    COPD hospitalisations in last 12 months1 (0–3)0.5 (0–1)1 (1–3)<0.0001
    HAD-Total12.5±6.812.1±6.312.7±7.10.38
    HAD-Anxiety7.0±4.26.7±4.07.1±4.30.28
    HAD-Depression5.5±3.65.4±3.45.6±3.80.63
    Anxiety41.039.542.10.61
    Depression28.726.530.20.44
    Health status SGRQ total score58±1752±1762±16<0.0001
    FEV1 % pred38.4±18.244.8±19.434.1±15.9<0.0001
    FVC % of pred61.8±19.266.2±19.258.8±20.70.0005
    Long-term oxygen23.616.228.40.005
    Cardiovascular diseases44.645.643.90.76
    Diabetes10.37.512.20.13
    Anticholinergics35.843.630.70.009
    Short acting β2-agonists35.933.837.30.53
    Long acting β2-agonists61.460.561.90.78
    Inhaled corticosteroids69.969.970.00.98
    Nebulised treatment33.219.941.8<0.0001
    Oral theophylline27.719.732.90.004
    Oral corticosteroids65.762.467.90.26
    • Data presented as n, mean±sd, median (interquartile range) or %. COPD: chronic obstructive pulmonary disease; HAD: hospital anxiety and depression scale; SGRQ: St George's Respiratory Questionnaire; FEV1: forced expiratory volume in one second; FVC: forced vital capacity. Chi-squared test and unpaired t-tests was used to calculate the p-values.

  • Table. 2—

    Determinants for re-admissions analysed by Cox regression

    All subjectsSGRQ total ≤60SGRQ total >60
    Subjects n340170170
    Age 10 yrs1.16 (1.00–1.35)1.14 (0.92–1.419)1.19 (0.95–1.50)
    Current smoker0.78 (0.55–1.10)0.69 (0.37–1.29)0.82 (0.53–1.26)
    HAD-total 4 units*1.03 (0.93–1.13)0.87 (0.74–1.03)1.13 (1.01–1.27)
    HAD-anxiety 4 units*1.10 (0.95–1.28)0.81 (0.63–1.04)1.36 (1.12–1.65)
    HAD-depression 4 units*0.96 (0.80–1.15)0.83 (0.61–1.14)1.02 (0.81–1.28)
    Anxiety*1.06 (0.79–1.41)0.43 (0.25–0.74)1.73 (1.18–2.53)
    Depression*1.09 (0.80–1.51)0.84 (0.46–1.55)1.20 (0.81–1.79)
    FEV1 10% pred0.83 (0.76–0.91)0.80 (0.70–0.92)0.83 (0.53–1.26)
    SGRQ-total 4 units1.06 (1.02–1.11)1.06 (0.97–1.15)1.08 (0.98–1.18)
    • Data presented as n and hazard ratio (95% confidence interval). SGRQ: St George's Respiratory Questionnaire; HAD: hospital anxiety and depression scale; FEV1: forced expiratory volume in one second. *: Entered separately into the model.

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Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression
G. Gudmundsson, T. Gislason, C. Janson, E. Lindberg, R. Hallin, C. S. Ulrik, E. Brøndum, M. M. Nieminen, T. Aine, P. Bakke
European Respiratory Journal Sep 2005, 26 (3) 414-419; DOI: 10.1183/09031936.05.00078504

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Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression
G. Gudmundsson, T. Gislason, C. Janson, E. Lindberg, R. Hallin, C. S. Ulrik, E. Brøndum, M. M. Nieminen, T. Aine, P. Bakke
European Respiratory Journal Sep 2005, 26 (3) 414-419; DOI: 10.1183/09031936.05.00078504
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