In-hospital Mortality Patterns and Readmissions in Patients With Chronic Obstructive Pulmonary Disease: An Analysis of the Role of Pulmonary Hypertension

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline COPD status were also obtained. There were 766,561 (7.43%) patients with concomitant PH and COPD among 10,312,543 patients with COPD. Patients with PH and COPD were older, female, and more often had a length of stay ≥7 days (all p < 0.001). Patients with PH suffered more from in-hospital mortality than those without PH (5.84% versus 3.94%, p < 0.001). PH predicted in-hospital mortality (adjusted odds ratio [aOR]: 1.22 [1.21-1.24], p < 0.001). COVID-19 (aOR: 6.20 [6.11-6.30]), metastatic cancer (aOR: 3.28 [3.23-3.32]), and moderate/severe liver disease (aOR: 3.09 [3.04-3.15]) were the strongest positive predictors of in-hospital mortality (all p < 0.001) in all patients with COPD. The 30-day readmission rate for the entire cohort was approximately 16%. Most patients had PH coded as unspecified/other.PH was associated with increased in-hospital mortality among patients with COPD, highlighting a high-risk group for targeted interventions to reduce morbidity and mortality.