Steroid Dosing, Glucose Levels Do Not Increase Likelihood of COPD Readmissions

Readmission for COPD exacerbation within 30 days was more likely for individuals discharged to a post-hospital facility or those who went home.
Readmission for COPD exacerbation within 30 days was more likely for individuals discharged to a post-hospital facility or those who went home.

This article is part of MPR's coverage of the American Thoracic Society's International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.


SAN DIEGO — A retrospective observational study has found that steroid dosing and glucose levels were not associated with hospital readmissions in individuals with chronic obstructive pulmonary disease (COPD) exacerbations. This research was presented at the American Thoracic Society 2018 International Conference, held May 18-23, 2018, in San Diego, California.

The study researchers included 1120 hospital readmissions related to COPD exacerbations at a Texas medical center between February 2014 and July 2016. The majority of participants in this study were women (57%), the average body mass index was 29.4 (standard deviation [SD], 9.8), and the mean age was 69 (SD, 12). Participants were monitored for blood glucose level, the corticosteroid dose administered per day, and 30-day and 90-day readmission rates.

The rate of 30-day readmission was 16% and 90-day readmission was 14%, with an average prednisone-equivalent daily dose of 86 mg (SD, 52) and a total dose of 352mg (SD, 310) during a patient's entire hospitalization. Readmission within 30 days was more likely for individuals discharged to a post-hospital facility (14%) or those who went home (21%; P=.002). Patients discharged to a post-hospital facility received more total prednisone (441mg) than those who went home (324mg; P=.002).

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Readmission was not linked in a statistically significant way to an elevated maximum glucose of >180 during any given reading, average daily glucose, or equivalent daily dose of prednisone when analyzed with a multivariable regression model. The model did show an increased 90-day readmission rate for participants with high maximum glucose (17%) compared with other participants (13%), but the statistical significance was small (P =.06).

The researchers concluded that “[s]teroid dosing and glucose level did not impact 30-day readmission after COPD exacerbation discharge. In addition, guideline discordant dosing of steroids did not appear to affect the readmission rate in this cohort. Additional research is needed to understand if and how in-hospital treatment of exacerbation impacts functioning and health after discharge.”

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Reference

Boethel C, Hochhalter A, White HD, et al. Steroid dosing and glucose levels in COPD patients are not associated with increased readmissions. Presented at: American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, CA. Abstract 4969.