In-hospital outcomes of patients admitted with chronic obstructive pulmonary disease exacerbation (COPDE) and comorbid lung cancer: An analysis of the National Inpatient Sample (NIS).

Abstract

e20032 Background: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition among smokers, often leading to substantial morbidity. Lung cancer patients, many of whom have a history of smoking, frequently experience concurrent COPD and are at an increased risk of COPD exacerbations. However, the impact of COPDE on clinical outcomes in patients with lung cancer remains insufficiently studied. This study aims to explore the effects of COPDE on inpatient outcomes in this population, addressing an important gap in the current body of knowledge. Methods: Data from the 2019 National Inpatient Sample were analyzed to identify patients with a diagnosis of lung cancer using International Classification of Diseases, 10th Revision (ICD-10) codes. The study population was divided into two groups: those with COPD exacerbation (COPDE) and those without. Sociodemographic variables and comorbidities were compared between the groups. The primary outcome was all-cause in-hospital mortality, with several secondary outcomes also assessed. Multivariate regression models were utilized to evaluate differences in outcomes between the groups, with statistical significance set at p < 0.05. Results: Among 317,180 adult patients hospitalized with lung cancer, 10,155 (3.2%) were admitted with a diagnosis of chronic obstructive pulmonary disease exacerbation (COPDE). These patients were older on average (mean age: 70.1 years vs. 69.5 years) and included a higher proportion of females (54.6%) compared to males (45.4%). Patients with lung cancer and COPDE demonstrated significantly reduced odds of all-cause mortality (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.21–0.38; p < 0.001), concurrent pulmonary embolism (aOR: 0.39; 95% CI: 0.26–0.59; p > 0.001), acute kidney injury (aOR: 0.59; 95% CI: 0.51–0.69; p < 0.001), and sudden cardiac death (aOR: 0.31; 95% CI: 0.14–0.66; p = 0.002). Additionally, patients with COPDE had shorter hospital stays (mean length of stay: 4.4 days vs. 6.1 days; p < 0.001) and incurred lower hospitalization costs ($44,103 vs. $70,100; p < 0.001). Conclusions: Lung cancer patients with concurrent COPDE demonstrated significantly lower odds of mortality, acute kidney injury, pulmonary embolism, and sudden cardiac death. They also experienced shorter hospital stays and reduced hospitalization costs compared to those without COPDE. These findings provide important insights into the prognosis of lung cancer patients with COPDE, highlighting potential differences in outcomes that may guide clinical management strategies.