Prevalence and factors associated with clinical outcomes among patients hospitalized with chronic obstructive lung disease on the pulmonology wards at Kiruddu and Mulago National Referral Hospital.

Abstract

Background: COPD is a chronic airway disease condition currently on the rise in many low middle-income countries (LMICs). This is attributed to poorly treated TB, asthma, cigarette smoking and air pollution among others. COPD patients experience a wide range of short-term outcomes during their hospital admissions however there is paucity of information regarding these short-term outcomes, their prevalence and risk factors in most LMIC. This study aimed at determining the prevalence the of COPD, short-term clinical outcomes of patients admitted with COPD on the pulmonology units of Kiruddu and Mulago National Referral Hospitals and associated factors to the clinical outcomes. Objectives: To determine the prevalence of COPD, short-term clinical outcomes, and the risk factors for the clinical outcomes among COPD patients admitted on pulmonology wards of Kiruddu National Referral Hospital (KNRH) and Mulago National Referral Hospital (MNRH). Methods: This was a prospective cohort study conducted on the pulmonology ward at KNRH and MNRH over a period of six months. All patient admissions on the pulmonology ward were screened, to establish the prevalence of COPD. COPD patients were followed up, to determine the clinical outcomes that included; symptom resolution, length of hospitalisation and death within 30 days. Modified Poisson regression analysis was used to determine the risk-factors for the clinical outcomes among these hospitalised COPD patients. Result: A total of 896 patients were screened, with 62.2% (n=56) males, and the median age (IQR) was 70(60-78) years. The proportion of COPD patients was 10.04% (90), among all hospitalized patients on pulmonary wards of KNRH and MNRH. 68.9 % (n=62) patients had symptom resolution in less than 8 days after admission and the average length of hospitalization was 7 days (SD, 5.7 days), while 8% (n=7) of the patients died within the 30 days of follow-up from the time of admission. Delayed symptom resolution and a longer duration of hospitalization were associated with history of smoking, low-income status (ARR;4.09, 95% CI (1.30-12.9), p-value= 0.016) and history of oxygen therapy (ARR; 2.80, 95% CI (1.71-4.60), p-value <0.001). Conclusion: There is a high proportion of COPD patients among hospitalized patients on the pulmonology wards of MNRH and KNRH. Majority of the patients with COPD experienced symptom resolution in less than 8 days, a mean hospital-stay of 7 days and a relatively high 30-day periodic mortality observed at 8%.