• Phyo Kyaw Myint, Derek Lowe, Robert A Stone, Rhona J Buckingham, and C Michael Roberts.
• Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK. Phyo.K.Myint@uea.ac.uk
• Respiration. 2011 Jan 1; 82 (4): 320-7.

BackgroundLimited comparative data exist on the outcomes of patients presenting with chronic obstructive pulmonary disease (COPD) exacerbations with or without radiological pneumonia.ObjectiveTo examine the outcome differences amongst these patients.MethodsWe analysed 2008 U.K. National COPD audit data to examine the characteristics, management and outcomes, inpatient- and 90-day mortality and length of stay of patients admitted with COPD exacerbations.ResultsOf 9,338 admissions, 16% (1,505) had changes consistent with pneumonia indicated on the admission chest X-ray. They tended to be older (mean ages 75 vs. 72 years), male (53 vs. 50%), more likely to come from care homes, with more disability, higher BMI and co-morbidity, lower albumin but higher urea levels, and less likely to be current smokers. COPD exacerbations with pneumonia were associated with worse outcomes: inpatient mortality was 11 and 7% and 90-day mortality was 17 and 13% for pneumonia and non-pneumonia patients, respectively (p < 0.001). After adjusting for factors that are significantly different between the 2 groups, including age, sex, place of residence, level of disability, co-morbidity, albumin and urea levels, estimated risk ratios for inpatient and 90-day mortality for pneumonia compared to non-pneumonia cases in this series were 1.19 (1.01,1.42) and 1.09 (0.96,1.23), respectively. The adjusted risk ratio of a prolonged acute hospital stay of more than 7 days was 1.15 (1.07, 1.23).ConclusionsPatients who present with radiological pneumonia have worse outcomes compared to those admitted without pneumonia in exacerbation of COPD.Copyright © 2011 S. Karger AG, Basel.

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