Inpatient AECOPD Mortality Significantly Higher in Women vs Men Who Smoke

Women who smoke and have acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have a significantly higher in-hospital mortality rate than men with AECOPD who smoke, according to study findings published in BMC Pulmonary Medicine.

The finding is based on data from the prospective, noninterventional, real-world MAGNET AECOPD (MAnaGement aNd advErse ouTcomes in inpatients with acute exacerbation of COPD) registry study, which evaluated characteristics, treatment, and adverse outcomes in patients with AECOPD.

Participants were admitted to the hospital for AECOPD from 10 medical centers in China between September 2017 and July 2021.

The study included 14,007 patients (78.7% male) with AECOPD, with an overall mean (SD) age of 72.32 (10.39) years. Female patients were older than male patients (74.02 [10.79] vs 71.86 [10.23] years, respectively). Among male patients, a higher percentage smoked (76% vs 10%), a lower number had comorbidities (1.73 [1.57] vs 2.23 [1.65]), fewer had altered mental status (2.9% vs 5.0%), and diastolic blood pressure was higher (79.04 [12.47] vs 78.04 [12.96] mmHg), compared with female patients.

Overall, cough (94.3%), expectoration (91.7%), dyspnea (61.0%), and wheeze (24.6%) were the most common clinical manifestations of AECOPD, with cough, expectoration, and dyspnea slightly higher in male patients and wheeze slightly higher in female patients. No significant difference occurred in the frequency of hospitalization from AECOPD within the past year between male and female patients.

Anemia and increased white blood cell counts occurred more frequently in male patients, and lower eosinophil ratios and platelet counts were more common in female patients (all P <.05). Male patients had increased levels of creatinine and C-reactive protein and lower levels of albumin in blood compared with female patients.

Inhaled/nebulized bronchodilators, inhaled/nebulized corticosteroids, systemic corticosteroids, and theophylline drugs were prescribed more frequently for male patients vs female patients, and antibiotics were more commonly used in female patients vs male patients.

Regarding respiratory support, 20.1% and 3.3% of participants received noninvasive and invasive mechanical ventilation during hospitalization, respectively. Female patients more frequently received high levels of respiratory support vs male patients (including noninvasive [22.8% vs 19.3%, P <.001] or invasive mechanical ventilation [4.3% vs 3.0%, P =.001]).

Male patients had a lower rate of in-hospital mortality (1.4% vs 1.5%) and ICU admission (6.9% vs 9.1%) and an increased 3-year mortality (35.3% vs 31.4%) compared with female patients. The mean length of stay and total costs during hospitalization were not significantly different in the 2 groups.

In-hospital mortality and the incidence of ICU admission in female patients who smoked were significantly increased compared with male smokers (3.3% vs 1.2%, P =.002; 9.6% vs 6.7%, P =.044, respectively). Female patients who smoked had a higher 3-year mortality than male patients who smoked, although the difference was not statistically significant (40.7% vs 33.1%, P =.146).

Among several limitations, the researchers were unable to assess the Global Initiative for Chronic Obstructive Lung Disease ABCD classifications, and a small proportion of patients completed follow-up.

“In AECOPD inpatients, females and males had similar in-hospital and long-term survival despite some sex differences in clinical characteristics and treatments, but female smokers had significantly worse in-hospital outcomes than male smokers,” the study authors concluded.

This article originally appeared on Pulmonology Advisor