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Risk assessment for hospital admission in patients with COPD; a multi-centre UK prospective observational study.

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Bolton, Charlotte E  ORCID logo
Mohan, Divya 
Macnee, William 


In chronic obstructive pulmonary disease (COPD), acute exacerbation of COPD requiring hospital admission is associated with mortality and healthcare costs. The ERICA study assessed multiple clinical measures in people with COPD, including the short physical performance battery (SPPB), a simple test of physical function with 3 components (gait speed, balance and sit-to-stand). We tested the hypothesis that SPPB score would relate to risk of hospital admissions and length of hospital stay. Data were analysed from 714 of the total 729 participants (434 men and 280 women) with COPD. Data from this prospective observational longitudinal study were obtained from 4 secondary and 1 tertiary centres from England, Scotland, and Wales. The main outcome measures were to estimate the risk of hospitalisation with acute exacerbation of COPD (AECOPD and length of hospital stay derived from hospital episode statistics (HES). In total, 291 of 714 individuals experienced 762 hospitalised AECOPD during five-year follow up. Poorer performance of SPPB was associated with both higher rate (IRR 1.08 per 1 point decrease, 95% CI 1.01 to 1.14) and increased length of stay (IRR 1.18 per 1 point decrease, 95% CI 1.10 to 1.27) for hospitalised AECOPD. For the individual sit-to-stand component of the SPPB, the association was even stronger (IRR 1.14, 95% CI 1.02 to 1.26 for rate and IRR 1.32, 95% CI 1.16 to 1.49 for length of stay for hospitalised AECOPD). The SPPB, and in particular the sit-to-stand component can both evaluate the risk of H-AECOPD and length of hospital stay in COPD. The SPPB can aid in clinical decision making and when prioritising healthcare resources.



Aged, Female, Hospitalization, Humans, Length of Stay, Longitudinal Studies, Male, Middle Aged, Outcome Assessment, Health Care, Patient Admission, Physical Functional Performance, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Risk Assessment, United Kingdom

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PLoS One

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Public Library of Science (PLoS)


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Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
British Heart Foundation (RG/18/13/33946)
Medical Research Council (G0701619)
Medical Research Council (MR/K014811/1)
This was an investigator sponsored study. The study was funded by a grant (9157-61188) from Innovate UK (formerly known as Technology Strategy Board) with contributory funding in kind (e.g. scientific expertise and meeting rooms) from GSK, a consortium partner, who also funded the corresponding author’s PhD. As a consortium partner, GSK was involved in the study design, data analysis, decision to publish, and preparation of the manuscript. The specific roles of all authors are articulated in the ‘author contributions’ section. RTS was a co-investigator on the grant and as a consortium member was involved in the decision to publish, and preparation of the manuscript. IBW, JC and CMM acknowledge funding support from the NIHR Cambridge Comprehensive Biomedical Research Centre. CEB is supported by the NIHR Nottingham BRC respiratory theme. This work was supported by core funding from: the UK Medical Research Council (MR/L003120/1), the British Heart Foundation (RG/13/13/30194; RG/18/13/33946) and the National Institute for Health Research [Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust].