Corticosteroid Dosing and Glucose Levels in COPD Patients Are Not Associated with Increased Readmissions.

Introduction Hospital admissions and readmissions for chronic obstructive pulmonary disease (COPD) exacerbations are associated with increased mortality and higher cost. The management of exacerbations with a shortened course of systemic corticosteroids has similar efficacy as compared to longer steroid courses, but actual overall steroid dose given is still variable. The outcomes associated with steroid side effects, such as hyperglycemia, need further evaluation. We hypothesize that the use of higher doses of corticosteroids, and the subsequent hyperglycemia, contributes to readmission. Methods This is an retrospective study at a tertiary care referral center in Central Texas between February 2014 and July 2016. Daily corticosteroid dose, blood glucose levels, and readmission rates at 30 and 31-90 days were recorded. Sample characteristics are described using descriptive statistics. A chi-square test or student's t-test were used to test for associations in bivariate comparisons. Multivariable logistic regression assessed the association between readmission rate and demographic and clinical characteristics. Results There were 1,120 patients admitted for COPD exacerbation between February 2014 and July 2016. Fifty seven percent were female, mean age was 69 (SD 12), and average BMI was 29.4 (SD 9.8). Of the total, 349 (31%) had diabetes prior to admission. The 30 days readmission rate was 16%, and the readmission rate from 31-90 days was 14%. The average prednisone equivalent dose per day during hospitalization was 86 mg (SD 52). A multivariable logistic regression model did not show any significant association between readmission and average daily glucose, high maximum glucose (>180 mg/dL on any reading), or prednisone equivalent administered per day. Conclusion Corticosteroid dose and hyperglycemia were not associated with an increased 30 or 31-90 days readmission rate after COPD exacerbation discharge. In addition, using higher doses of corticosteroids instead of standard-of-care (Prednisone 40 mg per day for a 5-day period) did not appear to affect the readmission rate in this cohort.