Conference Coverage

Comorbid COPD Increases Readmission Risk After Acute Chest Syndrome in Adults with Sickle Cell Disease

Edited by:
Anthony Calabro, MA

Key Highlights

  • Comorbid chronic obstructive pulmonary disease (COPD) increased 30-, 60-, and 90-day readmission hazards in adults with sickle cell disease hospitalized for acute chest syndrome.
  • COPD was associated with longer length of stay and higher total hospital charges.
  • In-hospital mortality did not differ between patients with and without COPD.

A national retrospective analysis presented at the 67th ASH Annual Meeting and Exposition in Orlando, FL, found that adults with sickle cell disease (SCD) hospitalized for acute chest syndrome (ACS) faced substantially worse post-discharge outcomes when chronic obstructive pulmonary disease (COPD) was also present. While ACS remains a leading cause of morbidity in SCD, the contribution of COPD to readmission risk and resource utilization has been unclear.

Researchers used the Nationwide Readmissions Database (NRD) from 2018 to 2022 to identify adults hospitalized with a principal diagnosis of ACS and concurrent SCD. COPD served as the primary exposure. The team applied 1:1 propensity score matching using a 0.2 caliper and included demographics, hospital characteristics, and severity markers to balance groups. Standardized mean differences confirmed adequate matching across 5115 patient pairs. Primary outcomes included all-cause readmission at 30, 60, and 90 days. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges. Survey-weighted Cox proportional hazards and generalized linear models were used for outcome assessment.

Study Findings

The analysis identified 19,064 hospitalizations meeting criteria, with 26.8% of patients carrying a COPD diagnosis. In the matched cohort, COPD did not increase in-hospital mortality (adjusted odds ratio [aOR], 0.85; 95% CI, 0.62–1.15; P = .280). However, COPD was associated with significantly greater resource utilization, including longer LOS (adjusted rate ratio [aRR], 1.09; 95% CI, 1.04–1.13; P < .001) and higher hospital charges (aRR, 1.07; 95% CI, 1.00–1.15; P = .050).

COPD was also a significant independent predictor of readmission across all time points. Compared with matched patients without COPD, those with COPD had higher hazards of 30-day (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.04–1.52; P = .018), 60-day (aHR, 1.33; 95% CI, 1.14–1.55; P < .001), and 90-day readmission (aHR, 1.35; 95% CI, 1.19–1.53; P < .001).

Clinical Implications

According to the study authors, these findings show that COPD contributes significantly to the clinical and economic burden experienced by adults with SCD during and after hospitalization for ACS. The authors also noted that COPD may compound the cardiopulmonary stress inherent to ACS, increasing the likelihood of recurrent healthcare utilization. They emphasize the need for targeted inpatient strategies and more robust discharge planning for this high-risk subgroup.

Expert Commentary

“Future strategies should focus on optimizing cardiopulmonary care during the index admission and implementing enhanced post-discharge management, such as multidisciplinary follow-up and care coordination, to mitigate readmission risk and improve long-term outcomes for these vulnerable patients,” the researchers concluded.

Reference
Marrero Castillo M, Amalraj B, Ananthaneni A. Comorbid COPD as a major independent predictor of post-discharge morbidity in adults hospitalized for sickle cell acute chest syndrome: A national propensity-matched analysis. Presented at: 67th ASH Annual Meeting and Exposition in Orlando, FL. December 6, 2025. https://submit.hematology.org/program/presentation/671213.