Steroid Duration Predicts Extended Hospital Stays in AECOPD, Suggests Study

Although acute exacerbation of chronic obstructive pulmonary disease (AECOPD) frequently requires inpatient management with variable length of stay (LOS) ranging from 3 to 16 days, prior research has yielded inconsistent predictors of prolonged stays, leaving a critical clinical gap regarding validated determinants in Indian tertiary care settings. Addressing this knowledge gap, Dr. Paritosh Joshi from Dr. Joshi Hospital, Dr. Komal D Kaur from Dr. B. R. Ambedkar State Institute of Medical Sciences, and Dr. Varinder Saini, Dr. Deepak Aggarwal, and Dr. Mandeep K Sodhi from Government Medical College and Hospital evaluated clinical and treatment parameters to identify factors influencing extended hospitalization.

Therefore, the 1.5-year prospective, cross-sectional study evaluated 50 consecutive AECOPD patients at a North Indian tertiary center under standardized GOLD-guided therapy, comparing hospital stays of ≤9 versus >9 days. Excluding cases with primary cardiac failure, pulmonary embolism, or pneumonia, the trial used univariate and multivariable linear regression to identify independent predictors of prolonged hospitalization.

Key Clinical Findings of the Study Includes:

• Steroid Therapy Duration: The investigation demonstrated that systemic corticosteroid therapy was significantly longer in patients with prolonged hospitalization compared to those discharged within nine days (10.11 ± 6.61 days vs. 2.60 ± 3.89 days, p < 0.001), standing as the sole independent predictor on multivariable analysis.
• Ventilatory Support Needs: The research found that non-invasive ventilation (NIV) was required in 32% of admissions, with 93.8% of NIV-treated patients (15 of 16) experiencing extended stays (>9 days) compared to 4.3% in the short-stay group (p = 0.039).
• Arterial Blood Gas Metrics: The trial observed that patients with prolonged stays presented with significantly higher baseline partial pressure of carbon dioxide (pCO2) (55.77 ± 17.80 mm Hg vs. 44.95 ± 11.29 mm Hg, p = 0.009) and lower peripheral oxygen saturation (SpO2) (83.14 ± 7.69% vs. 87.95 ± 2.83%, p = 0.044).
• Nutritional and Age Variance: The analysis revealed that individuals requiring longer hospitalizations had a significantly lower body mass index (BMI) (21.23 ± 5.45 kg/m² vs. 24.36 ± 3.65 kg/m², p = 0.025) and a lower mean age (62.14 ± 9.36 years vs. 65.91 ± 6.31 years, p = 0.048).
• Comorbid and Inflammatory Indicators: The study noted that smoking pack-years (26.44 ± 10.72 vs. 30.91 ± 3.52, p = 0.044), diabetes mellitus prevalence (7.4% vs. 4.3%, p = 0.044), and total leucocyte count (TLC) (p = 0.047) showed univariate associations with stay duration but lost significance in multivariable modeling.

The results suggest that among hospitalized patients with an overall median length of stay of 10 days, 54% experienced prolonged stays exceeding nine days (median 13 vs. 7 days), driven independently by systemic corticosteroid therapy duration (p < 0.001) as a marker of exacerbation severity and delayed recovery.

Early identification of high-risk patients presenting with severe exacerbations can assist clinicians in tailoring management strategies, optimizing hospital resource utilization, and refining discharge planning.

While constrained by a small single-center sample size and individualized corticosteroid tapering schedules that limit direct causal inference, these preliminary observations highlight the value of larger multicenter studies to confirm these findings and evaluate long-term patient outcomes.

Reference

Joshi P, Kaur KD, Saini V, Aggarwal D, Sodhi MK. Predictors of Prolonged Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study. Indian J Chest Dis Allied Sci 2026;68(3):109–113.