İsmail AĞI, İremgül GÜNGÖR
Intercontinental Journal of Internal Medicine - 2026;4(2):34-41
Aims: This study aimed to identify the clinical and laboratory determinants of recurrent hospitalisations within one year among patients admitted to hospital via the emergency department due to acute exacerbation of chronic obstructive pulmonary disease (COPD). Particular emphasis was placed on evaluating the potential contribution of inflammatory indices derived from routine laboratory tests in predicting the risk of recurrent admissions. Methods: This retrospective observational study included a total of 117 patients who were hospitalised with a diagnosis of acute exacerbation of COPD during the predefined study period. Patients were categorised into two groups according to the occurrence of recurrent hospitalisation during the one-year follow-up period. Sociodemographic characteristics, clinical variables, requirement for intensive care, use of long-term oxygen therapy (LTOT) at home, and routine laboratory parameters were recorded. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Systemic Immune-inflammation Index (SII), and the CALLY (CRP-albumin-lymphocyte) index were calculated. Between-group comparisons were performed using appropriate parametric and non-parametric statistical tests. Results: Of the 117 patients included in the study, 50 (42.7%) experienced recurrent hospitalisations during the follow-up period, whereas 67 patients (57.3%) had no recurrent admissions. The proportion of male patients was significantly higher in the recurrent hospitalisation group compared with the non-recurrent group (78.0% vs. 41.8%; p<0.001). No significant difference was observed between the groups in terms of age (71.78+/-9.08 vs. 72.37+/-9.92 years; p=0.738). The need for intensive care during the index admission was more frequent in patients who subsequently developed recurrent hospitalisation (38.0% vs. 20.9%; p=0.042). However, no statistically significant differences were identified between the groups regarding the presence of pneumonia or length of hospital stay. The use of LTOT was significantly more common among patients with recurrent admissions. Among laboratory parameters, lower arterial pH (p=0.025) and higher partial pressure of carbon dioxide (PCO?) levels (p=0.011) were significantly associated with recurrent hospitalisation. While no significant differences were observed between the groups in terms of NLR and PLR, the CAR (p=0.027), SII (p=0.038), and CALLY (p=0.008) indices were found to be significantly associated with recurrent admission. Conclusion: Recurrent hospitalisations following acute exacerbation of COPD appear to be more closely associated with disease severity, chronic physiological burden, and a multidimensional inflammatory response rather than with age or simple haematological ratios alone. Composite inflammatory indices, particularly CAR, SII, and CALLY, may contribute to the early identification of patients at high risk of readmission. Such an approach could facilitate closer post-discharge surveillance and the implementation of targeted care strategies in this vulnerable population.
