Abstract Purpose Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) contribute significantly to hospitalizations and healthcare costs. Coexisting influenza infections may influence clinical outcomes and resource utilization. This study analyzes temporal trends, demographic disparities, and the clinical impact of influenza in patients hospitalized with AECOPD. Methods We conducted a retrospective cohort study using a nationally representative sample from the National Inpatient Sample (2016-2022) to analyze trends in the frequency of concomitant influenza infection and in-hospital mortality over seven years. ICD-10 codes identified study groups. Patient demographics, comorbidities, and hospital characteristics were compared. Multivariable logistic and linear regression analyses assessed independent associations of AECOPD and influenza with in-hospital mortality, length of stay (LOS), and total hospital charges, with significance set at p 0. 05. Results Among 3, 253, 242 AECOPD hospitalizations, 28, 145 (0. 87%) had concomitant influenza. The mean age was similar between groups (67. 88 vs. 68. 04 years; p = 0. 276), but influenza cases had a higher proportion of females (59. 43% vs. 57. 41%; p = 0. 002) and Black patients (16. 24% vs. 15. 07%; p = 0. 005). While in-hospital mortality rates were comparable (0. 84% vs. 1. 05%; p = 0. 112), influenza cases had longer hospital stays (4. 39 vs. 4. 14 days; p 0. 001) and higher hospital costs (9, 512 vs. 9, 243; p = 0. 082). Multivariable analysis confirmed that influenza was not an independent predictor of mortality (OR 0. 88; 95% CI: 0. 66-1. 17; p = 0. 366), but was associated with a longer hospital stay (β = 0. 29 days; p 0. 001) and higher costs (β = 334; p = 0. 033). Temporal trends showed a peak in influenza-associated AECOPD hospitalizations in 2018 (6, 020 cases), a sharp decline in 2021 (650 cases), and a rebound in 2022 (4, 755 cases). In-hospital mortality trends mirrored this pattern, peaking in 2018 (70 deaths), declining sharply in 2021 (0 deaths), and slightly increasing in 2022 (25 deaths). Conclusions In this large retrospective study, AECOPD with concomitant influenza was not an independent predictor of mortality. Temporal variations, including a sharp decline in 2021, were likely influenced by the COVID-19 pandemic. Clinical Implications Although mortality rates are similar, influenza-associated AECOPD results in longer hospital stays and higher costs, highlighting the importance of seasonal vaccination for prevention. This abstract is funded by: NA
Shraddha et al. (Fri,) studied this question.