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Research Snapshot Theater: Pulmonary/Epidemiology - Outcomes, Adult

Comparing COVID-19 With Influenza in Acute COPD Exacerbation: Nationwide Inpatient Sample Analysis

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 18

  • Dhiraj Regmi, MBBS

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SR

    Sabita Regmi, N/A

    Medical Student, MS3
    Tribhuvan University Teaching Hospital

    Disclosure information not submitted.

  • LW

    Laxman Wagle, MBBS

    Physician
    Ascension Saint Agnes Hospital

    Disclosure information not submitted.

Introduction: After COVID‑19 pandemic in 2019, SARS‑CoV‑2 mutated and transitioned into an endemic role. Influenza is a common virus implicated in chronic obstructive pulmonary disease (COPD) exacerbation. Respiratory viral panels with influenza and COVID‑19 PCR (polymerase chain reaction) are commonly used.
The goal of this study is to compare differences between acute COPD exacerbation due to COVID‑19, influenza, and neither (other COPD) in incidence, intubation, hospital stay, and mortality.


Methods: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) 2022 Nationwide Inpatient Sample (NIS) was performed. COPD exacerbation was identified by ICD‑10 code J44.1. Influenza codes: J09X1, J10.00, J10.001, J11.00, J11.08. J09X2, J19.08, J11.1, J09.X3, J10.1. COVID‑19 codes: U07.1, J12.82, J96.0X, J80, J98.8. Intubation codes: 0BH17EZ, 0BH18EZ. Sample weighting produced national estimates. Multivariable survey‑weighted logistic and linear regression adjusted for age, sex, race, primary payer, Charlson Comorbidity Index, hospital teaching status, location, and bed size compared outcomes.


Results: There were approximately 249,195 cases of COPD exacerbation in 2022. COVID‑19 accounted for 1.53% and influenza for 2.6%. After adjustment, the odds of intubation were significantly lower in Influenza‑COPD (aOR 0.46, 95% CI 0.29–0.74) and other COPD (aOR 0.44, 95% CI 0.32–0.61) compared to COVID‑COPD (p ≤ 0.001). In‑hospital mortality was also significantly lower in Influenza‑COPD (aOR 0.24, 95% CI 0.12–0.47) and other COPD (aOR 0.27, 95% CI 0.19–0.39) compared to COVID‑COPD (p < 0.001). Adjusted mean hospital length of stay was 2.6 days shorter for both Influenza‑COPD and other COPD compared to COVID‑COPD (p < 0.001), and total hospital charges were approximately $24,000 lower (p < 0.001).


Conclusions: In 2022, influenza accounted for more cases of COPD exacerbations than COVID-19. However, COVID‑19–related exacerbations were associated with significantly higher odds of intubation and mortality, as well as longer hospital stays and higher costs than influenza‑related or non‑COVID non-Influenza COPD exacerbations. Influenza‑related and non‑Influenza non-COVID COPD exacerbations were similar across these outcomes.