Background: Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden.

Aims: To explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalization using an individual patient data meta-analysis (IPDMA) design.

Methods: A systematic review was conducted in accordance with the PRISMA-IPD guidelines identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalization. Stratified and pooled analyses, and  univariate and multivariate Cox proportional hazards regressions were performed using a harmonized protocol.

Results: Data of 65945 patients with COPD were analyzed. Median follow-up time was 365 days. Mean in-hospital mortality rate was 6.2% (95% CI 6.0-6.4), mean post-discharge mortality rate was 15.2% (95% CI 14.8-15.6), and mean hospital readmission rate was 32.8% (95% CI 32.4-33.3). Non-invasive mechanical ventilation, and a history of ?2 ECOPD-related hospitalizations <12 months were predictors of mortality and hospital readmission.

Conclusions: This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalization across the world. Whilst global standardization of the management and follow-up of ECOPD-related hospitalization should be at the heart of future implementation research, policy makers should focus on reimbursing evidence based therapies that decrease (recurrent) ECOPD.