Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort

Abstract

Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

“…Of the patients surviving the index event, results for post-discharge mortality were available in 30 597 patients from 41 studies [18, 32 , 33 , 36 , 37 , 39 – 44 , 47 – 58 , 60 – 75 ]. Baseline characteristics of the pooled data subset are displayed in supplementary table S5 .…”

“…The exact time till death after hospital discharge was available in 27 out of the 41 studies included in the post-discharge mortality dataset (n=25 909) [ 32 , 33 , 37 , 39 – 42 , 47 , 49 , 50 , 52 , 55 , 56 , 58 , 61 – 65 , 67 , 68 , 70 , 72 – 75 ]. Median survival time after discharge from the index event was 5.1 years (95% CI 4.8–5.3) ( supplementary figure S5 ).…”

Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

“…In the present study, critically ill AECOPD patients with CAP had higher inhospital mortality (20%), than individuals without CAP, who had 10%. However, Takir et al 5 reported that inhospital mortality in COPD patients with pneumonia in the ICU was 12.5%. Many factors may account for these inconsistent results.…”

“… 3 , 4 In recent years, mounting evidence has indicated that community-acquired pneumonia (CAP), which impairs lung defense, is reported to be one of the more common reasons for admission into ICUs and to affect outcomes of COPD patients. 5 A previous study reported inhospital mortality in COPD patients complicated by CAP to be 12.2%. 6 Pneumonia also predicts higher mortality in COPD patients with repeated exacerbation events.…”

Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

“…COPD is the most frequent comorbidity in patients with pneumonia, which induces acute exacerbation of COPD and respiratory failure. In a recent study, pneumonia was the second cause (19.7%) for intensive care unit (ICU) admissions among COPD patients,3 and a long-term (12 months) follow-up showed that the mortality of the COPD patients who were admitted to ICU due to pneumonia was higher than patients admitted for other reasons 3…”