Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

Abstract

AimTo determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD).MethodsA retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years.ResultsOf 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit).ConclusionHigh in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.

The v‐DECAF score can predict 90‐day all‐cause mortality in patients with COPD exacerbation requiring invasive mechanical ventilation

“…Previous reports have estimated the incidence of anemia (hemoglobin <120 g/L) at 18%‐79.9% in COPD patients requiring IMV . Many studies have shown that anemia affects the prognosis of AECOPD patients, especially when the patient requires mechanical ventilation (IMV or NIV) …”

“…14,15 Many studies have shown that anemia affects the prognosis of AECOPD patients, 27 especially when the patient requires mechanical ventilation (IMV or NIV). [13][14][15][16] Causes of anemia in COPD are multifactorial. Anemia may develop in response to chronic disease, inflammation, iron and vitamin deficiencies, comorbidities, or hypogonadism, or anemia may be treatment related.…”

“…Some studies have identified acidaemia as a potential predictor, 8,9 while other studies have not. 10,11 Notably, in the prognostic model of AECOPD combined with ARF, anemia (a comorbidity of severe COPD) was shown to have a greater impact on patient outcomes than acidaemia, 12,13 and published reports indicate that anemia may be associated with increased mortality among COPD patients requiring IMV. [13][14][15][16] We hypothesize that anemia (Hb < 120g/L) is a better predictor of outcomes in AECOPD patients with ARF who require IMV than acidaemia (pH < 7.30).…”

“…10,11 Notably, in the prognostic model of AECOPD combined with ARF, anemia (a comorbidity of severe COPD) was shown to have a greater impact on patient outcomes than acidaemia, 12,13 and published reports indicate that anemia may be associated with increased mortality among COPD patients requiring IMV. [13][14][15][16] We hypothesize that anemia (Hb < 120g/L) is a better predictor of outcomes in AECOPD patients with ARF who require IMV than acidaemia (pH < 7.30). We propose that a ventilator (v)-DECAF score (Dyspnoea, Eosinopenia, Consolidation, Anemia, and atrial Fibrillation) ( Table 1), in which "anemia" replaces "acidaemia," is a more effective predictive tool than the traditional DECAF score in AECOPD patients with ARF who require IMV.…”

Impact of COPD and anemia on motor and cognitive performance in the general older population: results from the English longitudinal study of ageing

“…Next to interdependency, decline of both motor and cognitive function may be further enhanced by certain conditions common in the older population, such as COPD and low HB (hemoglobin) level [5][6][7][8]. When individuals suffer from both low HB level and COPD, existing evidence indicates that outcomes such as the development of respiratory failure and mortality in critically ill hospitalized patients but also in the general population may occur more frequently than in persons who suffer only from one condition [9] [10]. Both factors have previously been shown to independently reduce exercise capability and increase feelings of dyspnea [11], while persons suffering from both conditions reported lower quality of life compared to persons with COPD alone [12].…”