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

Lü, Zhiwei; Cheng, Yusheng; Tu, Xin; Liang, Chen; Chen, Hu; Jiao, Yang; Wang, Jinyan; Zhang, Liqin

doi:10.2147/copd.s113510

Cited by 15 publications

(7 citation statements)

References 27 publications

(32 reference statements)

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“…10 The patients with pneumonic exacerbation have been found to be admitted to intensive care units more often and stay there longer than those with non-pneumonic exacerbations. 11 The use of corticosteroids has a beneficial effect on severe AECOPD patients and also increases the risk of pneumonia. 11,12 In-hospital mortality in COPD complicated by community-acquired pneumonia has been reported to be 12.2%.…”

Section: Introductionmentioning

confidence: 99%

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Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

et al. 2018

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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. Pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. We performed a prospective cohort study to evaluate the prognosis of AECOPD patients with or without community-acquired pneumonia (CAP) who hospitalized from January 2012 to December 2015. We investigated mortality and readmission rates within 6 months after the first admission between two groups and analyzed the difference of survival rate according to readmission duration (≤30 vs. >30 days) or intensive care unit (ICU) treatment. Total 308 AECOPD patients (134 with CAP and 174 without CAP) were enrolled. The mean age was 72.3 ± 9.5 years old, and 235 patients (76.3%) were male. The 180-day mortality was higher in AECOPD with CAP than without CAP (24.6% vs. 13.2%; hazard ratio (HR): 1.982; 95% CI: 1.164–3.375; p = 0.012). However, readmission rate showed no significant difference between two groups (51.5% vs. 46.6%; HR: 1.172; 95% CI: 0.850–1.616; p = 0.333). It showed a significantly lower survival rate in AECOPD with CAP rather than without CAP when were readmitted within 30 days (HR: 1.738; 95% CI:1.063–3.017; p = 0.031). According to ICU treatment, survival rate was not significantly different between two groups. Multivariate analysis revealed the readmission within 30 days (p < 0.001), serum hemoglobin concentration (p = 0.010), and albumin level (p = 0.049) were significantly associated with 180-day mortality of AECOPD with CAP. AECOPD with CAP showed lower survival rate than AECOPD without CAP during 6 months. Early readmission within 30 days was significantly associated with an increased risk of mortality.

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Section: Introductionmentioning

confidence: 99%

“…11 The use of corticosteroids has a beneficial effect on severe AECOPD patients and also increases the risk of pneumonia. 11,12 In-hospital mortality in COPD complicated by community-acquired pneumonia has been reported to be 12.2%. 13…”

Section: Introductionmentioning

confidence: 99%

Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

et al. 2018

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“…Infectious exacerbations or end-stage disease have been identified as major causes of ICU admittance [12][13][14] . As yet, many studies have attempted to identify independent predictors of the outcomes of these patients in the ICU, however, the results are not consistent across studies, except for Acute Physiology and Chronic Health Evaluation (APACHE)-II score which seems to have a reproducible effect [15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with COPD exacerbation

Galani¹,

Kyriakoudi²,

Filiou³

et al. 2021

Pneumon

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INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in 'Sotiria' Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04-1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04-1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25-2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14-18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients.

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“…Previous research has demonstrated that serum PCT levels are elevated following bacterial infection, and PCT has been proven to be a useful marker for early diagnosis of bacterial infection and for measuring infectious severity 11, 12, 13, 14. CRP is an acute-phase protein that becomes elevated during infections such as pneumonia and sepsis, and it is predominantly produced by liver cells 15, 16. However, from the viewpoint of the authors, limited information is available on the significance of PCT and CRP in the diagnosis of infection in GPP patients.…”

Section: Introductionmentioning

confidence: 99%

Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis

Wang

Xie

Shen

2019

Anais Brasileiros de Dermatologia

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BackgroundThere is an obvious need for more prompt and specific biomarkers of bacterial infections in generalized pustular psoriasis patients.ObjectiveThe aim of this study was to evaluate the diagnostic properties and define appropriate cut-off values of procalcitonin and C-reactive protein in predicting bacterial infection in generalized pustular psoriasis patients.MethodsSixty-four generalized pustular psoriasis patients hospitalized from June 2014 to May 2017 were included in this retrospective study. The values of procalcitonin, C-reactive protein, details of infection, and other clinical parameters were analyzed.ResultsReceiver operating characteristic curve analysis generated similar areas (p = 0.051) under the curve for procalcitonin 0.896 (95% CI 0.782–1.000) and C-reactive protein 0.748 (95% CI 0.613–0.883). A cut-off value of 1.50 ng/mL for procalcitonin and 46.75 mg/dL for C-reactive protein gave the best combination of sensitivity (75.0% for procalcitonin, 91.7% for C-reactive protein) and specificity (100% for procalcitonin, 53.8% for C-reactive protein). Procalcitonin was significantly positively correlated with C-reactive protein levels both in the infected (r = 0.843, p = 0.040) and non-infected group (r = 0.799, p = 0.000).Study limitationsThe sample size and the retrospective design are limitations.ConclusionsThe serum levels of procalcitonin and C-reactive protein performed equally well to differentiate bacterial infection from non-infection in generalized pustular psoriasis patients. The reference value of procalcitonin and C-reactive protein applied to predicting bacterial infection in most clinical cases may not be suitable for generalized pustular psoriasis patients. C-reactive protein had better diagnostic sensitivity than procalcitonin; however, the specificity of procalcitonin was superior to that of C-reactive protein.

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

Cited by 15 publications

References 27 publications

Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with COPD exacerbation

Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis

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