How do COPD comorbidities affect ICU outcomes?

Abstract

Background and aimChronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality.MethodsA retrospective, observational cohort study was performed in a tertiary teaching hospital’s respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients’ demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups.ResultsDuring the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70±10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m2, pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7–49.0, P<0.001; 6.6, 3.5–412.7, P<0.001; 5.1, 2.9–8.8, P<0.001; 2.9, 1.5–5.6, P<0.001; 2.7, 1.4–5.2, P<0.003; 2.6, 1.5–4.4, P<0.001; 2.2, 1.2–3.9, P<0.008; and 1.1, 1.03–1.11, P<0.001.ConclusionPatients with severe COPD and cardiac comorbidities and cachexia should be closely monitored in ICU due to their high risk of ICU mortality.

Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?

“…Factors indicating a poor prognosis for COPD subjects in the ICU are the need for IMV, presence of pneumonia, cachexia, coronary artery diseases, arrhythmia, hypertension, and higher APACHE II scores. 31 Mortality risk factors in the present study were found to be similar: the need for IMV, the presence of arrhythmia as a comorbidity, the presence of septic shock and a resistant pathogen infection, CRP values ≥50 mg/mL, and an NLR ≥16 on admission to the ICU. A meta-analysis that included 979 COPD subjects from 14 studies found that COPD subjects had an average of 35% intubation for IMV and a mean mortality rate of 45%.…”

“…A previously published study investigating the outcomes of ARF subjects with COPD requiring ICU admission from 2008 to 2012 (n=1,013) showed a 16.9% mortality rate. 31 Mortality in 698 subjects with COPD exacerbations of infectious origin was 21.6%; however, COPD subjects with pneumonia (n=241) had a higher rate of mortality (39%). Factors indicating a poor prognosis for COPD subjects in the ICU are the need for IMV, presence of pneumonia, cachexia, coronary artery diseases, arrhythmia, hypertension, and higher APACHE II scores.…”

Modafinil: a novel alternative to non-invasive ventilation in&nbsp;hypercapnic respiratory failure?

“…Third, other co morbidity as chronic renal failure or neurologic conditions influence by hypercapnic could difficult interaction of modafinil as coincident psychiatric drugs like antidepressive or anxiolytic, that in some cases are associated in chronic respiratory insufficiency. 4 – 6 Additionally, coexistence of COPD and sleep breathing disorders determinate more complexity in this prescription. 7 , 8 …”

Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit

“…This finding is in accordance with those reported by Teixeira et al They observed that patients with history of COPD had a high mortality rate in ICU (27%) and two years after hospital discharge (68%) 24 . Ongel et al recommend that cases with severe COPD and cardiac comorbidities might be carefully monitored in intensive care settings because of the elevated risk of mortality 25 .…”