Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia

Abstract

The mortality rate of chronic obstructive pulmonary disease (COPD) patients with community-acquired pneumonia (CAP) is reported to be low. However, studies carried out to date have included ,20% of critically ill patients.The current authors performed a secondary analysis of a prospective study evaluating 428 immunocompetent patients admitted to the intensive care unit (ICU) for severe CAP.In total, 176 COPD patients were compared with 252 non-COPD patients. In COPD patients, ICU mortality (odds ratio (OR) 1.58; 95% confidence interval (CI) 1.01-1.43) and mechanical ventilation (OR 2.78; 95% CI 1.63-4.74) rates were higher than in non-COPD patients. The ICU mortality was 39% for COPD patients initially intubated and 50% for those who failed noninvasive ventilation. The proportion of patients who were males, aged o70 yrs, smokers and who had chronic heart disease or Pseudomonas aeruginosa were higher in COPD patients. Inappropriate empirical antibiotic therapy was associated with higher mortality (OR 3.8; 95% CI 1.19-12.6). ICU mortality in COPD patients with adequate therapy was associated with bilateral pneumonia (OR 2.32; 95% CI 1.18-4.53) and shock (OR 3.53; 95% CI 1.31-9.71).In conclusion, chronic obstructive pulmonary disease patients hospitalised with communityacquired pneumonia in the intensive care unit had higher mortality and need of mechanical ventilation when compared with patients without chronic obstructive pulmonary disease.

Validity of pneumonia severity index/pneumonia outcome research trial and Curb-65 severity scoring systems in community acquired pneumonia in Indian setting

“…COPD was present in a total of 8 patients of which only 4 (3%) were in the survivor group and 5 (31.3%) were in the death group. As in our study, a significantly higher mortality associated with COPD and CAP was reported by Restrepo et al and Rello et al 18,20 The study of Falguera M et al demonstrated association between death from CAP and diabetes mellitus and in the same study diabetes was found to be an independent risk factor for development of pleural effusion. 21 However the results from our study differed in both these respects in that diabetes mellitus was found to have association neither with death (p=0.689), nor with development of effusions.…”

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

“…23,24 In patients with severe pneumonia, COPD is associated with an unfavorable clinical course, more complications, ICU admission, mechanical ventilation, and higher mortality than in those without COPD. 17,25 We found that hypoalbuminemia was associated with hypoxemia in patients with mild pneumonia. Hypoalbuminemia is also associated with higher pneumonia severity, higher mortality, higher hospital costs, and longer recovery time.…”

Bacteriological Differences Between COPD Exacerbation and Community-Acquired Pneumonia

“…10 Some studies have carefully examined whether patients with community-acquired pneumonia and COPD present differences in clinical manifestations, etiology, or outcome, with special emphasis on mortality compared to those that do not have COPD. 11,12 To our knowledge, the present study is the first to compare the clinical features, etiological distribution, and treatment outcomes of patients with COPD exacerbation versus patients with community-acquired pneumonia.…”