Predictors of 1-Year Mortality at Hospital Admission for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Slenter, R.H.J.; Sprooten, Roy T.M.; Kotz, Daniel; Wesseling, Geertjan; Wouters, Emiel F.M.; Rohde, Gernot

doi:10.1159/000342036

Cited by 75 publications

(78 citation statements)

References 83 publications

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“…Additionally, according to a univariate analysis, we detected two statistically significant predictors of the need to initiate NIV: PaCO2 and FEV1% predicted. It is reasonable that both the PaCO2 and FEV1% predicted, which are established prognostic factors in patients with COPD, are also predictors of the need to initiate NIV during exacerbation, given that the need for NIV support implies the development of severe respiratory failure associated with a poor prognosis (1,(24)(25)(26)(27)(28)(29). However, it is noteworthy that, in the multivariate logistic regression analysis, the severity of airway obstruction assessed according to the FEV1% predicted was no longer identified as a predictor.…”

Section: Discussionmentioning

confidence: 98%

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Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

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Section: Discussionmentioning

confidence: 98%

“…Consequently, the PaCO2 is regarded to be a poor prognostic indicator in general and has been demonstrated to be associated with the development of COPD-AE (1,7,(24)(25)(26)(27)(28)(29)(30). However, the majority of studies have focused on severely hypoxemic patients requiring NIV or patients who had previously experienced COPD-AE.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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“…Hypercapnia has long been recognized as a marker of poor prognosis in patients with COPD, among whom pulmonary infections are a major cause of morbidity and mortality (2)(3)(4)(5)(6). Hypercapnia is also an independent risk factor for mortality in hospitalized patients with community-acquired pneumonia and in patients with cystic fibrosis awaiting lung transplantation (7)(8)(9)(10).…”

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confidence: 99%

Hypercapnia Impairs Lung Neutrophil Function and Increases Mortality in Murine Pseudomonas Pneumonia

Gates

Howell²,

Nair

et al. 2013

Am J Respir Cell Mol Biol

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Hypercapnia, an elevation of the level of carbon dioxide (CO 2 ) in blood and tissues, is a marker of poor prognosis in chronic obstructive pulmonary disease and other pulmonary disorders. We previously reported that hypercapnia inhibits the expression of TNF and IL-6 and phagocytosis in macrophages in vitro. In the present study, we determined the effects of normoxic hypercapnia (10% CO 2 , 21% O 2 , and 69% N 2 ) on outcomes of Pseudomonas aeruginosa pneumonia in BALB/c mice and on pulmonary neutrophil function. We found that the mortality of P. aeruginosa pneumonia was increased in 10% CO 2 -exposed compared with air-exposed mice. Hypercapnia increased pneumonia mortality similarly in mice with acute and chronic respiratory acidosis, indicating an effect unrelated to the degree of acidosis. Exposure to 10% CO 2 increased the burden of P. aeruginosa in the lungs, spleen, and liver, but did not alter lung injury attributable to pneumonia. Hypercapnia did not reduce pulmonary neutrophil recruitment during infection, but alveolar neutrophils from 10% CO 2 -exposed mice phagocytosed fewer bacteria and produced less H 2 O 2 than neutrophils from air-exposed mice. Secretion of IL-6 and TNF in the lungs of 10% CO 2 -exposed mice was decreased 7 hours, but not 15 hours, after the onset of pneumonia, indicating that hypercapnia inhibited the early cytokine response to infection. The increase in pneumonia mortality caused by elevated CO 2 was reversible when hypercapnic mice were returned to breathing air before or immediately after infection. These results suggest that hypercapnia may increase the susceptibility to and/or worsen the outcome of lung infections in patients with severe lung disease.Keywords: carbon dioxide; pulmonary infection; reactive oxygen species; phagocytosis; inflammation Hypercapnia occurs in patients with severe acute and chronic lung diseases such as chronic obstructive pulmonary disease (COPD), currently the third leading cause of death in the United States (1). Individuals with COPD and other chronic respiratory disorders are also at risk for the development of acute respiratory failure, which may be accompanied by acute or acute-on-chronic hypercapnia. In addition, patients with acute respiratory distress syndrome (ARDS) and status asthmaticus may develop hypercapnia.Hypercapnia has long been recognized as a marker of poor prognosis in patients with COPD, among whom pulmonary infections are a major cause of morbidity and mortality (2-6). Hypercapnia is also an independent risk factor for mortality in hospitalized patients with community-acquired pneumonia and in patients with cystic fibrosis awaiting lung transplantation (7-10). Moreover, hypercapnic patients with acute respiratory failure can develop ventilatorassociated pneumonia, which prolongs intensive care unit and hospital stays, and carries a mortality rate of 33-50% (11). On the other hand, in some studies, hypercapnia accompanying low tidal volume mechanical ventilation ("permissive hypercapnia") has been associated with reduced mor...

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“…In this issue of Respiration , Slenter et al [1] report on the prognosis of patients following hospital admission for an exacerbation of chronic obstructive pulmonary disease (COPD). In this setting of a Dutch University Medical Center, well known for its excellent COPD research, 1 in 4 patients had died within 1 year of discharge after an exacerbation of COPD and half of those surviving had been rehospitalised at least once.…”

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confidence: 99%

“…The paper by Slenter et al [1] focuses on predictors of mortality. A number of easily assessable factors are identified and discussed.…”

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confidence: 99%

Hospitalised for Chronic Obstructive Pulmonary Disease: On a Dangerous Route

Vestbo

2012

Respiration

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Predictors of 1-Year Mortality at Hospital Admission for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Cited by 75 publications

References 83 publications

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Hypercapnia Impairs Lung Neutrophil Function and Increases Mortality in Murine Pseudomonas Pneumonia

Hospitalised for Chronic Obstructive Pulmonary Disease: On a Dangerous Route

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