Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit

Abstract

Background Studies report high in-hospital mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) especially for those requiring admission to an intensive care unit. Recognizing factors associated with mortality in these patients could reduce health care costs and improve end-of-life care. Methods This retrospective study included AECOPD patients admitted to the respiratory intensive care unit of a tertiary hospital in Beijing from Jan 1, 2011 to Dec 31, 2018. Patients demographic characteristics, blood test results and comorbidities were extracted from the electronic medical record system and compared between survivors and non-survivors. Results We finally enrolled 384 AECOPD patients: 44 (11.5%) patients died in hospital and 340 (88.5%) were discharged. The most common comorbidity was respiratory failure (294 (76.6%)), followed by hypertension (214 (55.7%)), coronary heart disease (115 (29.9%)) and chronic heart failure (76 (19.8%)). Multiple logistic regression analysis revealed that independent risk factors associated with in-hospital mortality included lymphocytopenia, leukopenia, chronic heart failure and requirement for invasive mechanical ventilation. Conclusions The in-hospital mortality of patients with acute COPD exacerbation requiring RICU admission is high. Lymphocytes < 0.8 × 109/L, leukopenia, requirement for invasive mechanical ventilation, and chronic heart failure were identified as risk factors associated with increased mortality rates.

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

“…Factors associated with hospitalization [12][13][14][15] and long-term mortality in COPD [16,17] have been widely investigated. In our cohort, the hospital, 1-year, and overall mortalities at a median 3-year of follow-up were 13.1%, 33.8%, and 51.4%, respectively.…”

“…Accordingly, the most common cause of hospitalization of COPD is AECOPD, which is a devastating event known as the "stroke of the lungs" that requires treatment with systemic glucocorticoids and antibiotics [9][10][11]. In addition, cardiovascular diseases (CVD) are highly prevalent in COPD patients and are a clinically relevant cause of morbidity and mortality [12].…”

“…Factors associated with short-term mortality in hospitalized patients with COPD include old age, progression to respiratory failure requiring mechanical ventilation, illness severity, and comorbidities [12][13][14][15]. For long-term mortality prediction, factors including age, dyspnea, airflow obstruction, and multiple comorbidities were identified by previous studies [16][17][18][19].…”

Characteristics and predictors of mortality in patients with severely exacerbated COPD with acute respiratory failure

“…Acute exacerbation of COPD is often life-threatening. In previous studies of this condition, in-hospital mortality was high, ranging from 11.5-24% [4][5][6][7]. Some of its predictors of mortality were reported, including age, body mass index (BMI), atrial brillation, congestive heart failure, alveolar-arterial oxygen gradient, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), and serum albumin [4,8].…”

Characteristics and predictors of mortality in patients with severely exacerbated COPD with acute respiratory failure

“…7. One hundred and seventyve patients (46%) received bilevel positive airway pressure as a NIPPV, and 262 patients (68%) were admitted to the ICU.…”