Relationship of Metabolic Alkalosis, Azotemia and Morbidity in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnia

Uçgun, İrfan; Öztuna, Funda; Dagli, Canan Eren; Yıldırım, Hüseyin; Bal, Cengiz

doi:10.1159/000131707

Cited by 22 publications

(21 citation statements)

References 44 publications

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“…Ucgun et al reported that development of sufficient metabolic compensation and adequate renal function significantly decreases the mortality rate 22. All these results are similar to results obtained by us.…”

Section: Discussionsupporting

confidence: 87%

Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

Altinoz

Adıgüzel

Saltürk

et al. 2016

COPD

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Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m 2 , and the second group consisted of subjects with BMI >30 kg/m 2 . Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m 2 , while 80 subjects had BMI >30 kg/m 2 . The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects ( P =0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.

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Section: Discussionsupporting

confidence: 87%

Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

Altinoz

Adıgüzel

Saltürk

et al. 2016

COPD

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“…In patients with hypercapnic respiratory failure due to COPD exacerbation, the presence of a sufficient metabolic compensation and adequate renal function significantly decreases mortality [17]. In our study, the bicarbonate increase overcame the expected renal compensatory response, reflecting a mixed acid-base disorder with metabolic alkalosis due to various causes in patients with multiple comorbidities and undergoing multidrug treatment.…”

Section: Discussionmentioning

confidence: 50%

Mixed Acid-Base Disorders, Hydroelectrolyte Imbalance and Lactate Production in Hypercapnic Respiratory Failure: The Role of Noninvasive Ventilation

et al. 2012

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BackgroundHypercapnic Chronic Obstructive Pulmonary Disease (COPD) exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV) when treating hypercapnic respiratory failure.MethodsSixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO2 and PaCO2 and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV.ResultsNine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7%) mixed respiratory acidosis–metabolic alkalosis, 10/36 (27.8%) respiratory acidosis and 3/5 (60%) mixed respiratory-metabolic acidosis patients (p = 0.026), with durations of 45.1±9.8, 36.2±8.9 and 53.3±4.1 hours, respectively (p = 0.016). The duration of ventilation was associated with higher blood lactate (p<0.001), lower pH (p = 0.016), lower serum sodium (p = 0.014) and lower chloride (p = 0.038). Hyponatremia without hypervolemic hypochloremia occurred in 11 respiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis–metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder.ConclusionsMixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated.

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“…Interestingly, most of the relevant pathophysiological factors also play an important role as predictors of mortality. Furthermore, it has been shown that sufficient metabolic compensation of respiratory acidosis and adequate renal function significantly decrease mortality [41]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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Background: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are related to high mortality, especially in hospitalized patients. Predictors for severe outcomes are still not sufficiently defined. Objectives: To assess the mortality rate and identify potential determinants of mortality in a cohort of patients hospitalized for AE-COPD. Methods: A retrospective, observational cohort study including all consecutive patients admitted between January 1, 2009, and April 1, 2010, for AE-COPD. Potential predictors were assessed at initial presentation at the emergency room. The primary outcome was mortality during 1-year follow-up. Univariate and multivariate time-to-event analyses using Cox proportional hazard models were employed for statistical analysis. Results: A total of 260 patients were enrolled in this study. Mean age was 70.5 ± 10.8 years, 50.0% were male and 63.4% had severe COPD. The in-hospital mortality rate was 5.8% and the 1-year mortality rate was 27.7%. Independent risk factors for mortality were age [hazard ratio (HR) = 1.04; 95% confidence interval (CI) = 1.01–1.07], male sex (HR = 2.00; 95% CI = 1.15–3.48), prior hospitalization for AE-COPD in the last 2 years (HR = 2.56; 95% CI = 1.52–4.30), prior recorded congestive heart failure (HR = 1.75; 95% CI = 1.03–2.97), Paco₂ ≥6.0 kPa (HR = 2.90; 95% CI = 1.65–5.09) and urea ≥8.0 mmol/l (HR = 2.38; 95% CI = 1.42–3.99) at admission. Conclusions: Age, male sex, prior hospitalization for AE-COPD in the last 2 years, prior recorded congestive heart failure, hypercapnia and elevated levels of urea at hospital admission are independent predictors of mortality within the first year after admission.

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Relationship of Metabolic Alkalosis, Azotemia and Morbidity in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnia

Cited by 22 publications

References 44 publications

Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

Mixed Acid-Base Disorders, Hydroelectrolyte Imbalance and Lactate Production in Hypercapnic Respiratory Failure: The Role of Noninvasive Ventilation

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

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