Impact of non-exacerbated COPD on mortality in critically ill patients.
Chest. 2011 Mar 10;
Authors: Rodríguez A, Lisboa T, Solé-Violán J, Gomez F, Roca O, Trefler S, Gea J, Masclans JR, Rello J
Abstract BACKGROUND: The real contribution of non-exacerbated chronic obstructive pulmonary disease (COPD) on mortality has not been studied. The aim of our study was to evaluate the impact of non-exacerbated COPD on mortality in patients requiring mechanical ventilation. METHODS: Prospective, observational study that included critically ill ventilated patients without evidence of respiratory infection. COPD patients were the study group. Clinical and demographics variables were recorded. The main end-point was ICU mortality. RESULTS: Of the 235 patients included, 60 (25.5%) intubated patients had COPD (Study group). The remaining 175 (74.5%) patients were considered as the control group. COPD patients were more often medical, older and had higher number of comorbidities and APACHE II score than intubated without COPD (p<0.05). The overall ICU mortality was 26.3% (62/235) and significantly higher in non-exacerbated COPD patients (36.7% vs. 22.9%, p<0.05), with an attributable mortality to COPD of 13.8%. Ventilator-associated pneumonia (VAP) incidence was not significantly different between non-exacerbated COPD (11.9/1000 MV days) and non-COPD patients (16.0 /1000 MV days; p=0.40). In the multivariate analysis, only COPD (HR=2.1 95%CI 1.10-3.94) and shock at ICU admission (HR= 2.0 95%CI 1.01-4.01) and medical condition (HR=1.7 95%IC 1.01-3.18) were variables independently associated with mortality. CONCLUSION: Intubated non-exacerbated COPD patients were not exposed to higher risk of VAP but had higher mortality.
PMID: 21393392 [PubMed - as supplied by publisher]