Age, Illness Severity Linked to Poor COPD Outcomes After ICU Admission

Researchers investigating the factors associated with hospital mortality in patients requiring intensive care unit admission for acute exacerbations of chronic obstructive pulmonary disease found that patient age, requirement for invasive mechanical ventilation, and illness severity were associated with poor patient outcomes.

When a patient with chronic obstructive pulmonary disease (COPD) experiences an acute exacerbation they often require admission to intensive care units (ICU). Researchers who investigated the factors associated with hospital mortality in patients requiring ICU admission for COPD acute exacerbations found that patient age, requirement for invasive mechanical ventilation (IMV), and illness severity were associated with poor patient outcomes.

The study included patients who were admitted to the ICU at Frankston Hospital in Australia between January 2005 and June 2015 with an admission diagnosis of COPD. Medical records and patient information, including patients’ comorbidities, arterial blood gas results, and in-patient interventions were considered during the analysis.

“In addition to this significant rate of mortality, COPD has a high level of morbidity and patients often require admission to the intensive care unit (ICU) during acute exacerbations,” the authors stated. “Patients admitted to ICU with COPD often have multiple comorbidities and present with acute respiratory failure as a result of an infective exacerbation or at the end stage of their disease.”

During the 10-year study period, a total of 305 patients were admitted to Frankston Hospital’s ICU with a primary diagnosis of COPD. The mean age of patients was 67.41 years old and the majority of patients were female (58.7%). Of the total patients, 77% required non-invasive ventilation while 38.7% required invasive mechanical ventilation for a median of 127.2 hours. Additionally, the mean ICU length of stay (LOS) was 4.5 days, while hospital LOS was 11.6 days.

The researchers found that the overall in-hospital mortality was 18.7%. Furthermore, the patient age, Acute Physiology and Chronic Health Evaluation-II score, and the requirement for IMV, was found to be significantly associated with in-hospital mortality. Overall, mortality was found to be significantly associated with the biochemical marker of high blood urea concentration. Patients who did not survive hospital admission had significantly increased white cell counts at ICU admission, according to the results.

“Mortality from COPD remains high, and exacerbations of COPD are a significant cause of hospitalization and ICU admission,” the study explained. “In the present study, patient age, APACHE-II score, ICU LOS, and IMV requirement were independent factors associated with in-hospital mortality for patients admitted to ICU for acute exacerbations of COPD.”

The study noted the need for future research in order to elucidate the relationship between baseline spirometry values and patient outcomes in the long and short-term, in addition to long-term follow-ups of outcomes and quality of life post-ICU discharge.

Reference

Brown H, Dodic S, Goh SS, et al. Factors associated with hospital mortality in critically ill patients with exacerbation of COPD. [published online August 2, 2018]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S168983