Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with copd exacerbation

Abstract

INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in ‘Sotiria’ Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04–1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04–1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25–2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14–18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients.