Factors associated with hospital mortality in critically ill patients with exacerbation of COPD

• Main Authors: Brown H, Dodic S, Goh SS, Green C, Wang WC, Kaul S, Tiruvoipati R
• Format: Article
• Language: English
• Published: Dove Medical Press 2018-08-01
• Series: International Journal of COPD
• Subjects: COPD; Intensive Care; Mechanical ventilation; Mortality; Outcome
• Online Access: https://www.dovepress.com/factors-associated-with-hospital-mortality-in-critically-ill-patients--peer-reviewed-article-COPD

Hamish Brown,1,* Stefan Dodic,1,* Sheen Sern Goh,2 Cameron Green,3 Wei C Wang,1 Sameer Kaul,4 Ravindranath Tiruvoipati1,3 1Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia; 2Department of Medicine, Frankston Hospital, Melbourne, VIC, Australia; 3Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia; 4Department of Respiratory Medicine, Frankston Hospital, Melbourne, VIC, Australia *These authors contributed equally to this work Introduction: COPD is a leading cause of morbidity and mortality worldwide. Patients with COPD often require admission to intensive care units (ICU) during an acute exacerbation. Objective: This study aimed to identify the factors independently associated with hospital mortality in patients requiring ICU admission for acute exacerbation of COPD. Methods: Patients admitted to the ICU of Frankston Hospital between January 2005 and June 2016 with an admission diagnosis of COPD were retrospectively identified from ICU databases. Patients’ comorbidities, arterial blood gas results, and in-patient interventions were retrieved from their medical records. Outcomes analyzed included hospital and ICU length of stay (LOS) and mortality. Results: A total of 305 patients were included. Mean age was 67.4 years. A total of 77% of patients required non-invasive ventilation; and 38.7% required invasive mechanical ventilation (IMV) for a median of 127.2 hours (SD =179.5). Mean ICU LOS was 4.5 days (SD =5.96), and hospital LOS was 11.6 days (SD =13). In-hospital mortality was 18.7%. Multivariate analysis revealed that patient age (odds ratio [OR] =1.06; 95% CI: 1.031–1.096), ICU LOS (OR =1.26; 95% CI: 1.017–1.571), Acute Physiology and Chronic Health Evaluation-II score (OR =1.07; 95% CI: 1.012–1.123), and requirement for IMV (OR =4.09; 95% CI: 1.791–9.324) to be significantly associated with in-hospital mortality. Conclusion: Patient age, requirement for IMV, and illness severity were associated with poor patient outcomes. Keywords: COPD, intensive care, mechanical ventilation, mortality, outcome, critically ill