Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia.
The mortality rate of chronic obstructive pulmonary disease (COPD) patients with community-acquired pneumonia (CAP) is reported to be low. However, studies carried out to date have included <20% of critically ill patients. The current authors performed a secondary analysis of a prospective study evaluating 428 immunocompetent patients admitted to the intensive care unit (ICU) for severe CAP. In total, 176 COPD patients were compared with 252 non-COPD patients. In COPD patients, ICU mortality (odds ratio (OR) 1.58; 95% confidence interval (CI) 1.01-1.43) and mechanical ventilation (OR 2.78; 95% CI 1.63-4.74) rates were higher than in non-COPD patients. The ICU mortality was 39% for COPD patients initially intubated and 50% for those who failed noninvasive ventilation. The proportion of patients who were males, aged >/=70 yrs, smokers and who had chronic heart disease or Pseudomonas aeruginosa were higher in COPD patients. Inappropriate empirical antibiotic therapy was associated with higher mortality (OR 3.8; 95% CI 1.19-12.6). ICU mortality in COPD patients with adequate therapy was associated with bilateral pneumonia (OR 2.32; 95% CI 1.18-4.53) and shock (OR 3.53; 95% CI 1.31-9.71). In conclusion, chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia in the intensive care unit had higher mortality and need of mechanical ventilation when compared with patients without chronic obstructive pulmonary disease.
Rello
J
J
Critical Care Dept, Joan XXIII University Hospital, Carrer Mallafre Guasch 4, E43007 Tarragona, Spain. jordi.rello@urv.net
Rodriguez
A
A
Torres
A
A
Roig
J
J
Sole-Violan
J
J
Garnacho-Montero
J
J
de la Torre
M V
MV
Sirvent
J M
JM
Bodi
M
M
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002423:Cause of Death; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality*; D015897:Comorbidity; D016001:Confidence Intervals; D019348:Empiricism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012121:Respiration, Artificial / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure
D000900:Anti-Bacterial Agents