title: The impact of COPD on ICU mortality in patients with ventilator-associated pneumonia.
abstract: OBJECTIVE
  To determine the impact of COPD on intensive care unit (ICU) mortality in patients with VAP.
  
  
  METHODS
  This prospective observational study was performed in a mixed ICU during a 3-year period. Eligible patients received mechanical ventilation for >48 h and met criteria for microbiologically confirmed VAP. Risk factors for ICU mortality were determined using univariate and multivariable analyses.
  
  
  RESULTS
  Two hundred and fifteen patients with microbiologically confirmed VAP were included. Most VAP episodes were late-onset (88%), and Pseudomonas aeruginosa was the most frequently isolated bacterium (39% of VAP episodes). ICU mortality was significantly lower in non-COPD patients (n = 150) compared to COPD patients (n = 65) (43.3% vs 60%, p = 0.027, OR [95% CI] = 1.96 [1.8-3.54]). Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 25 (15-42) and 30 (18-48), whereas in COPD patients were 31 (19-45) and 36 (20-48) (p > 0.05). The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage IV) patients (p = 0.001 and p = 0.02, respectively). Multivariable analysis identified COPD [OR (95% CI) 2.58 (1.337-5)], SAPS II [1.024 (1.006-1.024)] and presence of shock at VAP diagnosis [3.72 (1.88-7.39)] as independent risk factors for ICU mortality.
  
  
  CONCLUSIONS
  COPD, SAPS II, and shock at VAP diagnosis are independently associated with ICU mortality in patients who present VAP.
authors: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France. appollon7@hotmail.com
authors: Demosthenes
authors: D
authors: Makris
authors: Benoit
authors: B
authors: Desrousseaux
authors: Epaminondas
authors: E
authors: Zakynthinos
authors: Alain
authors: A
authors: Durocher
authors: Saad
authors: S
authors: Nseir
mesh_terms: D000704:Analysis of Variance; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors