title: Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients.
abstract: Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with community-acquired pneumonia (CAP). We investigated the impact of COPD on outcomes of CAP patients. We prospectively studied the clinical presentation of 1,379 patients admitted with CAP during a 4-yr period. A comparative analysis of disease severity and course was performed between 212 patients with COPD, as confirmed by spirometry, and 1,167 non-COPD patients. COPD patients (mean forced expiratory volume in 1 s 47.7 ± 16.3% predicted) were older and more likely to have previously received antibiotics (37.1% versus 28.3%; p<0.01) than those without COPD. They presented with more severe respiratory failure (arterial oxygen tension/inspiratory oxygen fraction 270.4 versus 287.8; p<0.01) and more severe pneumonia (pneumonia severity index 118.3 versus 108.5; p<0.001) compared with non-COPD patients. However, COPD patients had less multilobar infiltration (44 (21%) versus 349 (30%); p<0.01) and fewer pulmonary complications (24 (14%) versus 241 (24%); p<0.01). A total of 89 (6.5%) patients died within 30 days. COPD patients had no significant difference in their 30-day mortality rate compared with non-COPD patients (nine (4.2%) patients versus 81 (7%); p = 0.14). Despite worse clinical presentation, COPD patients had a similar mortality rate compared to non-COPD patients. Previous antibiotic treatment and the decreased incidence of pulmonary complications in COPD may account for these findings.
authors.affiliation: Intensive Care Unit, Evaggelismos Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Liapikou
authors.forename: E
authors.initials: E
authors.lastname: Polverino
authors.forename: S
authors.initials: S
authors.lastname: Ewig
authors.forename: C
authors.initials: C
authors.lastname: Cillóniz
authors.forename: M A
authors.initials: MA
authors.lastname: Marcos
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: S
authors.initials: S
authors.lastname: Bello
authors.forename: I
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: R
authors.initials: R
authors.lastname: Menéndez
authors.forename: A
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry
chemical_list: D000900:Anti-Bacterial Agents