Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.
OBJECTIVE
The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality.


METHODS
An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses.


RESULTS
Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality.


CONCLUSIONS
Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.
Department of Pulmonary Diseases, School of Medicine, Akdeniz University, Antalya, Turkey. Electronic address: acilli@akdeniz.edu.tr.
Aykut
A
Cilli
Hakan
H
Erdem
Zuhal
Z
Karakurt
Hulya
H
Turkan
Ozlem
O
Yazicioglu-Mocin
Nalan
N
Adiguzel
Gokay
G
Gungor
Ugur
U
Bilge
Canturk
C
Tasci
Gulden
G
Yilmaz
Oral
O
Oncul
Aygul
A
Dogan-Celik
Ozcan
O
Erdemli
Nefise
N
Oztoprak
Anil Aktas
AA
Samur
Yakup
Y
Tomak
Asuman
A
Inan
Burcu
B
Karaboga
Demet
D
Tok
Sibel
S
Temur
Hafize
H
Oksuz
Ozgur
O
Senturk
Unase
U
Buyukkocak
Fatma
F
Yilmaz-Karadag
Dilek
D
Ozcengiz
Ahmet
A
Karakas
Umit
U
Savasci
Aylin
A
Ozgen-Alpaydın
Erol
E
Kilic
Nazif
N
Elaldi
Hayati
H
Bilgic
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications* / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000401:mortality*; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology
D000305:Adrenal Cortex Hormones
COPD; Community-acquired pneumonia; Intensive care unit