How do COPD comorbidities affect ICU outcomes?
OBJECTIVE
Chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality.


METHODS
A retrospective, observational cohort study was performed in a tertiary teaching hospital's respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients' demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups.


RESULTS
During the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70 ± 10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m(2), pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7-49.0, P<0.001; 6.6, 3.5-412.7, P<0.001; 5.1, 2.9-8.8, P<0.001; 2.9, 1.5-5.6, P<0.001; 2.7, 1.4-5.2, P<0.003; 2.6, 1.5-4.4, P<0.001; 2.2, 1.2-3.9, P<0.008; and 1.1, 1.03-1.11, P<0.001.


CONCLUSIONS
Patients with severe COPD and cardiac comorbidities and cachexia should be closely monitored in ICU due to their high risk of ICU mortality.
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Esra Akkutuk
EA
Ongel
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Zuhal
Z
Karakurt
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Cuneyt
C
Salturk
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Huriye Berk
HB
Takir
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Bunyamin
B
Burunsuzoglu
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Feyza
F
Kargin
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Gulbanu H
GH
Ekinci
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Ozlem
O
Mocin
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Gokay
G
Gungor
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Nalan
N
Adiguzel
Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
Adnan
A
Yilmaz
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002100:Cachexia / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
chronic obstructive pulmonary disease; comorbidity; intensive care unit