title: Impact of COPD in the outcome of ICU-acquired pneumonia with and without previous intubation.
abstract: BACKGROUND
  COPD seems related to poor outcome in patients with ventilator-associated pneumonia (VAP). However, many patients in the ICU with COPD do not require intubation but can also develop pneumonia in the ICU. We, therefore, compared the characteristics and outcomes of patients with ICU-acquired pneumonia (ICUAP) with and without underlying COPD.
  
  
  METHODS
  We prospectively assessed the characteristics, microbiology, systemic inflammatory response, and survival of 279 consecutive patients with ICUAP clustered according to underlying COPD or not. The primary end point was 90-day survival.
  
  
  RESULTS
  Seventy-one patients (25%) had COPD. The proportion of VAP was less frequent in patients with COPD: 30 (42%) compared with 126 (61%) in patients without COPD (P = .011). Patients with COPD were older; were more frequently men, smokers, and alcohol abusers; and more frequently had previous use of noninvasive ventilation. The rate of microbiologic diagnosis was similar between groups, with a higher rate of Aspergillus species and a lower rate of Enterobacteriaceae in patients with COPD. We found lower levels of IL-6 and IL-8 in patients with COPD without previous intubation. The 90-day mortality was higher in patients with COPD (40 [57%] vs 74 [37%] in patients without COPD, P = .003). Among others, COPD was independently associated with decreased 90-day survival in the overall population (adjusted hazard ratio, 1.94; 95% CI, 1.11-3.40; P = .020); this association was observed only in patients with VAP but not in those without previous intubation.
  
  
  CONCLUSIONS
  COPD was independently associated with decreased 90-day survival in patients with VAP but not in those without previous intubation.
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rinaudo
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain (CibeRes, CB06/06/0028). Electronic address: miferrer@clinic.ub.es.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy; Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terraneo
authors.affiliation: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy; Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Rosa
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Peralta
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain (CibeRes, CB06/06/0028).
authors.forename: Laia
authors.initials: L
authors.lastname: Fernández-Barat
authors.affiliation: Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain (CibeRes, CB06/06/0028).
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Li Bassi
authors.affiliation: Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain (CibeRes, CB06/06/0028); Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D055732:Pulmonary Aspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents