title: Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study.
abstract: BACKGROUND
  Gastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis. However, few studies have investigated whether GORD increases the risk of severe outcomes such as intensive care unit (ICU) admittance or mechanical ventilator use among COPD patients.
  
  
  METHODS
  Propensity score matching by age, sex, comorbidities and COPD severity was used to match the 1,210 COPD patients with GORD sourced in this study to 2,420 COPD patients without GORD. The Kaplan-Meier method was used to explore the incidence of ICU admittance and machine ventilation with the log rank test being used to test for differences. Cox regression analysis was used to explore the risk of ICU admittance and mechanical ventilation use for patients with and without GORD.
  
  
  RESULTS
  During the 12-month follow-up, GORD patients and non-GORD patients had 5.22 and 3.01 ICU admittances per 1000 person-months, and 4.34 and 2.41 mechanical ventilation uses per 1000 person-month, respectively. The log rank test revealed a difference in the incidence of ICU admittance and machine ventilation between the two cohorts. GORD was found to be an independent predicator of ICU admittance (adjusted hazard ratio (HRadj) 1.75, 95% confidence interval (CI) 1.28-2.38) and mechanical ventilation (HRadj 1.92, 95% CI 1.35-2.72).
  
  
  CONCLUSIONS
  This is the first investigation to detect a significantly higher incidence rate and independently increased risk of admission to an ICU and mechanical ventilation use among COPD patients who subsequently developed GORD during the first year following their GORD diagnosis than COPD patients who did not develop GORD.
authors.affiliation: Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, No. 325 sec. 2 Chenggong Road, Taipei, 114, Taiwan. doc10376@gmail.com.
authors.forename: Chen-Liang
authors.initials: CL
authors.lastname: Tsai
authors.affiliation: Graduate Institute of Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 110, Taiwan. grace.yuhuei@gmail.com.
authors.forename: Yu-Huei
authors.initials: YH
authors.lastname: Lin
authors.affiliation: School of Pharmacy, National Defense Medical Center, No. 161, Minguan E. Road, Taipei, 114, Taiwan. wmt2341@gmail.com.
authors.forename: Meng-Ting
authors.initials: MT
authors.lastname: Wang
authors.affiliation: School of Health Care and Administration, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 110, Taiwan. lnchien@tmu.edu.tw.
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Chien
authors.affiliation: Graduate Institute of Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 110, Taiwan. Chii@tmu.edu.tw.
authors.forename: Chii
authors.initials: C
authors.lastname: Jeng
authors.affiliation: Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, No. 325 sec. 2 Chenggong Road, Taipei, 114, Taiwan. sonice3982@gmail.com.
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Chian
authors.affiliation: Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, No. 325 sec. 2 Chenggong Road, Taipei, 114, Taiwan. wperng@ms27.hinet.net.
authors.forename: Wann-Cherng
authors.initials: WC
authors.lastname: Perng
authors.affiliation: Division of Respiratory Therapy, Chest Department, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, 112, Taiwan. chiang1990@gmail.com.
authors.forename: Chi-Huei
authors.initials: CH
authors.lastname: Chiang
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 110, Taiwan. hychiou@tmu.edu.tw.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011159:Population Surveillance / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors