title: Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units.
abstract: OBJECTIVE
  The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit.
  
  
  METHODS
  A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann-Whitney U-test. Kaplan-Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox's proportional hazards regression model was performed to identify risk factors for multivariate analysis.
  
  
  RESULTS
  A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, P<0.05). Kaplan-Meier survival analysis showed that patients with CAP had a worse survival rate than patients without CAP (P<0.05). Clinical characteristics, including Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein, and CAP, were found to be closely associated with survival of AECOPD individuals. Further multivariate Cox regression analysis confirmed that CAP and APACHE II were independent risk factors for inhospital mortality in critically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50-18.47, P<0.01 and APACHE II: hazard ratio, 1.20; 95% CI, 1.06-1.37, P<0.01).
  
  
  CONCLUSIONS
  CAP may be an independent risk factor for higher inhospital mortality in critically ill AECOPD patients.
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Zhiwei
authors: Z
authors: Lu
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Yusheng
authors: Y
authors: Cheng
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Xiongwen
authors: X
authors: Tu
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Liang
authors: L
authors: Chen
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Hu
authors: H
authors: Chen
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Jian
authors: J
authors: Yang
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Jinyan
authors: J
authors: Wang
authors: Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors: Liqin
authors: L
authors: Zhang
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: AECOPD; community-acquired pneumonia; critically ill; mortality; respiratory intensive care unit; risk factor