COPD Exacerbation: Mortality Prognosis Factors in a Respiratory Care Unit

Aburto, Myriam; Esteban, Cristóbal; Moraza, Francisco Javier; Aguirre, Urko; Egurrola, Mikel; Capelastegui, Alberto

doi:10.1016/S1579-2129(11)70018-0

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Abstract

Objective

The aim of our study was to determine the predictive factors for mortality during hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation in a Spanish intermediate respiratory care unit (IRCU).

Patients and methods

Ours is a 2-year prospective observational study including all patients with acute COPD exacerbation and hypercapnic respiratory failure admitted to an IRCU. We analyzed different sociodemographic, functional and clinical variables as well as physical activity.

Results

We collected data from 102 consecutive cases admitted to IRCU (90.1% men). Mean age was 69.4±10.6. Mean APACHE II was 19.6±5.0 and 9.5% presented failure of another non-respiratory organ. Noninvasive mechanical ventilation was applied in 75.3% of the episodes, and this treatment failed in 11.6%. Mean IRCU stay was 3.5±2.1 days, and mean hospitalization was 8.0±5.3 days. Mortality rate during hospitalization was 6.9%, and 12.7% 90 days after discharge. In order to predict hospital mortality, multivariate statistics identified a predictive model with an AUC of 0.867, based on 3 variables: the number of hospitalizations for COPD exacerbation in the previous year (p=0.048), the respiratory rate (RR) 2 hours after admittance to the IRCU (p=0.0484) and the severity of the disease established with ADO score (p=0.0241).

Conclusions

The number of hospitalizations for COPD exacerbation in the previous year, the respiratory rate two hours after being admitted to the IRCU and the severity of the disease established with the multidimensional ADO score allowed us to identify which patients were susceptible to death during hospitalization in IRCU for decompensated COPD.

Keywords:

COPD

Prognostic factors

Exacerbation

Intermediate respiratory care unit (IRCU)

Prognostic factors

Resumen

Objetivo

Determinar los factores predictores de mortalidad hospitalaria durante un ingreso por exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC) en una unidad de cuidados respiratorios intermedios (UCRI).

Metodología

Estudio prospectivo observacional de 2 años de duración en el que se incluyeron todos los ingresos en una UCRI por exacerbación de la EPOC. Se analizaron diferentes variables sociodemográficas, funcionales, clínicas y la actividad física.

Resultados

Durante este periodo evaluamos 102 episodios (90,1% varones), con una edad media de 69,4±10,6. El APACHE II (Acute Physiology and Chronic Health Evaluation Score) fue de 19,6±5,0 y el 9,5% presentaban fallo de otro órgano no respiratorio. El 75,3% recibieron ventilación mecánica no invasiva y esta fracasó en el 11,6% de ellos. La duración de la estancia en la UCRI y en el hospital fue de 3,5±2,1 y 8,0±5,3 días, respectivamente. La mortalidad durante el episodio de hospitalización fue de 6,9% y un 12,7% a los 90 días del alta hospitalaria. El análisis multivariante identificó un modelo predictivo con un estadístico C de 0,867, basado en el número de ingresos por exacerbación durante el año previo (p=0,048), la frecuencia respiratoria (FR) a las 2 horas del ingreso en la UCRI (p=0,048) y la puntuación obtenida en la escala multidimensional ADO (p=0,024).

Conclusiones

El número de ingresos por exacerbación de la EPOC durante el año previo, la FR a las 2 horas del ingreso en la UCRI y la escala multidimensional ADO nos permitirían identificar los pacientes susceptibles de fallecer durante un ingreso por descompensación de la EPOC en la UCRI.

Palabras clave:

EPOC

Factores predictores

Exacerbación

Unidad de cuidados respiratorios

intermedios (UCRI)

Ventilación mecánica no invasiva

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