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

Article information

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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References

[1.]

A.F. Connors, N.V. Dawson, C. Thomas, F.E. Harrell, N. Desbiens, W.J. Fulkerson, et al.

Outcomes following acute exacerbation of severe chronic obstructive lung disease.

Am J Resp Crit Care Med, 154 (1996), pp. 959-967

http://dx.doi.org/10.1164/ajrccm.154.4.8887592 | Medline

[2.]

J.J. Soler-Cataluña, M.A. Martínez-García, P. Román, E. Salcedo, M. Navarro, R. Ochando.

Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.

Thorax, 60 (2005), pp. 925-931

http://dx.doi.org/10.1136/thx.2005.040527 | Medline

[3.]

A.M. Almagro, E. Calbo, A. Ochoa de Echagüen, B. Barreiro, S. Quintana, J.L. Heredia, et al.

Mortality after hospitalization for COPD.

Chest, 121 (2002), pp. 1441-1448

Medline

[4.]

B. Afessa, I.J. Morales, P.D. Scanlon, S.G. Peters.

Prognostic factors, clinical course and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure.

Crit Care Med, 30 (2002), pp. 1610-1615

Medline

[5.]

M.G. Seneff, D.P. Wagner, R.P. Wagner, J.E. Zimmerman, W.A. Knaus.

Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.

JAMA, 274 (1995), pp. 1852-1857

Medline

[6.]

C. Ai-Ping, K.H. Lee, T.K. Lim.

In hospital and 5 year mortality of patients treated in the ICU for acute exacerbation of COPD. A retrospective study.

Chest, 128 (2005), pp. 518-524

http://dx.doi.org/10.1378/chest.128.2.518 | Medline

[7.]

D. Breen, T. Churches, F. Hawker, P.J. Torzillo.

Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study.

Thorax, 57 (2002), pp. 29-33

Medline

[8.]

M.J. Wildman, C.F. Sanderson, J. Groves, B.C. Reeves, J.G. Ayres, D. Harrison, et al.

Survival and quality of life for patients with COPD or asthma admitted to intensive care in UK multicentre cohort: the COPD and asthma outcomes study (CADS).

Thorax, 64 (2009), pp. 128-132

http://dx.doi.org/10.1136/thx.2007.091249 | Medline

[9.]

J.M. Añon, A. García de Lorenzo, A. Zarazaga, V. Gómez-Tello, G. Garrido.

Mechanical ventilation of patients on long term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost utility analysis.

Intensive Care Med, 25 (1999), pp. 452-457

Medline

[10.]

A. Esteban, N.D. Ferguson, M.O. Meade, F. Frutos-Vivar, C. Apezteguia, L. Brochard, VENTILA Group, et al.

Evolution of mechanical ventilation in response to clinical research.

Am J Respir Crit Care Med, 177 (2008), pp. 170-177

http://dx.doi.org/10.1164/rccm.200706-893OC | Medline

[11.]

P.K. Plant, J.L. Owen, M.W. Elliot.

Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.

Lancet, 355 (2000), pp. 1931-1935

Medline

[12.]

F.S. Ram, J. Picot, J. Lightower, J.A. Wedzicha.

Non invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease.

Cochrane Database Syst Rev, (2004),

[13.]

M. Gorini, R. Ginanni, G. Villella, D. Tozzi, A. Augustynen, A. Corrado.

Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure.

Intensive Care Med, 30 (2004), pp. 875-881

http://dx.doi.org/10.1007/s00134-003-2145-9 | Medline

[14.]

R. Agarwal, R. Gupta, A.N. Agarwal, D. Gupta.

Non invasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: effectiveness and predictors of failure in a respiratory ICU in North India.

Int J Chron Obstruct Pulmon Dis, 3 (2008), pp. 737-743

Medline

[15.]

A. Torres, M. Ferrer, J.B. Blanquer, M. Calle, V. Casolive, J.M. Echave, et al.

Unidades de cuidados respiratorios intermedios. Definición y características.

Arch Bronconeumol, 41 (2005), pp. 505-512

Medline

[16.]

From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Adapted 2009. Available from: www.goldcopd.org.

[17.]

Medical Research Council's Committee on environmental, occupational setting.

Questionnaire on respiratory symptoms.

MRC, (1986),

[18.]

M.E. Charlson, P. Pompei, K.L. Ales, C.R. MacKenzie.

A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.

J Chron Dis, 40 (1987), pp. 373-383

Medline

[19.]

W.A. Knaus, D.P. Drapper, J.E. Zimmerman.

APACHE II: A severity of disease classification system.

Crit Care Med, 13 (1985), pp. 818-829

Medline

[20.]

J.L. Vincent, A. De Mendonça, F. Cantraine, R. Moreno, J. Takala, P.M. Suter, et al.

Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsisrelated problems” of the European Society of Intensive Care Medicine.

Crit Care Med, 26 (1998), pp. 1793-1800

Article | Medline

[21.]

M.A. Puhan, J. García-Aymerich, M. Frey, G. ter Riet, J.M. Antó, A.G. Agustí, et al.

Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index.

Lancet, 374 (2009), pp. 704-711

http://dx.doi.org/10.1016/S0140-6736(09)61301-5 | Medline

[22.]

M. Confalonieri, G. Garuti, M.S. Cattaruzza, J.F. Osborn, M. Antonelli, G. Conti, Italian non invasive positive pressure ventilation study group, et al.

A chart of failure risk for non-invasive ventilation in patient with COPD exacerbation.

Eur Resp J, 25 (2005), pp. 348-355

[23.]

G. Bertolini, M. Confalonieri, C. Rossi, G. Rossi, B. Simini, M. Gorini, et al.

Cost of COPD. Differences between intensive care unit and respiratory intermediate care unit.

Resp Med, 99 (2005), pp. 894-900

[24.]

B. Chakrabarti, R.M. Angus, S. Agarwal, S. Lane, P.M.A. Calverley.

Hyperglycaemia as predictor of outcome during non invasive ventilation in descompensated COPD.

Thorax, 64 (2009), pp. 857-862

http://dx.doi.org/10.1136/thx.2008.106989 | Medline

[25.]

R. Scala, S. Bartolucci, M. Naldi, M. Rossi, M. Elliot.

Co-morbidity and acute descompensations of COPD requiring non-invasive positive-pressure ventilation.

Intensive Care Med, 30 (2004), pp. 1747-1754

http://dx.doi.org/10.1007/s00134-004-2368-4 | Medline

[26.]

C.M. Chu, V.L. Chan, A.W. Lin, I.W. Wong, W.S. Leung, C.K. Lai.

Readmission rates and life threating events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure.

Thorax, 59 (2004), pp. 1020-1025

http://dx.doi.org/10.1136/thx.2004.024307 | Medline

[27.]

D. Goodrigge, J. Lawson, W. Duggleby, D. Marciniuk, D. Rennie, M. Stang.

Health utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life.

Resp Med, 102 (2008), pp. 885-891

Article

[28.]

J.R. Hurst, W.R. Perera, T.M. Wilkinson, G.C. Donaldson, J.A. Wedzicha.

Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease.

Am J Resp Crit Care Med, 173 (2006), pp. 71-78

http://dx.doi.org/10.1164/rccm.200505-704OC | Medline

[29.]

J. Phua, K. Kong, K.H. Lee, L. Shen, T.K. Lim.

Non invasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs other conditions: effectiveness and predictors of failure.

Intensive Care Med, 31 (2005), pp. 533-539

http://dx.doi.org/10.1007/s00134-005-2582-8 | Medline

[30.]

A. Antón, R. Güell, J. Gómez, J. Serrano, A. Castellano, J.L. Carrasco, et al.

Predicting the results of non invasive ventilation in severe acute exacerbations of patients with chronic airflow limitation.

Chest, 117 (2000), pp. 828-833

Medline

[31.]

I. Ucgun, M. Metintas, H. Moral, F. Alatas, H. Yildirim, S. Erginel.

Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.

Resp Med, 100 (2006), pp. 66-74

[32.]

O. Fruchter, M. Yigla.

Predictors of long term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.

Respirology, 13 (2008), pp. 851-855

http://dx.doi.org/10.1111/j.1440-1843.2008.01367.x | Medline

[33.]

H. Gunen, S.S. Hacievliyagil, F. Kosar, L.C. Mutlu, G. Gulbas, E. Pehlivan, et al.

Factors affecting survival of hospitalised patients with COPD.

Eur Resp J, 26 (2005), pp. 234-241

[34.]

B.R. Celli, C.G. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Mendez, et al.

The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.

N Engl J Med, 350 (2004), pp. 1005-1012

http://dx.doi.org/10.1056/NEJMoa021322 | Medline

[35.]

C. Esteban, J.M. Quintana, M. Aburto, J. Moraza, A. Capelastegui.

A simple score for assessing stable chronic obstructive pulmonary disease.

QJM, 99 (2006), pp. 751-759

http://dx.doi.org/10.1093/qjmed/hcl110 | Medline

[36.]

A. Briggs, M. Spencer, H. Wang, D. Mannino, D. Sin.

Development and validation of a prognostic index for health outcomes in chronic obstructive pulmonary disease.

Arch Intern Med, 168 (2008), pp. 71-79

http://dx.doi.org/10.1001/archinternmed.2007.37 | Medline

[37.]

C. Cotte, L. Dordelly, B. Celli.

Impact of COPD exacerbations on patient-centered outcomes.

Chest, 131 (2007), pp. 696-704

http://dx.doi.org/10.1378/chest.06-1610 | Medline

[38.]

K.C. Ong, A. Earnest, S.J. Lu.

A multidimensional grading system (BODE index) as predictor of hospitalization for COPD.

Chest, 128 (2005), pp. 3810-3816

http://dx.doi.org/10.1378/chest.128.6.3810 | Medline

[39.]

M. Antonelli, G. Conti, M.L. Moro, A. Esquinas, G. Gonzalez-Diaz, M. Confalioneri, et al.

Predictors of failure of nonninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study.

Intensive Care Med, 27 (2001), pp. 1718-1728

http://dx.doi.org/10.1007/s00134-001-1114-4 | Medline

[40.]

G.U. Meduri, R.E. Turner, N. Abou-Shala, R. Wunderink, E. Tolley.

Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure.

Chest, 109 (1996), pp. 179-193

Medline

[41.]

M. Moretti, C. Cilione, A. Tampieri, C. Fracchia, A. Marchioni, S. Nava.

Incidence and causes of non invasive mechanical ventilation failure alter initial sucess.

Thorax, 55 (2000), pp. 819-825

Medline

[42.]

F.A. McAlister, S.R. Majumdar, S. Blitz, B.H. Rowe, J. Romney, T.J. Marrie.

The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia.

Diabetes Care, 28 (2005), pp. 810-815

Medline

[43.]

E.H. Baker, C.H. Janaway, B.J. Philips, A.L. Brennan, D.L. Baines, D.M. Word, et al.

Hyperglycaemia is associated with poor outcomes in patient admitted to a hospital with acute exacerbations of chronic obstructive pulmonary disease.

Thorax, 61 (2006), pp. 284-289

http://dx.doi.org/10.1136/thx.2005.051029 | Medline

[44.]

N.J. Cano, C. Pichard, H. Roth, I. Court-Fortune, L. Cynober, M. Gerard-Boncompain, et al.

C-reactive protein and body mass index predict outcome in end-stage respiratory failure.

Chest, 126 (2004), pp. 540-546

http://dx.doi.org/10.1378/chest.126.2.540 | Medline

[45.]

C. Cote, M.D. Zilberberg, S.H. Mody, L.J. Dordelly, B. Celli.

Haemoglobin level and its clinical impact in a cohort of patients with COPD.

Eur Resp J, 29 (2007), pp. 923-929

[46.]

S. Puttinati, L. Ballerin, M. Piatella, G.L. Panella, A. Potena.

Is it posible to predict the success of non invasive positive pressure ventilation in acute respiratory failure due to COPD?.

Resp Med, 94 (2000), pp. 997-1001

[47.]

E. Balcells, J.M. Antó, J. Gea, F.P. Gómez, E. Rodríguez, A. Marín, PAC-COPD Study Group, et al.

Characteristics of patients admitted for the first time for COPD exacerbation.

Resp Med, 103 (2009), pp. 1293-1302

[48.]

J. Duran, S. Esnaola, R. Rubio, A. Iztueta.

Obstructive sleep apnea-hypopnea and related clinical features in population based sample of subjects aged 30 to 70 yr.

Am J Resp Crit Care Med, 163 (2001), pp. 685-689

http://dx.doi.org/10.1164/ajrccm.163.3.2005065 | Medline

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