COPD Exacerbation: Mortality Prognosis Factors in a Respiratory Care Unit

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.