Abstract
IntroductionGastro-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.MethodsPropensity 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.ResultsDuring 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).ConclusionThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0849-1) contains supplementary material, which is available to authorized users.
Highlights
Gastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis
As mechanical ventilation use and intensive care unit (ICU) admission are reliable markers of poor COPD prognosis, this study aimed to investigate whether GORD is associated with an independently increased risk of ICU admittance and mechanical ventilation use to better understand the effect of GORD on COPD severity
The authors hope that these results will encourage physicians treating COPD patients with GORD to exercise caution and be cognizant of their increased risk for severe outcomes
Summary
Gastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis. Earlier studies have reported a high prevalence of GORD among COPD patients [7,8,9,10,11], with preliminary data suggesting that gastro-oesophageal reflux may heighten bronchial reactivity in GORD patients. The studies in the literature exploring the association between GORD and COPD exacerbations have all utilized self-reported GORD symptoms and prevalent cases in their analyses [12,13,14,18]. While these studies did observe an increase in the frequency of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), they did not comment on the extent of the AECOPD event severity. The data available in the literature are insufficient to establish causality, to establish temporality, or to link the effect of GORD to any specific outcome severity among COPD patients
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