Impact of chronic obstructive pulmonary disease on ICU mortality in patients with ventilator-associated pneumonia

Abstract

Objective To determine the impact of chronic obstructive pulmonary disease (COPD)on intensive care unit (ICU) mortality in patients with VAP.Methods This prospective observational study was preformed in EICU of Taizhou Hospital during a 1.5-yearperiod.Eligible patients received mechanical ventilation for ＞48 h and met criteria for microbiologically confirmed VAP.Risk factors for ICU mortality were determined using univariate and multivariable analyses.Results Ninty patients with microbiologically confirmed VAP were included.Most VAP episodes were late-onset (84％),and Pseudomonas aeruginosa was the most frequently isolated bacterium (39％ of VAP episodes).ICU mortality was significantly lower in non-COPD patients (n =63) compared to COPD patients (n =27)[42.9％ vs 59.3％,P =0.038,OR (95％ CI)=1.67(1.04～6.85)].Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 24 (16-41) d and 31 (17-46) d.Whereas in COPD patients were 30(18-43) d and 37(21-50) d (P ＞0.05).The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage Ⅳ) patients (P =0.001 and P =0.002,respectively).Multivariable analysis identified COPD [OR (95％ CI) 2.52 (1.34-5.12)] at VAP diagnosis [3.70 (1.86-7.34)] as independent risk factors for ICU mortality.Conclusions COPD at VAP diagnosis are independently associated with ICU mortality in patients who present VAP. Key words: Pneumonia; Mechanical ventilation; Chronic obstructive pulmonary disease; Mortality; Intensive care