Abstract
BackgroundFactors associated with hospital mortality are unclear in patients with acute exacerbation of COPD (AECOPD) requiring intensive care unit (ICU) admission. We aimed to characterize these patients and identify factors associated with hospital mortality.Patients and methodsWe used a retrospective observational case-control design and recruited patients between January 2015 and March 2017. Of 146 patients enrolled, 24 (16.4%) died during their hospital stay, while 122 survived.ResultsMultivariate logistic regression analyses revealed factors associated with hospital mortality: age (adjusted odds ratio [AOR] 1.12, 95% CI: 1.03–1.23), C-reactive protein (CRP) level >7.5 mg/dL at the emergency room (AOR 4.52, 95% CI: 1.27–16.04), peak eosinophil-to-neutrophil ratio (ENR)×102 on days 8–14 of treatment (AOR 0.22, 95% CI: 0.08–0.63), and in-hospital complications (AOR 4.23, 95% CI: 1.12–15.98) (all P<0.05). After receiver operating characteristic curve analyses, cutoff level for peak ENR×102 was 0.224. To examine the synergistic effects of CRP level and peak ENR, we divided patients into four groups: (G0, reference group) Peak ENR×102 >0.224 on days 8–14 and initial CRP <7.5 mg/dL; (G1) Peak ENR×102 >0.224 on days 8–14 and initial CRP >7.5 mg/dL; (G2) Peak ENR×102 <0.224 on days 8–14 and initial CRP <7.5 mg/dL; and (G3) Peak ENR×102 <0.224 on days 8–14 and initial CRP >7.5 mg/dL. For G2 and G3 patients, the AOR of mortality was significantly different from that of the reference group (G2: AOR 10.00, P = 0.020; G3: AOR 61.79, P<0.001). The relationship between 28-day mortality and the four groups was statistically significant (log-rank test, P<0.001).ConclusionOlder age, initial CRP >7.5 mg/dL, peak ENR on days 8–14, and in-hospital complications were associated with hospital mortality in patients with AECOPD requiring ICU admission. Patients with both biomarkers, initial CRP >7.5 mg/dL, and peak ENR×102 <0.224 on days 8–14 of treatment, had an increased risk of hospital mortality.
Highlights
Chronic obstructive pulmonary disease (COPD), a common respiratory disease characterized by persistent airflow limitation, is a leading global cause of morbidity and mortality [1]
Multivariate logistic regression analyses revealed factors associated with hospital mortality: age, C-reactive protein (CRP) level >7.5 mg/dL at the emergency room (AOR 4.52, 95% confidence intervals (CIs): 1.27–16.04), peak eosinophil-toneutrophil ratio (ENR)×102 on days 8–14 of treatment (AOR 0.22, 95% CI: 0.08–0.63), and in-hospital complications (AOR 4.23, 95% CI: 1.12–15.98)
Initial CRP >7.5 mg/dL, peak eosinophil-to-neutrophil ratio (ENR) on days 8–14, and in-hospital complications were associated with hospital mortality in patients with acute exacerbation of COPD (AECOPD) requiring intensive care unit (ICU) admission
Summary
Chronic obstructive pulmonary disease (COPD), a common respiratory disease characterized by persistent airflow limitation, is a leading global cause of morbidity and mortality [1]. Patients with AECOPD who require intensive care unit (ICU) admission for respiratory distress and critical illness [3] face a high mortality rate of 16.9 to 48.8% [4,5,6]. Information on patients with AECOPD admitted to the ICU is limited and independent factors to predict their hospital mortality are not routinely available. Based on the current literature, [4, 12,13,14] both biological characteristics and inflammatory biomarkers may simultaneously impact hospital outcomes and independently predict hospital mortality among AECOPD patients admitted to the ICU. Factors associated with hospital mortality are unclear in patients with acute exacerbation of COPD (AECOPD) requiring intensive care unit (ICU) admission. We aimed to characterize these patients and identify factors associated with hospital mortality
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