The prognostic factors of in-hospital death among patients with pneumonic COPD acute exacerbation

Chigusa Shirakawa,Yuki Kataoka,Hiroshi Shiba,Shinya Matsushita,Akihiro Shiroshita,Keisuke Tomii,Kenya Sato

doi:10.1016/j.resinv.2021.11.009

Abstract

Pneumonic acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) is associated with worse outcomes compared with non-pneumonic COPD-AE. We aimed to explore prognostic factors among patients with pneumonic COPD-AE. This multicentered retrospective cohort study was conducted across five hospitals in Japan. Hospitalized patients ≥40 years of age with pneumonic COPD-AE who were administered systemic corticosteroids during hospitalization were included. Patients with other causes of respiratory failure, daily systemic steroid users, and patients who were not treated with systemic steroids were excluded. Based on existing clinical prediction models, the following potential prognostic factors were selected in advance: age, blood eosinophil count, blood urea nitrogen, respiratory rate, diastolic blood pressure, and altered mental status. Multivariate logistic regression was conducted to determine the association between potential prognostic factors and in-hospital death. After excluding 897 patients based on the exclusion criteria, 669 patients with pneumonic COPD-AE who were administered systemic corticosteroids were included. The in-hospital mortality rate was 5.1%. Altered mental status was associated with mortality (odds ratio, 4.47; 95% confidence intervals, 2.00 to 10.00), and eosinophilia was associated with a lower risk of mortality (odds ratio, 0.19; 95% confidence intervals: 0.06 to 0.56). Altered mental status may be a prognostic factor for in-hospital death among patients with pneumonic COPD-AE who were administered systemic corticosteroids. Moreover, eosinophilia may be a prognostic factor for lower in-hospital mortality rate among these patients.

Highlights

Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of death worldwide.[1,2,3] Acute exacerbation of COPD (COPD-AE) is the major cause of impaired health status in patients with stable COPD, and chronic obstructive pulmonary disease (COPD-AE) is the major cause of death
Altered mental status may be the prognostic factor of in-hospital death among patients with pneumonic COPD-AE who are receive systemic corticosteroids
The univariate logistic regression showed that only altered mental status was associated with in-hospital death (4.51; 95% confidence interval: 2.12 to 9.30; Table 3). This multicentered retrospective study showed that (1) altered mental status was associated with higher mortality of patients hospitalized for pneumonic COPD-AE and (2) high eosinophilia was associated with a lower risk of mortality in these patients

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of death worldwide.[1,2,3] Acute exacerbation of COPD (COPD-AE) is the major cause of impaired health status in patients with stable COPD, and COPD-AE is the major cause of death. The singlecentered prospective cohort study found that readmission within 30 days, serum hemoglobin concentration, and albumin level were associated with 180-days mortality.[14] this study was limited by its small sample size and oversimplified study design, which ignored heterogeneity in the treatment strategy (differenced in treatment patterns, which types of drugs were administered [steroids, antibiotics], and steroid dose) We conducted this multicenter retrospective cohort study to evaluate patients with pneumonic COPD-AE all of whom received the same treatment — systemic corticosteroids which are a recommended treatment according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD.[15]

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