Clinical presentation and predictors of outcome in patients with severe acute exacerbation of chronic obstructive pulmonary disease requiring admission to intensive care unit

BMC Pulm Med. 2006 Dec 19:6:27. doi: 10.1186/1471-2466-6-27.


Background: Severe acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is a common reason for emergency room (ER) visit about which little has been documented from India.

Methods: Prospective study of the clinical presentation and predictors of outcome in 116 patients presenting with severe AE-COPD requiring admission to the medical intensive care unit between January 2000 and December 2004.

Results: Their mean age was 62.1 +/- 9.8 years. There were 102 males. Mean duration of COPD was 7.2 +/- 5.8 years. All males were smokers (22.3 +/- 11.2 pack years); 35.2% smoked cigarettes and 64.8% smoked bidis. All women were exposed to domestic fuel. Associated co-morbid illnesses were present in 81 patients (69.8%); 53(45.7%) had one co-morbid illness and the remaining 28 (54.3%) had two or more co-morbid illnesses. Evidence of past pulmonary tuberculosis (PTB) was present in 28.4% patients; 5 patients who also had type II diabetes mellitus had active PTB. Arterial blood gas analysis revealed respiratory failure in 40 (33.8%) patients (type I 17.5% and type II 82.5%). Invasive mechanical ventilation was required in 18 patients. Sixteen (13.7%) patients died. Stepwise multivariate logistic regression analysis revealed need for invasive ventilation (OR 45.809, 95% CI 607.46 to 3.009;p < 0.001); presence of co-morbid illness (OR 0.126, 95% CI 0.428 to 0.037;p < 0.01) and hypercapnia (OR 0.114, 95% CI 1.324 to 0.010;p < 0.05) were predictors of death.

Conclusion: Co-morbid conditions and metabolic abnormalities render the diagnosis of AE-COPD difficult and also contribute to mortality. High prevalence of past PTB and active PTB in patients with AE-COPD suggests an intriguing relationship between smoking, PTB and COPD which merits further study.

MeSH terms

  • Aged
  • Comorbidity
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Hypercapnia / epidemiology
  • Intensive Care Units
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiration, Artificial
  • Smoking / epidemiology
  • Treatment Outcome
  • Tuberculosis, Pulmonary / epidemiology