Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality

J Crit Care. 2013 Dec;28(6):975-9. doi: 10.1016/j.jcrc.2013.08.004. Epub 2013 Sep 24.

Abstract

Purpose: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality.

Materials and methods: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses.

Results: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality.

Conclusion: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Keywords: COPD; Community-acquired pneumonia; Intensive care unit.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Community-Acquired Infections / complications*
  • Community-Acquired Infections / mortality*
  • Female
  • Health Status Indicators
  • Hospital Mortality*
  • Humans
  • Hypertension / complications
  • Intensive Care Units
  • Length of Stay / statistics & numerical data
  • Male
  • Pneumonia / complications*
  • Pneumonia / mortality*
  • Predictive Value of Tests
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Respiration, Artificial / adverse effects*
  • Risk Factors
  • Severity of Illness Index
  • Turkey / epidemiology

Substances

  • Adrenal Cortex Hormones