Patients with influenza infection may develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. Some patients with ARDS receiving extracorporeal membrane oxygenation (ECMO) support die of infectious complications. We aimed to investigate the risk factors affecting the clinical outcomes in critically ill patients with influenza. We retrospectively reviewed the medical records of influenza patients between January 2006 and May 2016 at the Kaohsiung Veterans General Hospital in Taiwan. Patients aged below 20 years or without laboratory-confirmed influenza were excluded. Critically ill patients who presented with ARDS (P = 0.004, odds ratio (OR): 8.054, 95% confidence interval (CI): 1.975–32.855), a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.008, OR: 1.102, 95% CI: 1.025–1.184), or higher positive end-expiratory pressure (P = 0.008, OR: 1.259, 95% CI: 1.061–1.493) may have a higher risk of receiving ECMO. Influenza A (P = 0.037, OR: 0.105, 95% CI: 0.013–0.876) and multiple organ failure (P = 0.007, OR: 0.056, 95% CI: 0.007–0.457) were significantly associated with higher mortality rates. In conclusion, our study showed critically ill influenza patients with ARDS, higher APACHE II scores, and higher positive end-expiratory pressure have a higher risk of receiving ECMO support. Influenza A and multiple organ failure are predictors of mortality.

Background Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease associated with high mortality when acutely exacerbated. However, the mortality may be higher in patients needing mechanical ventilation due to severely exacerbated COPD with acute respiratory failure. Hence, we performed a cohort study to investigate the predictors in these patients. Methods We retrospectively reviewed medical records of patients diagnosed with exacerbated COPD with acute respiratory failure, who had been treated with invasive mechanical ventilation or noninvasive positive pressure ventilation (NIPPV). We included patients admitted to our hospital, Kaohsiung Veterans General Hospital in Taiwan, from January 2011 to December 2021. Multivariate logistic regression was used to conduct a nomogram for determining the predictors of short-term 30-day in-hospital mortality. Patients were excluded if they were aged below 20 years or had incomplete clinical or laboratory test data. Results We enrolled 384 COPD patients with acute respiratory failure and found that the short-term 30-day in-hospital mortality rate was 20% after ventilation in patients with severely exacerbated COPD with acute respiratory failure. Patients with age ≥ 70 years (P: 0.007, adjusted odds ratio (aOR): 2.21, 95% confident interval (CI): 1.25–3.92), shock (P < 0.001, aOR: 4.39, 95% CI: 2.26–8.55), high serum lactate > 4 mmole/L (P: 0.008, aOR: 2.82, 95% CI: 1.31–6.07), PaCO2 < 50 mmHg (P: 0.003, aOR: 2.35, 95% CI: 1.33–4.14), and NIPPV (P < 0.001, aOR: 4.24, 95% CI: 2.29–7.84) were independent predictors for higher short-term 30-day in-hospital mortality rate in stepwise logistic regression analysis which showed significant predictive performance (c-statistic, 0.771; 95% CI, 0.712–0.830). Conclusions The established nomogram which is practical for clinical using with five significant factors showed impressive performance of mortality in patients with severely exacerbated COPD with acute respiratory failure. Age ≥ 70 years, shock, high serum lactate > 4 mmol/L, PaCO2 < 50 mmHg, and NIPPV were associated with higher short-term 30-day in-hospital mortality rates in these patients.

Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease associated with high mortality when acutely exacerbated. However, the mortality may be higher in patients needing mechanical ventilation due to severely exacerbated COPD with acute respiratory failure. Hence, we performed a cohort study to investigate the predictors in these patients.Methods: We retrospectively reviewed medical records of patients diagnosed with exacerbated COPD with acute respiratory failure, who had been treated with invasive mechanical ventilation or noninvasive positive pressure ventilation (NIPPV). We included patients admitted to our hospital, Kaohsiung Veterans General Hospital in Taiwan, from January 2011 to December 2021. Patients were excluded if they were aged below 20 years or had incomplete clinical or laboratory test data.Results: We found that the 30-day in-hospital mortality rate was 20% after ventilation in patients with severely exacerbated COPD with acute respiratory failure. Patients with age ≥70 years (P: 0.007, adjusted odds ratio (aOR): 2.21, 95% confident interval (CI): 1.25–3.92), shock (P < 0.001, aOR: 4.39, 95% CI: 2.26–8.55), high serum lactate > 4 mmole/L (P: 0.008, aOR: 2.82, 95% CI: 1.31–6.07), PaCO2 < 50 mmHg (P: 0.003, aOR: 2.35, 95% CI: 1.33–4.14), and NIPPV (P < 0.001, aOR: 4.24, 95% CI: 2.29–7.84) were independent predictors for higher 30-day in-hospital mortality rate in stepwise logistic regression analysis.Conclusions: We identified clinical predictors of mortality in patients with severely exacerbated COPD with acute respiratory failure. Age ≥70 years, shock, high serum lactate > 4 mmol/L, PaCO2 < 50 mmHg, and NIPPV were associated with higher 30-day in-hospital mortality rates in these patients.

Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease associated with high mortality when acutely exacerbated. However, the mortality may be higher in patients needing mechanical ventilation due to severely exacerbated COPD with acute respiratory failure. Hence, we performed a cohort study to investigate the predictors in these patients.Methods: We retrospectively reviewed medical records of patients diagnosed with exacerbated COPD with acute respiratory failure, who had been treated with invasive mechanical ventilation or noninvasive positive pressure ventilation (NIPPV). We included patients admitted to our hospital, Kaohsiung Veterans General Hospital in Taiwan, from January 2011 to December 2021. Patients were excluded if they were aged below 20 years or had incomplete clinical or laboratory test data.Results: We found that the 30-day in-hospital mortality rate was 20% after ventilation in patients with severely exacerbated COPD with acute respiratory failure. Patients with age ≥70 years (P: 0.007, adjusted odds ratio (aOR): 2.21, 95% confident interval (CI): 1.25–3.92), shock (P < 0.001, aOR: 4.39, 95% CI: 2.26–8.55), high serum lactate > 4 mmole/L (P: 0.008, aOR: 2.82, 95% CI: 1.31–6.07), PaCO2 < 50 mmHg (P: 0.003, aOR: 2.35, 95% CI: 1.33–4.14), and NIPPV (P < 0.001, aOR: 4.24, 95% CI: 2.29–7.84) were independent predictors for higher 30-day in-hospital mortality rate in stepwise logistic regression analysis.Conclusions: We identified clinical predictors of mortality in patients with severely exacerbated COPD with acute respiratory failure. Age ≥70 years, shock, high serum lactate > 4 mmol/L, PaCO2 < 50 mmHg, and NIPPV were associated with higher 30-day in-hospital mortality rates in these patients.