Characteristics and predictors of mortality in patients with severely exacerbated COPD with acute respiratory failure

Abstract

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.