Impact of COPD in the Outcome of ICU-Acquired Pneumonia With and Without Previous Intubation

Rinaudo, Mariano; Ferrer, Miquel; Terraneo, Silvia; Rosa, Francesca; Peralta, Rogelio; Fernández-Barat, Laia; Bassi, Gianluigi Li; Torres, Antoni

doi:10.1378/chest.14-2005

Cited by 13 publications

(29 citation statements)

References 33 publications

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“…Other independent predictors of 90-day mortality were COPD, liver disease, and use of corticosteroids at the time of ICU-AP diagnosis. These findings are consistent with previous publications by our group [42,43,44], and, in addition, lymphocytopenia may help to stratify the mortality risk of populations enrolled in randomized controlled trials designed to explore potential differences in treatment effects.…”

Section: Discussionsupporting

confidence: 92%

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Ceccato¹,

Panagiotarakou

Ranzani

et al. 2019

JCM

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Background: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP. Methods: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016). Results: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94). Conclusion: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.

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Section: Discussionsupporting

confidence: 92%

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Ceccato¹,

Panagiotarakou

Ranzani

et al. 2019

JCM

Self Cite

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“…Especially in these patient groups, VAP may adversely affect the clinical outcome [7,8]: thus, it is commonly suggested to avoid intubation and, whenever possible, to employ non-invasive ventilation (NIV) [9,10].…”

Section: Introductionmentioning

confidence: 99%

Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

Scaravilli

Grasselli

Castagna

et al. 2015

Journal of Critical Care

249

232

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“…COPD is a complex disease with high socio-economic impact, morbidity, and mortality. [ 1 2 3 4 5 6 ] Increased severity, as measured by GOLD class, is associated with increased complications related to ventilator associated pneumonias,[ 43 ] IMV duration[ 44 ] and overall ICU LOS. [ 45 ] In-hospital mortality rates for ventilated COPD patients have been reported as high as 24%, with 1-year mortality rates up to 59%.…”

Section: Discussionmentioning

confidence: 99%

Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients

Vahedian‐Azimi

Bashar

Quinn

et al. 2020

Int J Crit Illn Inj Sci

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Objectives: The negative inspiratory force (NIF) has been used to help clinicians predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH 2 O may not be appropriate for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients. Methods: A prospective-observational multi-center study was conducted in intensive care units of six academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive, and negative predictive value (PPV, NPV), positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy recorded. Results: A total of 90 patients with COPD (39 males and 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation ( P = 0.654). The threshold value of ≤−25 cmH 2 O offered the optimal performance in COPD patients: area under the receiver operating characteristic (ROC) curves ROC curves 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, and NPV 95.6%., LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%. Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH 2 O was a moderate-to-good predictor for successful ventilator liberation, and outperforms the traditional threshold of ≤−30 cmH 2 O.

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Impact of COPD in the Outcome of ICU-Acquired Pneumonia With and Without Previous Intubation

Cited by 13 publications

References 33 publications

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients

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