Impact of Sepsis on Outcomes of Hospitalizations Due to Copd

Abstract

PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death worldwide and its prevalence is expected to rise further. Sepsis is a life-threatening condition defined by organ dysfunction caused by a dysregulated host response to infection. Patients with COPD have been reported to be at a higher risk of developing sepsis due to the use of corticosteroids, underlying comorbidities, and possibly impaired barrier function. Hence in our study, we used the nationally representative database to outline the trends, impact and predictors of poor outcomes due to sepsis among COPD hospitalizations. METHODS:We identified adult hospitalizations due to primary diagnosis of COPD by using International Classification of Diseases (9th/10th Editions) Clinical Modification (ICD-9-CM/ICD-10-CM) from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Sepsis was identified as the presence of codes in secondary fields. We identified comorbidities by Elixhauser comorbidity software supplied by HCUP. Primary outcomes of interest were in-hospital mortality and discharge to facilities. We utilized the Cochran Armitage trend test to analyze the trends of outcomes and multivariable survey logistic regression models to estimate the impact of sepsis.RESULTS: Out of a total 6,940,615 hospitalizations due to primary diagnosis of COPD, 64,748 (0.93%) were complicated with sepsis. Among the patients who developed sepsis, 31% were discharged to facilities and 19% died during the hospitalization. After adjusting with confounding factors, sepsis was associated with significantly higher in-hospital mortality (OR 4.9; 95% CI 4.5-5.3; p<0.01) and discharge to facilities (OR 2.2; 95% CI 2.1 -2.3; p<0.01). In trend analysis, adjusted odds of in-hospital mortality remained stable (aOR 6.1 in 2007 to aOR 5.3 in 2018; ptrend:0.31) and discharge to facilities increased (aOR 2.2 in 2007 to aOR 2.6 in 2018; ptrend:0.02). Among those who developed sepsis, increasing age, Caucasians (OR 1.2; 95% CI 1.1 -1.4; p<0.01), northeast region (OR 1.4; 95% CI 1.2 -1.7; p<0.01), DIC (OR 3.7; 95% CI 2.2 -6.1; p<0.01), pneumococcal infection (OR 1.2; 95% CI 1.1 -1.4; p<0.01), CHF (OR 1.2; 95% CI 1.1 -1.3 p<0.01) and Renal failure (OR 1.4 95% CI 1.2 -1.5 p<0.01) were also associated with in-hospital mortality. CONCLUSIONS:In this nationally representative study, we observed that sepsis was associated with significantly high mortality among COPD hospitalizations and remained stable over the past decade. We were also able to delineate several factors which were significantly associated with in-hospital mortality.CLINICAL IMPLICATIONS: Our study highlights the need for better risk stratification in patients with COPD developing sepsis to improve the outcomes. Further studies are warranted to consider factoring some of the modifiable factors into account and to ameliorate the outcomes of sepsis during COPD hospitalizations.

Independent risk factors of mortality in patients with sepsis receiving single-dose etomidate as an induction agent during rapid sequence intubation in a large tertiary emergency department in Thailand

“…Concordant with other previous studies [ 19 – 22 ], our results confirmed that pre-intubation lactate level was associated with mortality of septic patients regardless of intubation status and induction agents used for RSI. Conversely, although chronic lung disease and respiratory infection have been identified as predictors of poor outcomes in previous studies [ 23 , 24 ], our study proved otherwise. Both factors could have been associated with lower mortality because patients with pathologies involving the respiratory system were possibly intubated earlier when their degree of sepsis severity was not as high compared to patients with infection at other sites.…”

“…Further studies, preferably prospectively conducted, with enough outcome events and complete data on important and potential associated factors should be conducted. Lastly, it is even more important to note that it is still unclear whether these independent factors are specific to patients receiving etomidate since many of these factors have also been identified as predictors of adverse outcomes in general septic patients receiving any induction agents [ 21 , 23 , 24 , 33 ]. Ideally, further studies comparing etomidate to other induction agents in septic patients should be performed.…”