The Influence of COPD on Mortality and Severity Scoring in Community-Acquired Pneumonia

Snijders, Dominic; Eerden, Menno M. van der; Graaff, Casper de; Boersma, Wim

doi:10.1159/000213757

Cited by 36 publications

(45 citation statements)

References 48 publications

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“…In one prospective Spanish study, the mortality was 8%, which did not seem to be in excess of the rates reported for the general population [3]. Accordingly, in a subanalysis of a randomised clinical trial, the mortality was 8% and was not increased in patients with COPD hospitalised with CAP.…”

Section: Discussionmentioning

confidence: 83%

“…Whereas two studies do not support COPD as a risk factor for death [3,5], two other studies did show an excess mortality of CAP in patients with COPD [5,6].…”

mentioning

confidence: 88%

“…Although this respiratory disease is a clear risk factor for CAP, it has not been shown to be a risk factor for mortality [3]. Accordingly, COPD has not been included as one of the five main comorbidities determining the risk of death in the Pneumonia Severity Index (PSI) [4].…”

mentioning

confidence: 99%

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Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

Liapikou¹,

Polverino²,

Ewig³

et al. 2011

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with community-acquired pneumonia (CAP). We investigated the impact of COPD on outcomes of CAP patients.We prospectively studied the clinical presentation of 1,379 patients admitted with CAP during a 4-yr period. A comparative analysis of disease severity and course was performed between 212 patients with COPD, as confirmed by spirometry, and 1,167 non-COPD patients.COPD patients (mean forced expiratory volume in 1 s 47.7¡16.3% predicted) were older and more likely to have previously received antibiotics (37.1% versus 28.3%; p,0.01) than those without COPD. They presented with more severe respiratory failure (arterial oxygen tension/ inspiratory oxygen fraction 270.4 versus 287.8; p,0.01) and more severe pneumonia (pneumonia severity index 118.3 versus 108.5; p,0.001) compared with non-COPD patients. However, COPD patients had less multilobar infiltration (44 (21%) versus 349 (30%); p,0.01) and fewer pulmonary complications (24 (14%) versus 241 (24%); p,0.01). A total of 89 (6.5%) patients died within 30 days. COPD patients had no significant difference in their 30-day mortality rate compared with non-COPD patients (nine (4.2%) patients versus 81 (7%); p50.14).Despite worse clinical presentation, COPD patients had a similar mortality rate compared to non-COPD patients. Previous antibiotic treatment and the decreased incidence of pulmonary complications in COPD may account for these findings.

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Section: Discussionmentioning

confidence: 83%

“…Whereas two studies do not support COPD as a risk factor for death [3,5], two other studies did show an excess mortality of CAP in patients with COPD [5,6].…”

mentioning

confidence: 88%

See 1 more Smart Citation

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

Liapikou¹,

Polverino²,

Ewig³

et al. 2011

Eur Respir J

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“…Four studies 15,17,19,26 were multicenter studies, and two studies 16,29 analyzed data from the nationwide databases. Of these cohort studies, five were prospective and four 17,18,26,28 were retrospective. All cohort studies ascertained the diagnosis of CAP based on chest radiographic findings, whereas the two case-control studies identified the cases of CAP according to the International Classification of Diseases (ICD-10) codes.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…[15][16][17] Nevertheless, many other studies demonstrated that COPD was not associated with significant mortality, longer hospital stay and more intensive care unit (ICU) admission. [18][19][20] Thus, the aim of this systematic review and metaanalysis was to investigate whether COPD was associated with increased mortality and morbidity in patients with CAP.…”

Section: Introductionmentioning

confidence: 99%

Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta‐analysis

et al. 2015

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This review aimed to investigate whether chronic obstructive pulmonary disease (COPD) is associated with increased mortality and morbidity in patients hospitalized with community-acquired pneumonia (CAP). EMBASE,PubMed and Web of Science were searched for cohort studies and case-control studies investigating the impact of COPD on CAP. The primary outcome was all-cause mortality, and secondary outcomes included length of hospital stay, intensive care unit (ICU) admission and need for mechanical ventilation. Methodological quality was assessed using the Newcastle-Ottawa Scale. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risks (RRs) and mean differences (MD), respectively. Eleven studies (nine cohort studies and two casecontrol studies), involving 257 958 patients, were included. The overall methodological quality was high. COPD was not associated with increased mortality in hospitalized CAP patients (RR, 1.20; 95% confidence interval (CI): 0.92-1.56; P = 0.19; I 2 = 55%) in cohort studies, and was associated with reduced mortality in case-control studies (RR, 0.82; 95% CI: 0.74-0.90; P < 0.0001; I 2 = 80%). COPD was not associated with longer hospital stay (MD, 0.11; 95% CI: −0.42 to 0.64; P = 0.68; I 2 = 21%), more frequent ICU admission (RR, 0.97; 95% CI: 0.70-1.35; P = 0.87; I 2 = 65%), and more need for mechanical ventilation (RR 0.91, 95% CI: 0.71-1.16; P = 0.44; I 2 = 4%).The current available evidence indicates that COPD may not be associated with increased mortality and morbidity in patients hospitalized with CAP. This conclusion should be re-evaluated by prospective population-based cohort studies.

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COPD patients with ventilator-associated pneumonia: implications for management

Koulenti

Blot

Dulhunty

et al. 2015

Eur J Clin Microbiol Infect Dis

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Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.

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The Influence of COPD on Mortality and Severity Scoring in Community-Acquired Pneumonia

Cited by 36 publications

References 48 publications

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta‐analysis

COPD patients with ventilator-associated pneumonia: implications for management

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