Acute Crit Care.  2023 Feb;38(1):49-56. 10.4266/acc.2022.01011.

Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure

• Akbaş T
• Güneş H

• KMID: 2540314
• DOI: http://doi.org/10.4266/acc.2022.01011

Abstract

Background
This study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure.
Methods
This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020.
Results
One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had greater pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin levels (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality.
Conclusions
APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

Keyword

acute hypercapnic respiratory failure; chronic obstructive pulmonary disease exacerbation; mechanical ventilation; mortality; PaO/FiO ratio

Figure

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  Figure 1. Recruitment diagram of chronic obstructive pulmonary disease (COPD) patients with acute hypercarbic respiratory failure.

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  Figure 2. Receiver operating characteristic (ROC) analysis curve for the determination of intensive care unit mortality for chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Area under the ROC for Acute Physiology and Chronic Health Evaluation (APACHE) II score was 0.866 (95% confidence interval, 0.793–0.938; P<0.001) with sensitivity of 86% and specificity of 79%.

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