1

Short- and Long-term Mortality of COPD Patients Treated in the Respiratory Intensive

Care Unit for Acute Respiratory Failure

Tülay Yarkın, Dilay Demiryontar, Zuhal Karakurt,

Nalan Adıgüzel, Hilal Altınöz

SB Süreyyapaşa Chest and Cardiovascular Diseases Teaching Hospital, Respiratory Intensive Care Unit; İstanbul, Türkiye

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Study Objectives

• The prognosis of COPD patients with ARF admitted to

ICU is generally believed to be poor • In-hospital mortality rate varies between 8-11% in

patients hospitalized for acute exacerbation, while rises up

to 20% in patients admitted to ICU due to ARF • Age, previous intubation, APACHE II scores, prolonged

prednisolone use, albumine level and length of hospital

stay were reported independent predictors of hospital

mortality (Ai-Ping et al. Chest 2005)

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Study Objectives

• There is limited data on long-term prognosis and also prognostic factors following hospital discharge in such patients• One study (Breen et al. Thorax 2002) reported a mortality rate of 64% at 3 years, and the other (Ai-Ping et al. Chest 2005)

reported 75% at 5 years • We aimed to provide additional information to the short- and long-term mortality in this group of patients

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Materials and Method

• Design: Retrospective cohort study• Setting: Respiratory Intensive Care Unit (RICU) with 6 bed at a large teaching hospital• Study Period: April 2001 – June 2003• Patients: A total of 107 COPD patients admitted to RICU and ventilated invasively or noninvasively at least 24 h• Evaluation: Demografic and clinic characteristics of the patients were recorded from hospital files• Patients were followed up 2 years after hospital discharge by review of the clinic notes and telephone contacts

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Demografic Characteristics

Number of patients, n 107

Number of admissions, n 163

Gender, F/M 12/95

Age, y 61.7 ± 9 (39-80)

Co-morbidity, n (%) 62 (57.9)

COPD duration, y 10 ± 6

Smoking status, pac/y

Ex-smoker, n

Current smoker,n

59 ± 29 (12-150)

65

28

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Clinical Characteristics

FVC, ml (% pred) 1417 ±541 (44.8)

FEV1, ml (% pred) 747 ± 331 (29)

Using LTOT, n (%) 27 (25.2%)

Using Home-vent, n 0

Previous hospitalization in the last yr, % 51.5

Previous ICU admission in the last yr, % 22.4

Previous intubation in the last yr, % 10.3

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Clinical Characteristics on Admission

APACHE II 18.4 ± 5 (9-34)

pH 7.28 ± 0.08

PaCO2 86 ± 20.5

PaO2 58 ± 27

Htc, % 45.6 ± 6

Interventions

NIPPV, n (%)

IMV, n (%)

78 (73)

25 (27)

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Outcomes of the Patients

Total duration of MV, d 2.6 ± 3.3 (1- 21)

Length of RICU stay, d 5 ± 6

Length of hospital stay, d 13,7 ± 9

Survive out of RICU, n (%) 95 (89.8)

Survive out of hospital, n (%) 90 (84.1)

LTOT administered at discharge 21/90 (23.3%)

Home-vent administered at discharge 23/90 (25.5%)

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Follow-up

The longest follow-up, d 1085

Readmission rate following discharge

readmission at the first month

29/90 (32.2%)

17/29 (58.6%)

Median survival, m 13,5

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Mortality Rate Following Admission of ICU

ICU, n (%) 12 (11.2)

in-hospital, n (%) 17 (15.9)

at 30 days, n (%) 26 (24.3)

at 90 days, n (%) 35 (32.7)

at 180 days, n (%) 40 (37.4)

at 1 year, n (%) 50 (46.7)

at 2 year, n (%) 66 (61.7)

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Survival Curve Following Admission of RICU

Follow up (days)

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Comparison of the Survivors and Nonsurvivors

Variables

Survivors

(n=90)

Nonsurvivors

(n=17) p

Age, y 60.4 ± 8.8 68.2 ± 7 .001

APACHE II 17.5 ± 4.4 23.2 ± 6 .000

pH, at entry 7.29 ± 0.07 7.23 ± 0.1 .003

HCO3, at entry 42.4 ± 8.3 35.3 ± 8.4 .002

Htc, at entry 46 ± 5.5 42.8 ± 7.1 .04

Lenght of hospital stay, d 14.8 ± 9.4 8.5 ± 7.2 .01

MV type, NPPV / IMV 73/17 9/8 .024

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Predicted Factors of ICU and Hospital Mortality

Variables for ICU p O.R. C.I.

APACHE II, at entry .002 1.263 1.087-1.467

HCO3, at entry .014 0.866 0.772-0.971

Received IMV .029 7.893 1.235-50.456

Variables for Hospital after ICU

p O.R. C.I.

HCO3, at entry .033 0.717 0.528-0.974

PaCO2, at discharge from ICU

.013 1.270 1.050-1.530

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Mortality Rate Following Discharge from the Hospital

Number of patients, n 90

at 30 days, n (%) 9 (10)

at 90 days, n (%) 18 (20)

at 180 days, n (%) 23 (25.6)

at 1 year, n (%) 33 (36.7)

at 2 year, n (%) 50 (55.6)

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Survival Curve After Discharge from the Hospital

follow-up (days)

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Survival Function

Survival Curve After Discharge from the Hospital

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Predicted Factors of Mortality at 30 Days

Variables p O.R. C.I.

Age .011 1.119 1.026-1.221

APACHE II .002 1.241 1.082-1.424

Received IMV .039 4.855 1.087-21.688

Emphysematous findings on Chest X-Ray

.001 15.467 3.211-74.513

No LTOT .011 8.774 1.629-47.268

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Predicted Factors of Long-term Survival

Variables for 1-year p O.R. C.I.

Using LTOT .028 2.773 1.117-6.883

Home-ventilator .026 4.815 1207-19.204

Variables for 2-year p O.R. C.I.

Using LTOT .026 2.471 1.112-5.490

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Survival Curves According to LTOT

Follow up (days)

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LTOT

no

yes

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Survival Curves According to Home-Ventilator

Follow-up (days)

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home-vent

no

yes

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Conclusions

Author, year Pts, n ICU Hosp 6 mo 1 y 2 y 3 y 5 y

Ai-Ping,

Chest 2005

57

ARF

11.5 24.5 39 42.7 61.2 75.9

Breen,

Thorax 2002

74

ARF

13.5 20.3 40.5 48.6 58.1 63.5

Connors,

AJRCCM 1996

1016AECOPD

11 33 43 49

Gronewegen,

Chest 2003

171AECOPD

8 23

Current study 107

ARF

11.2 15.9 37.4 46.7 61.7

• Short- and long-term mortality rates were found similar to the previous studies.

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Conclusions

• Using LTOT at home was confirmed as a predictive factor for long-term survival• Also, using home-MV was found an independent predictive factor for 1 year survival

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