Title: Pre-Hospital and in-ICU Mortality Predictors in Critically COPD Patients Admitted with Acute Respiratory Failure
Authors: Osama M Momtaz, MD; Ali O Abdelaziz, MD; and Mohamed O Abdelaziz, MD
DOI: https://dx.doi.org/10.18535/jmscr/v4i11.02
Background: Patients with COPD requiring admission to an intensive care unit (ICU) for acute respiratory failure (RF) usually have a poor outcome especially when mechanical ventilation (MV) is mandatory. Determining the factors predicting mortality is pivotal for tailoring monitoring, modifying therapy and more better management of modifiable risk factors after hospital discharge. Objectives: To determine the pre-hospital and in-ICU predictors affecting mortality for critically COPD patients admitted with acute respiratory failure. Methods: The study included 93 patients of COPD presented with acute respiratory failure admitted to the ICU. All patients were subjected to full medical history, general examination, pulmonary function tests, arterial blood gases analysis, laboratory investigations, chest imaging, echocardiography and assessment by Acute physiology and chronic health evaluation (APACHE II) scoring. Patients were followed up until ICU discharge or demise. Various pre-hospital and in-hospital comparative parameters studied in survivors and non-survivors of all included patients and in patients managed by MV were analyzed and discussed. Results: The overall mortality was 21.4%. Sixty-two (66.7%) of all studied patients were managed by invasive mechanical ventilation (IMV). The most frequently mortality predictors were requirement for MV, higher smoking index, higher body mass index, higher APACHE II scores, presence of corpulmolale, higher pulmonary artery pressure, lower systolic arterial blood pressure, associated or in-ICU developed cardiac arrhythmias, pre-hospital dependence on home oxygen, less frequent preadmission use of systemic corticosteroids, higher CRP, urea, creatinine and total leucocytic count, more prolonged ICU stay and development of complications due to mechanical ventilation. The most common cause of respiratory failure was acute COPD exacerbation which had a favorable ICU outcome, followed by pneumonia, sepsis and heart failure which were more predictive of mortality. Various comparative parameters were submitted and discussed. Conclusion: We concluded that COPD patients admitted to ICU for acute RF are at substantial risk for hospital death. Important predictors related to hospital mortality should be thoroughly identified for proper modification and prophylaxis. Early identification of the high risk COPD patients is necessary for improving the ICU outcome by modifying management of the critically ill patients and may have the potential to decrease the rate of COPD decompensation after discharge by proper outpatient management. Keywords: Severe COPD, ICU, mortality predictors, APACHE II score. 1. Patil SP, Krishnan JA, Lechtzin N, Diette GB. In hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. 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