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Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia

¹ Hospital Joan XXIII, Universitat Rovira i Virgili/Institut Pere Virgili, Tarragona, ² Hospital Clinic, Barcelona, ⁴ Hospital Dr. Negrín, Las Palmas de Gran Canária, ⁵ Hospital Virgen del Rocio, Sevilla, ⁶ Hospital Virgen Victoria, Málaga, and ⁷ Hospital Joseph Trueta, Girona, Spain, ³ Hospital Verge de Meritxell, Andorra.

CORRESPONDENCE: J. Rello, Critical Care Dept, Joan XXIII University Hospital, Carrer Mallafre Guasch 4, E43007 Tarragona, Spain. Fax: 34 977295878. E-mail: jordi.rello{at}urv.net

Keywords: Community-acquired pneumonia

Received: November 25, 2005
Accepted February 7, 2006

The mortality rate of chronic obstructive pulmonary disease (COPD) patients with community-acquired pneumonia (CAP) is reported to be low. However, studies carried out to date have included <20% of critically ill patients.

The current authors performed a secondary analysis of a prospective study evaluating 428 immunocompetent patients admitted to the intensive care unit (ICU) for severe CAP.

In total, 176 COPD patients were compared with 252 non-COPD patients. In COPD patients, ICU mortality (odds ratio (OR) 1.58; 95% confidence interval (CI) 1.01–1.43) and mechanical ventilation (OR 2.78; 95% CI 1.63–4.74) rates were higher than in non-COPD patients. The ICU mortality was 39% for COPD patients initially intubated and 50% for those who failed noninvasive ventilation. The proportion of patients who were males, aged 70 yrs, smokers and who had chronic heart disease or Pseudomonas aeruginosa were higher in COPD patients. Inappropriate empirical antibiotic therapy was associated with higher mortality (OR 3.8; 95% CI 1.19–12.6). ICU mortality in COPD patients with adequate therapy was associated with bilateral pneumonia (OR 2.32; 95% CI 1.18–4.53) and shock (OR 3.53; 95% CI 1.31–9.71).

In conclusion, chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia in the intensive care unit had higher mortality and need of mechanical ventilation when compared with patients without chronic obstructive pulmonary disease.

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