Implications of COPD in patients admitted to the ICU by community-acquired pneumonia. A comparison with a cohort of non- COPD patients

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

^* To whom correspondence should be addressed. E-mail: jordi.rello{at}urv.net.

	Abstract

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 included <20% of critically ill patients.

We performed a secondary analysis of a prospective study evaluating 428 immunocompetent patients admitted to the ICU for severe CAP.

One hundred seventy-six COPD patients were compared with 252 non COPD patients. In COPD patients, ICU mortality (OR: 1.58; 95%CI 1.01 to 1.43) and mechanical ventilation (OR: 2.78; 95%CI 1.63 to 4.74) rates were higher than in non-COPD. The ICU mortality was 39% for COPD patients initially intubated and 50% for those who failed non-invasive ventilation. The proportion of patients who were males, 70 years, smokers, had chronic hearth disease, or had Pseudomonas aeruginosa were higher (p<0.05) in COPD patients. Inappropriate empirical antibiotic therapy was associated with higher mortality (OR: 3.8; 95%CI 1.19 to 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)

COPD patients hospitalized with CAP in the ICU had higher mortality and need of mechanical ventilation when compared to patients without COPD.

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