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What Are the Factors Affecting on the Mortality of COPD Patients in the ICU?

DOI: 
10.7727/wimj.2016.593

ABSTRACT

Background: Morbidity and mortality rates of Chronic obstructive pulmonary disease (COPD) are continuously increasing throughout the world. It is a major cause of death, imposes a great socioeconomic burden and constitutes a significant part of ICU patients.

Aim: To determine factors associated with in-hospital-mortality of all causes following   critical care admissions of patients with COPD.

Material and methods: COPD patients that admitted to ICU were included retrospectively. Patients were divided into two groups: Survived and non-survived patients. Features during admission to the ICU of patients were studied dividing into three: First, demographic and clinical features including GCS ve APACHE II scores. Second, laboratory analyses including Uric acid, Leukocyte, Red cell Distribution Width (RDW), Mean Platelet Volume (MPV), Gamma-Glutamyl Transferase (GGT), lymphocyte, neutrophil, urea, creatinine, arterial blood gases. Third, comorbid diseases accompanying COPD. Parameters that were significant between two groups were analyzed using logistic regression with enter method.

Results: A total of 178 patients were included: 120 (67.42%) of them belonged to mortal COPD patients and 58 (32.58%) were in the alive group. For demographic and clinical features, logistic regression analysis showed that initial intubation in ED (OR: 0.33 (95% CI: 0.13–0.83), p = 0.018), duration of Mechanical Ventilation (MV) (OR: 0.873, 95% CI: 0.802–0.949, p = 0.002) and Ejection Fraction (EF) % (OR: 1.072, 95% CI: 1.013–1.135, p = 0.016) were independent variables to define mortality. Second logistic regression analysis demonstrated that creatinine was the only independent laboratory parameter to define mortal patients (OR: 0.596 (95% CI: 0.397–0.897, p = 0.013). Among comorbidities, Congestive Heart Failure (CHF) (OR: 2.783 (95% CI: 1.225–6.323, p = 0.014), initial Atrial Fibrillation (AF) (OR: 0.45, 95% CI: 0.203–0.998, p = 0.049), Post-op care (OR: 0.07, 95% CI: 0.012–0.417, p = 0.004) were found to be independent parameters to define mortality.

Conclusion: Our results show that patients pre-ICU intubation situation, CHF and AF were major parameters for mortality. The only independent diagnostic laboratory feature was patients’ creatinine levels. Longer duration of MV was independently associated with mortality.

Accepted: 
30 Mar, 2017
PDF Attachment: 
e-Published: 27 Apr, 2017

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