Association Between Comorbid Chronic Obstructive Pulmonary Disease and Prognosis of Patients Admitted to the Intensive Care Unit for Non-COPD Reasons: A Retrospective Cohort Study
Authors Huang W, Xie R, Hong Y, Chen Q
Received 28 December 2019
Accepted for publication 21 January 2020
Published 7 February 2020 Volume 2020:15 Pages 279—287
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Chunxue Bai
Wencheng Huang,1 Ruijie Xie,2 Yuancheng Hong,1 Qingui Chen2
1Department of Respiratory Medicine, The 910th Hospital of People’s Liberation Army, Quanzhou, People’s Republic of China; 2Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
Correspondence: Qingui Chen
Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China
Tel +86-135 8044 2523
Email [email protected]
Background and Aim: Chronic obstructive pulmonary disease (COPD) is a rather common comorbid condition among patients admitted to the intensive care unit (ICU), while evidence of how this comorbidity affects prognosis is limited. This study aimed to investigate the associations between COPD comorbidity and prognoses of patients who were admitted to the ICU for non-COPD reasons, and to examine whether the associations varied between different types of ICU.
Methods: A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥ 18 years) patients of first ICU admission in the database were enrolled as study participants but those with a primary diagnosis of COPD were excluded. The primary endpoint was 28-day mortality after ICU admission and multivariable Cox regression analyses were employed to assess the associations between COPD comorbidity and the study endpoints. Different adjusting models including a propensity score were used to adjust potential confounders.
Results: A total of 29,499 patients were enrolled finally, among which 3,332 patients (11.30%) were comorbid with COPD. A higher 28-day mortality was observed among patients with COPD than those without COPD (13.90% versus 8.07%, P< 0.001), but there was no statistically significant difference in the proportion of patients who needed mechanical ventilation on the first day after ICU admission between the two groups. Multivariable Cox regression analyses found a significant association between COPD comorbidity and 28-day mortality (adjusted hazard ratio=1.32, 95% confidence interval=1.19– 1.47, P< 0.0001). The associations were broadly consistent among patients admitted to different types of ICU, but a much higher estimate was observed in patients admitted to cardiac surgery recovery unit (adjusted hazard ratio=2.03, 95% confidence interval=1.44– 2.86, P< 0.0001).
Conclusion: Comorbid COPD increased the risk of 28-day mortality among patients admitted to the ICU for non-COPD reasons, especially for those admitted to the cardiac surgery recovery unit.
Keywords: chronic obstructive pulmonary disease, comorbidity, intensive care units, prognosis, risk factors
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