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Hypercapnia at Hospital Admission as a Predictor of Mortality

Authors Vonderbank S, Gibis N, Schulz A, Boyko M, Erbuth A, Gürleyen H, Bastian A

Received 12 December 2019

Accepted for publication 2 June 2020

Published 26 June 2020 Volume 2020:12 Pages 173—180


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Hans-Christoph Pape

Sandy Vonderbank, Natalie Gibis, Alina Schulz, Mariya Boyko, Annika Erbuth, Hakan Gürleyen, Andreas Bastian

Marienkrankenhaus Kassel, Kassel, Germany

Correspondence: Andreas Bastian
Marienkrankenhaus Kassel, Kassel, Germany
Tel +49 561 8073 1212
Fax +49 561 8073 4200

Introduction: Hypercapnia is an indicator of ventilatory exhaustion. There is some disagreement regarding whether hypercapnia is also a predictor of mortality. In this prospective study, we aimed to investigate whether hypercapnia can predict in-hospital and 1-year mortality rates in patients with dyspnea or pulmonary diseases.
Patients and Methods: All patients with dyspnea or pulmonary diseases underwent routine blood gas analysis at hospital admission. During the 12-month enrollment period, 2710 patients were enrolled, and 588 patients with hypercapnia at admission were identified. Of the 1626 normocapnic patients, 62 were randomly selected as controls. In-hospital and 1-year mortality rates were determined.
Results: There were significant increases in mortality rate between acute hypercapnic patients and both chronic hypercapnic patients and normocapnic controls. Their in-hospital mortality rates were 17%, 6.7% and 3.2%, respectively. Their 1-year mortality rates were 32%, 20.2% and 14.5%, respectively. The 1-year mortality rates of hypercapnic patients with different underlying diseases were 24.6% (chronic obstructive pulmonary disease), 28.4% (congestive heart disease), 1.6% (obstructive sleep apnea syndrome/obesity hypoventilation syndrome), 50.9% (pneumonia), 0% (suppressed central respiratory drive, primarily due to opiate abuse) and 22.8% (other conditions).
Discussion: The 1-year mortality rate of patients with acute hypercapnia at hospital admission was 32%, with significant differences compared to chronic hypercapnic patients (20.2%) and normocapnic patients (14.5%). There was a wide range of 1-year mortality rates between the hypercapnic patients with different underlying diseases.

Keywords: hypercapnia, mortality, COPD

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