Yoğun bakım ünitesinde takip edilen KOAH'lı hastalarda mortalite ve hasta sonuçlarını etkileyen faktörler

Abstract

Amaç: KOAH alevlenme ile karakterize olup pnömoni ve sepsis gibi durumlarda yoğun bakım ünitesine yatışa neden olabilmektedir. Non-invaziv mekanik ventilasyon yoğun bakım ünitelerinde ilk tedavi seçeneği olmakla birlikte mortaliteyi ve hastanede kalış süresini azaltmaktadır. Çalışmamızda yoğun bakım ünitesine kabul edilen KOAH'lı hastalarda mortaliteyi etkileyen faktörleri belirlemeyi amaçladık. Materyal ve Metod: Çalışmamızda Bolu İzzet Baysal Devlet Hastanesi yoğun bakım ünitesine KOAH tanısı ile yatırılan hastaların verileri retrospektif olarak değerlendirildi. Yoğun bakımda kalış süresi, APACHE II skoru, komorbiditeler, noninvaziv mekanik ventilasyon ihtiyacı, CRP albumin oranı ve lökosit lenfosit oranı kaydedildi. Bulgular: Çalışmamıza 177'si (%42,5) kadın olmak üzere toplam 416 hasta dahil edilmiştir. Hastaların 107'si (%25,7) (Grup 1) KOAH alevlenmesi, 183'ü (%44) (Grup 2) pnömoni ve 126'sı (%30,3) (Grup 3) sepsis nedeniyle YBÜ'ye kabul edilmiştir. Hipertansiyon 112 hastada (%26,9) en sık görülen komorbidite olmuştur. Mortalite, pnömoni ve sepsis hastalarında KOAH alevlenmesi olan hastalara göre daha yüksekti. Tüm hastalar prognoza göre karşılaştırıldığında, ölen hastalarda yaş, YBÜ'de kalış süresi, NLR, CAR ve APACHE II skorları daha yüksekti. Non-invaziv mekanik ventilasyon süresi KOAH atağı olan hastalarda daha yüksekken, mortalite invaziv mekanik ventilasyon desteği alan hastalarda daha yüksekti. Sonuç: KOAH'lı hastalarda pnömoni ve sepsis mortaliteyi artırırken, NIMV bu hastalarda olumlu bir prognoza sahiptir ve cesaret verici sonuçlar vermektedir.

Keywords

• kronik obstrüktif akciğer hastalığı alevlenmesi
• noninaziv mekanik ventilasyon
• yoğun bakım ünitesi
• CRP albümin oranı
• Nötrofil lenfosit oranı

Factors affecting mortality and patient outcome in patients with COPD followed in the intensive care unit

Abstract

Objective: COPD is characterized by exacerbation and may lead to intensive care unit admission in cases such as pneumonia and sepsis. While non-invasive mechanical ventilation is the first treatment option in intensive care units, it reduces mortality and hospitalization. In our study, we aimed to determine the factors affecting mortality in patients with COPD admitted to intensive care unit. Materials and Methods: In our study, the data of patients admitted to the intensive care unit of Bolu Izzet Baysal State Hospital with COPD were evaluated retrospectively. Duration of intensive care unit stay, APACHE II score, comorbidities, need for noninvasive mechanical ventilation, CRP albumin ratio and leukocyte lymphocyte ratio were recorded. Results: A total of 416 patients, including 177 (42.5%) women, were included in our study. Of the patients, 107 (25.7%) (Group 1) were admitted to ICU for COPD exacerbation, 183 (44%) (Group 2) for pneumonia and 126 (30.3%) (Group 3) for sepsis. Hypertension was the most common comorbidity in 112 patients (26.9%). Mortality was higher in patients with pneumonia and sepsis than in patients with COPD exacerbation. When all patients were compared according to prognosis, age, length of ICU stay, NLR, CAR and APACHE II scores were higher in patients who died. The duration of non-invasive mechanical ventilation was higher in patients with an episode of COPD, while mortality was higher in patients receiving invasive mechanical ventilation support. CONCLUSION While pneumonia and sepsis increase mortality in patients with COPD, NIMV has a favorable prognosis in these patients with encouraging results.

Keywords

• chronic obstructive pulmonary disease exacerbation
• non inasive mechanical ventilation
• intensive care unit
• CRP to albümin ratio
• Neutrophil to lymphocyte ratio

References

1. 1-Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: systematic review and meta–analysis. J Glob Health 2015;5(2):020415.
2. 2- Centers for Disease Control and Prevention [Internet]. Chronic Obstructive Pulmonary Disease. Data and Statistics.2016 march. Available from: https://www.cdc. gov/copd/data/
3. 3- Jinjuvadia C, Jinjuvadia R, Mandapakala C, Durairajan N, Liangpunsakul S, Soubani AO. Trends in Outcomes, Financial Burden, and Mortality for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in the United States from 2002 to 2010. COPD. 2017;14(1):72-79.
4. 4- Ai-Ping C, Lee KH, Lim TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest 2005;128(2):518–24.
5. 5- Rivera-Fernández R, Navarrete-Navarro P, Fernández-Mondejar E, Rodriguez-Elvira M, Guerrero-López F, Vázquez-Mata G; Project for the Epidemiological Analysis of Critical Care Patients (PAEEC) Group. Six-year mortality and quality of life in critically ill patients with chronic obstructive pulmonary disease. Crit Care Med. 2006;34(9):2317-24.
6. 6- Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154(4 Pt 1):959-67. Erratum in: Am J Respir Crit Care Med 1997;55(1):386.
7. 7- Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA. 1995;274(23):1852-7.
8. 8- Alaithan AM, Memon JI, Rehmani RS, Qureshi AA, Salam A. Chronic obstructive pulmonary disease: hospital and intensive care unit outcomes in the Kingdom of Saudi Arabia. Int J Chron Obstruct Pulmon Dis. 2012;7:819-23.

9. 9- Raurich JM, Pérez J, Ibáñez J, Roig S, Batle S. In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Arch Bronconeumol. 2004;40(7):295-300.
10. 10- Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med. 2020;24(Suppl 1):61-81.
11. 11- Romero-Dapueto C, Budini H, Cerpa F, Caceres D, Hidalgo V, Gutiérrez T, Keymer J, et al. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation. Open Respir Med J. 2015;9:97-103.
12. 12- Jiang HL, Chen HX, Liu W, Fan T, Liu GJ, Mao B. Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta-analysis. Respirology. 2015;20(7):1046-54.
13. 13- Chen CH, Lai CC, Wang YH, Wang CY, Wang HC, Yu CJ et al. Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE). The Impact of Sepsis on the Outcomes of COPD Patients: A Population-Based Cohort Study. J Clin Med. 2018;7(11):393.
14. 14- Yu Y, Liu W, Jiang HL, Mao B. Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis. Respiration. 2021;100(1):64-76
15. 15- Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore). 2018;97(17):e0487.
16. 16- Crisafulli E, Menéndez R, Huerta A, Martinez R, Montull B, Clini E et al. Systemic inflammatory pattern of patients with community-acquired pneumonia with and without COPD. Chest. 2013;143(4):1009-1017.
17. 17- Dai RX, Kong QH, Mao B, Xu W, Tao RJ, Wang XR et al. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMC Pulm Med. 2018;18(1):12.
18. 18- Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003;138(11):861-70.
19. 19- Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. 2003;163(10):1180-6.
20. 20- Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557-82.
21. 21- Goodacre S, Stevens JW, Pandor A, Poku E, Ren S, Cantrell A et al. Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis. Acad Emerg Med. 2014;21(9):960-70.
22. 22- Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis. 2014;9:837-52.
23. 23- Díaz O, Bégin P, Torrealba B, Jover E, Lisboa C. Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD. Eur Respir J. 2002;20(6):1490-8
24. 24- British Thoracic Society Standards of Care Committee. Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57(3):192-211.
25. 25-. Gomez-Junyent J, Garcia-Vidal C, Viasus D. Clinical features, etiology and outcomes of communityacquired pneumonia in patients with chronic obstructive pulmonary disease. PLoS One. 2014;9(8):e105854.
26. 26- Cırık MÖ, Baldemir R, Doganay GE, Ünver M, Avcı S: The 30-day mortality predictor role of c-reactive protein/albumin ratio in critically ill COPD patients. Crit. Care Innov. 2020;3:1-12.
27. 27-Kim MH, Ahn JY, Song JE, Choi E, Ann HW, Kim JK, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goaldirected therapy. PLoS One.2015;10(7): e0132109.
28. 28-Oh TK, Ji E, Na H, Min B, Jeon YT, Do SH et al. C-reactive protein to albumin ratio predicts 30-day and 1-year mortality in postoperative patients after admission to the intensive care unit. J Clin Med. 2018;7(3):39.
29. 29- Xiong W, Xu M, Zhao Y, Wu X, Pudasaini B, Liu JM. Can we predict the prognosis of COPD with a routine blood test?. Int J Chron Obstruct Pulmon Dis 2017;12: 615-25.