Factors associated with in-hospital mortality in patients with chronic obstructive pulmonary disease hospitalized to the intensive care unit due to septic shock

Öz

Aim: This study aimed to evaluate in-hospital mortality-related factors in patients with chronic obstructive pulmonary disease (COPD) who were admitted to the intensive care unit (ICU) due to septic shock. Material and Methods: This retrospective study included 62 COPD patients diagnosed with septic shock in a tertiary ICU. The Sepsis-3 criteria were used to establish the diagnosis of sepsis shock. Demographic and clinical data, including comorbid conditions, laboratory parameters, inflammatory markers, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, and clinical outcomes were collected from electronic medical records. The modified Charlson Comorbidity Index (mCCI) calculation was based on the available comorbid conditions collected in the prehospital setting. Results: The mean age of the study population was 70.6 ± 11.0 years, and 67.7% were male. Higher mCCI scores [Hazard ratio (HR): 1.23, p = 0.002], along with elevated APACHE II (HR: 1.15, p < 0.001) and SOFA scores (HR: 1.35, p < 0.001), were independent predictors of in-hospital mortality. Among laboratory parameters, higher procalcitonin (HR: 1.04, p < 0.001), and C-reactive protein (HR: 1.03, p< 0.001) were associated with mortality in univariate analysis but did not remain significant in multivariate regression. The optimal mCCI cut-off for predicting mortality was ≥7, yielding a sensitivity of 72.5% and specificity of 94.7%. Conclusion: The mCCI, along with APACHE II and SOFA scores, serves as a significant independent predictor of mortality in COPD patients with septic shock. The mCCI may be a useful tool for risk stratification in this high-risk population.

Anahtar Kelimeler

• Comorbidity
• chronic obstructive pulmonary disease
• inflammation
• septic shock
• survival

Etik Beyan

The study was conducted with the permission of the XXX University Hospital Ethics Committee (Date: 26.09.2024, Decision No: 2024/005).

Septik şok nedeniyle yoğun bakım ünitesine yatırılan kronik obstrüktif akciğer hastalığı olan hastalarda hastane içi ölüm ile ilişkili faktörler

Öz

Amaç: Bu çalışma, septik şok nedeniyle yoğun bakım ünitesine (YBÜ) kabul edilen kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda hastane içi ölüm ile ilişkili faktörleri değerlendirmeyi amaçladı. Gereç ve Yöntemler: Bu retrospektif çalışmaya, bir üçüncü basamak yoğun bakım ünitesinde septik şok tanısı almış 62 KOAH hastası dahil edildi. Sepsis-3 kriterleri, septik şok tanısını koymada kullanıldı. Elektronik tıbbi kayıtlar aracılığıyla demografik ve klinik veriler, komorbid durumlar, laboratuvar parametreleri, inflamatuar belirteçler, Akut Fizyoloji ve Kronik Sağlık Değerlendirme II (APACHE II) skoru, Sekansiyel Organ Yetmezliği Değerlendirme (SOFA) skoru ve klinik sonuçlar toplandı. Modifiye Charlson Komorbidite İndeksi (mCCI), hastaların hastane öncesi dönemde sahip olduğu komorbid durumlar kullanılarak hesaplandı. Bulgular: Çalışma popülasyonunun ortalama yaşı 70.6 ± 11.0 yıl olup, %67.7'si erkekti. Daha yüksek mCCI skorları [Hazard oranı (HR):1.23, p = 0.002], yüksek APACHE II (HR: 1.15, p < 0.001) ve SOFA skorları (HR: 1.35, p < 0.001) ile birlikte hastane içi ölümün bağımsız öngörücüleriydi. Laboratuvar parametreleri arasında, yüksek prokalsitonin (HR: 1.04, p < 0.001) ve C-reaktif protein (HR: 1.03, p < 0.001) seviyeleri tek değişkenli analizde mortalite ile ilişkili bulundu, ancak çok değişkenli regresyon analizinde anlamlılığını korumadı. Mortaliteyi öngörmede mCCI eşik değeri ≥7 olarak belirlendi ve bu değer, %72.5 duyarlılık ve %94.7 özgüllük gösterdi. Sonuç: Septik şoklu KOAH hastalarında, mCCI, APACHE II ve SOFA skorlarıyla mortalitenin önemli bir bağımsız öngörücüsü olarak belirlendi. Bu yüksek riskli popülasyonda, mCCI risk sınıflandırması için yararlı bir araç olabilir.

Anahtar Kelimeler

• Eşlik eden hastalık
• kronik obstrüktif akciğer hastalığı
• inflamasyon
• septik şok
• sağkalım

Etik Beyan

The study was conducted with the permission of the XXX University Hospital Ethics Committee (Date: 26.09.2024, Decision No: 2024/005).

Kaynakça

1. Jo YS. Long-Term Outcome of Chronic Obstructive Pulmonary Disease: A Review. Tuberc Respir Dis (Seoul). 2022;85(4):289-301. DOI: 10.4046/trd.2022.0074.
2. Chen CH, Lai CC, Wang YH, et al. The Impact of Sepsis on the Outcomes of COPD Patients: A Population-Based Cohort Study. J Clin Med. 2018;7(11) DOI: 10.3390/jcm7110393.
3. Lee R, Lee D, Mamidi IS, Probasco WV, Heyer JH, and Pandarinath R. Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. Clin Orthop Relat Res. 2019;477(2):416-23. DOI: 10.1097/CORR.0000000000000531.
4. Piussan C, Risbourg B, Krim G, Herbaut C, Lenaerts C, and Quintard JM. [Evolutive fracture of skull bones (author's transl)]. Ann Pediatr (Paris). 1979;26(5):289-93.
5. Blanco J, Muriel-Bombin A, Sagredo V, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008;12(6):R158. DOI: 10.1186/cc7157.
6. Zhang L, Li X, Huang J, et al. Predictive model of risk factors for 28-day mortality in patients with sepsis or sepsis-associated delirium based on the MIMIC-IV database. Sci Rep. 2024;14(1):18751. DOI: 10.1038/s41598-024-69332-4.
7. Ongel EA, Karakurt Z, Salturk C, et al. How do COPD comorbidities affect ICU outcomes? Int J Chron Obstruct Pulmon Dis. 2014;9:1187-96. DOI: 10.2147/COPD.S70257.
8. Chen Y, Lu L, Li X, et al. Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database. BMC Pulm Med. 2023;23(1):435. DOI: 10.1186/s12890-023-02729-5.

9. Eroglu SA, Gunen H, Yakar HI, Yildiz E, Kavas M, and Duman D. Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients. J Thorac Dis. 2019;11(4):1379-86. DOI: 10.21037/jtd.2019.03.78.
10. Almagro P, Cabrera FJ, Diez J, et al. Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study. Chest. 2012;142(5):1126-33. DOI: 10.1378/chest.11-2413.
11. Stenberg H, Li X, Pello-Esso W, et al. The effects of sociodemographic factors and comorbidities on sepsis: A nationwide Swedish cohort study. Prev Med Rep. 2023;35:102326. DOI: 10.1016/j.pmedr.2023.102326.
12. Argun Baris S, Boyaci H, Akhan S, Mutlu B, Deniz M, and Basyigit I. Charlson Comorbidity Index in Predicting Poor Clinical Outcomes and Mortality in Patients with COVID-19. Turk Thorac J. 2022;23(2):145-53. DOI: 10.5152/TurkThoracJ.2022.21076.
13. Jouffroy R, Parfait PA, Gilbert B, et al. Relationship between prehospital modified Charlson Comorbidity Index and septic shock 30-day mortality. Am J Emerg Med. 2022;60:128-33. DOI: 10.1016/j.ajem.2022.08.003.
14. Leuzzi G, Galeone C, Taverna F, Suatoni P, Morelli D, and Pastorino U. C-reactive protein level predicts mortality in COPD: a systematic review and meta-analysis. Eur Respir Rev. 2017;26(143):160070. DOI: 10.1183/16000617.0070-2016.
15. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, and Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321. DOI: 10.1371/journal.pone.0059321.
16. Schuetz P, Birkhahn R, Sherwin R, et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017;45(5):781-89. DOI: 10.1097/CCM.0000000000002321.
17. Ergan B, Sahin AA, and Topeli A. Serum Procalcitonin as a Biomarker for the Prediction of Bacterial Exacerbation and Mortality in Severe COPD Exacerbations Requiring Mechanical Ventilation. Respiration. 2016;91(4):316-24. DOI: 10.1159/000445440.
18. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-74. DOI: 10.1001/jama.2016.0288.
19. Darden DB, Moore FA, Brakenridge SC, et al. The Effect of Aging Physiology on Critical Care. Crit Care Clin. 2021;37(1):135-50. DOI: 10.1016/j.ccc.2020.08.006.
20. Ibarz M, Haas LEM, Ceccato A, and Artigas A. The critically ill older patient with sepsis: a narrative review. Ann Intensive Care. 2024;14(1):6. DOI: 10.1186/s13613-023-01233-7.
21. Antonelli Incalzi R, Fuso L, De Rosa M, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10(12):2794-800. DOI: 10.1183/09031936.97.10122794.
22. Afessa B, Morales IJ, Scanlon PD, and Peters SG. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med. 2002;30(7):1610-5. DOI: 10.1097/00003246-200207000-00035.
23. Galani M, Kyriakoudi A, Filiou E, et al. Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with COPD exacerbation. Pneumon. 2021;34(2):9.
24. Choudhry N, Singh L, Tandon R, and Khattri U, Validity of APACHE II and SOFA score in predicting prognosis in mechanically ventilated patients in respiratory ICU. 2021, European Respiratory Society.
25. Kumar S, Gattani SC, Baheti AH, and Dubey A. Comparison of the Performance of APACHE II, SOFA, and mNUTRIC Scoring Systems in Critically Ill Patients: A 2-year Cross-sectional Study. Indian J Crit Care Med. 2020;24(11):1057-61. DOI: 10.5005/jp-journals-10071-23549.
26. Bloria SD, Chauhan R, Sarna R, Gombar S, and Jindal S. Comparison of APACHE II and APACHE IV score as predictors of mortality in patients with septic shock in intensive care unit: A prospective observational study. J Anaesthesiol Clin Pharmacol. 2023;39(3):355-59. DOI: 10.4103/joacp.joacp_380_21.
27. Hai PD and Viet Hoa LT. The Prognostic Accuracy Evaluation of mNUTRIC, APACHE II, SOFA, and SAPS 2 Scores for Mortality Prediction in Patients with Sepsis. Crit Care Res Pract. 2022;2022:4666594. DOI: 10.1155/2022/4666594.
28. Rios-Toro JJ, Marquez-Coello M, Garcia-Alvarez JM, et al. Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock. PLoS One. 2017;12(4):e0175254. DOI: 10.1371/journal.pone.0175254.
29. Kilinc Toker A, Celik I, Turunc Ozdemir A, et al. The value of C-reactive protein velocity (CRPv) on mortality in sepsis patients who are emergently hospitalized in the ICU: A retrospective single-center study. Heliyon. 2024;10(19):e38797. DOI: 10.1016/j.heliyon.2024.e38797.
30. Devran O, Karakurt Z, Adiguzel N, et al. C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit. Multidiscip Respir Med. 2012;7(1):47. DOI: 10.1186/2049-6958-7-47.
31. Shimazui T, Matsumura Y, Nakada TA, and Oda S. Serum levels of interleukin-6 may predict organ dysfunction earlier than SOFA score. Acute Med Surg. 2017;4(3):255-61. DOI: 10.1002/ams2.263.