Predictors of in-hospital mortality in patients with acute exacerbation of COPD requiring ventilation: a retrospective study

Background: Previous studies sought to identify survival or outcome predictors in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation (MV), but their findings are inconsistent. This study aims to identify clinical predictors of in-hospital mortality among these patients. Material and methods: We conducted a retrospective cohort study of 146 patients admitted to intensive care unit who required IMV for acute exacerbation of COPD between July 2010 and June 2014. Results: The mean age of the study population was 68 ± 11 years. Ninety-six of the patients accepted IMV immediately. Non-invasive positive pressure ventilation (NIPPV) was used in the 50 patients who refused to accept intubation. Of these, 21 patients accepted IMV when deterioration of their vital signs was observed, and 29 patients were given NIPPV continuously. The in-hospital mortality rate was 37.0% for the entire cohort, 29.2% for patients who accepted IMV immediately, 52.4% for patients who accepted IMV on deterioration of their vital signs, and 52.7% for patients given NIPPV continuously. Using binary logistic regression analysis, the in-hospital mortality rate of all 146 patients was positively correlated with multi-organ dysfunction syndrome (MODS), higher APACHEII (acute physiology and chronic health evaluation) score at the beginning of MV, delayed intubation, multidrug resistant organisms (MDRO), higher levels of brain natriuretic peptide (BNP) and the presence of Aspergillus. Conclusions: MODS, higher APACHE II score at the beginning of MV, delayed intubation, MDRO, higher levels of BNP and Aspergillus may be risk factors for mortality in patients who require IMV for acute respiratory failure attributable to COPD.