Chronic obstructive pulmonary disease (COPD) is an independent risk factor for death in patients with sepsis, although the association between COPD and higher mortality in patients with sepsis is still hypothetical, according to study findings published in BMC Pulmonary Medicine.
Previous research has been inconclusive as to whether or not COPD is associated with greater all-cause mortality in those with sepsis. Investigators therefore sought to evaluate the effect of COPD on the prognosis of patients with sepsis.
The investigators conducted a retrospective study using the Medical Information Mart for Intensive Care (MIMIC-III) database, using ICD-9 codes to identify patients with sepsis admitted to intensive care units (ICUs) between 2008 and 2012. From this patient population, the investigators identified patients with and without COPD and noted 28-day all-cause mortality rates.
MIMIC-III is a single-center critical care database that includes patients (at least 16 years of age) admitted to critical care units in the Beth Israel Deaconess Medical Center in Boston between 2001 and 2012. Sepsis was defined as suspected or documented infection and an acute change in total Sequential Organ Failure Assessment (SOFA) score of at least 2.
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“[T]he results revealed that septic patients with COPD had worse status than those without COPD when admitted in ICU.
Overall, 6257 patients with sepsis were included in analyses (n=955 [15.3%] with COPD; n=5302 [84.7%] without COPD). Patients with COPD vs those without tended to be older (median [interquartile range {IQR}] age, 73.5 [64.4-82.0] years vs 65.8 [52.9-79.1] years; P <.001); to be more likely to need mechanical ventilatory (MV) support (55.0% vs 48.9%; P =.001); and to have a higher simplified acute physiology score II (SAPSII; median [IQR], 40.0 [33.0-49.0] vs 38.0 [29.0-47.0]; P <.001). Patients with COPD tended to be White and less likely to be Black or Hispanic; the patients with COPD were also more likely to have comorbidities of atrial fibrillation, coronary artery disease, and congestive heart failure (all P <.001).
Patients with sepsis with COPD vs those with sepsis without COPD had higher 28-day all-cause mortality (23.6% vs 16.4%; P <.001). COPD was indicated as an independent risk factor for 28-day all-cause mortality in patients with sepsis, after adjusting for covariates (hazard ratio, 1.30; 95% CI, 1.12-1.50; P =.001). Patients with COPD had higher in-ICU mortality (13.5% vs 8.9%) and higher in-hospital mortality (17.1% vs 12.3%). Additionally, patients with COPD had higher 7-, 14-, and 21-day mortality.
Study limitations include use of ICD-9 codes as a proxy for spirometry in defining COPD and unaccounted-for confounding factors.
“Our study provided evidence that COPD was an independent risk factor for 28-day all-cause mortality in septic patients,” the investigators concluded, adding, “[T]he results revealed that septic patients with COPD had worse status than those without COPD when admitted in ICU.”
