Predictors of Hospital Outcome and Intubation of Patients Hospitalized for Exacerbation of Chronic Obstructive Pulmonary Disease

DISCUSSION

We studied 120 patients with COPD. Their mean age is 64.43±6.83 years old. This is correlating with reports from Ucgun et al in which mean age was 65.1 years. ³ 85.8% of them were male. This result agrees with the results of several studies. ^{3, 5} the high prevalence of COPD in men is due to higher prevalence of smoking in this sex, and males are also more exposed to smoking than females. ⁶

Regarding smoking status 57.5% of patients were smokers, 28.3% of them were ex-smoker which is coping with results of the study done by Said et al. ⁷Approximately 50% of smokers developing COPD during their lifetime .⁸

 In the present study patients were divided according to hospital course to three groups group I including 84 (70%) of studied patients who were improved, group II including 22 (18.3%) of studied patients who needed noninvasive ventilation and group III including 14 (11.7%) of studied Patients who needed invasive ventilation.

Our results indicated that patients suffered from ischemic heart disease with hypertension, old ischemic stroke and old hemorrhagic stroke with hypertension had bad hospital course which is coping with several studies that showed that patients with bad outcome of COPD exacerbation had more than two comorbidities, mostly cardiovascular comorbidities.^{5, 9} Anzueto et al   reported that cardiovascular comorbidities are risk factors for bad outcome in COPD patients. ⁹

 Table 1shows that there were statistically significant increase previous exacerbations (p value 0.001), hospitalization for COPD exacerbation (p value 0.001) and intubation last 5 years (p value <0.001) in patients need invasive ventilation. That is consistent with the results of Soler et al   whitch shows increased risk of death with frequent exacerbations. ¹⁰These results can be explained by the increase of severity of exacerbations over time, and also sputum purulence increases throughout the disease. This suggests that patients with more severe exacerbations have more inflammation. ¹¹

56.6% of patients were presented with dyspnea at admission, this finding is similar to results from Mohan et al. ¹² In this work most of patients were presented with cough and dyspnea, reports from Grolimund et al    and roche et al   agreed with these results. ^{13, 14}

Table 2 shows as regard to risk factors of COPD exacerbations among all studied groups there was statistically significant increase   in air pollution and pneumonia   in patients needed ventilation with p value of 0.037 and 0.038 respectively that may be due to complications of pneumonia and presence of air pollution that worsen the lung function.

As regard COPDSS there was statistically significant increase COPDSS in patients need invasive ventilation. Miravitlles et al   showed that COPDSS was found to be a predictor for failure of treatment in COPD exacerbation.⁴

In this study ABG was statistically significant in patients need MV as regard lower PH and higher Co₂, this correlate with results from Matkovic et al that assumed that ABG analysis had a high predictive value for outcome for patients hospitalized for COPD exacerbation⁵, also this result is coping with several studies that shows that higher Co₂ was related to bad outcome of COPD patients. ¹⁵

In the current study the mean of FEV₁/FVC was 0.62, mean of FVC was 72.66, mean of FEV₁ was 45.26. There was statistically significant increase in spirometry values in patients improved, that is consistent with study by Matkovic et al which shows there is increased spirometry values in patients with good outcome. ⁵ Similar results have been found in many studies and may be explained by the degree of ventilatory impairment and also exposure to the risk of colonization by aggressive bacteria which causes exacerbation.¹⁶

Our study shows that 14 patients needed intubation. 35.7% of them was intubated due to Low Glasgow coma score, while 21.4% of patients was intubated due to apnea and 21.4% was intubated due to Failure of NIV with confusion that is coping with. ³ In this work 6 patients were intubated at time of admission. 66% was intubated due to low Glasgow coma score, 33% of them was intubated due to apnea.

Our results indicate that as regard outcome of all studied groups there was high significance increase regarding discharge in patients improved (p value 0.000) and there was high significance increase regarding readmission and death in patients needed ventilation (p value 0.000). That is coping with results of Mohan et al. ¹²The lowest readmission rate (4.5%) was with patients needed NIV. this result is attributed to that NIV increases alveolar ventilation and improves gas exchanges. also NIV reduces the patients’ effort, dyspnea, the need for intubation, length of stay in ICU and the mortality rate. ¹⁷

CONCLUSION

The need for invasive ventilation and complications due to mechanical ventilation (MV) are the most important predictors connected to hospital mortality in COPD exacerbation. Comorbidities with Cardio vascular diseases, previous exacerbations, hospitalization for COPD exacerbation, intubation last 5 years, exposure to air pollution and pneumonia, dyspnea at time of admission, increase COPDSS and increase respiratory rate, pleural effusion, and bronchiectasis had highest risks to invasive ventilation. There was increase regarding readmission and death in patients needed ventilation.