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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Pulmonary Medicine 1/2018

The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2018
Autoren:
Ruo-Xuan Dai, Qing-Hua Kong, Bei Mao, Wen Xu, Ru-Jia Tao, Xiao-Ru Wang, Qing-Yao Kong, Jin-Fu Xu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12890-018-0587-7) contains supplementary material, which is available to authorized users.

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in community acquired pneumonia (CAP) patients. We aimed to investigate the characteristics and mortality risk factors of COPD patients hospitalized with CAP.

Methods

A retrospective cohort study was conducted at Shanghai Pulmonary Hospital and Shanghai Dahua Hospital. Clinical and demographic data in patients diagnosed with CAP were collected between January 2015 and June 2016. Logistic regression analysis was performed to screen mortality risk factors of COPD patients hospitalized with CAP.

Results

Of the total 520 CAP patients, 230 (44.2%) patients had been diagnosed comorbid with COPD (COPD-CAP). CAP patients comorbid with COPD patients had higher rate of need for ICU admission (18.3% vs 13.1%) and need for NIMV (26.1% vs 1.4%) than without COPD (nCOPD-CAP). The PSI, CURB-65 and APACHE-II scores in COPD-CAP patients were higher than that in nCOPD-CAP patients (95 vs 79, P < 0.001; 1 vs 1, P < 0.001; 13 vs 8, P < 0.001, respectively). Logistic regression analysis indicated that aspiration, D-dimer > 2.0 μg/mL and CURB-65 ≥ 3 were risk factors associated with in-hospital mortality ((odd ratio) OR = 5.678, OR = 4.268, OR = 20.764, respectively) in COPD-CAP patients. The risk factors associated with 60-day mortality in COPD-CAP patients were comorbid with coronary heart disease, aspiration, need for NIMV (non-invasive mechanical ventilation) and CURB-65 ≥ 3 (OR = 5.206, OR = 7.921, OR = 3.974, OR = 18.002, respectively).

Conclusions

COPD patients hospitalized with CAP had higher rate of need for NIMV, need for ICU admission and severity scores than those without COPD. Aspiration, D-dimer > 2.0 μg/mL, comorbid with coronary heart disease, need for NIMV and CURB-65 ≥ 3 were mortality risk factors in CAP patients comorbid with COPD.
Zusatzmaterial
Additional file 1: Figure S1. Computing processes of Youden index. The optimal Sensitivity and Specificity of each ROC curve are highlighted. (TIFF 3568 kb)
12890_2018_587_MOESM1_ESM.tif
Additional file 2: Table S1. Arterial blood gas analysis of COPD-CAP patients in stable stage and on admission. (DOC 31 kb)
12890_2018_587_MOESM2_ESM.doc
Additional file 3: Table S2. Logistic regression analyses of the risk factors associated with in-hospital mortality in CAP patients without COPD. (DOC 37 kb)
12890_2018_587_MOESM3_ESM.doc
Additional file 4: Table S3. Logistic regression analyses of the risk factors associated with 60-day mortality in CAP patients without COPD. (DOC 38 kb)
12890_2018_587_MOESM4_ESM.doc
Additional file 5: Figure S2. ROC curves for the PSI, CURB-65 and APACHE-II to predict primary outcomes in CAP patients with COPD. (A) ROC curves for the PSI, CURB-65 and APACHE-II to predict in-hospital mortality in CAP patients with COPD. (B) ROC curves for the PSI, CURB-65 and APACHE-II to predict 60-day mortality in CAP patients with COPD. ROC curve, receiver operating characteristic curve; AUC, area under the curve; Se, Sensitivity; Sp, Specificity; CI, confidence interval. (TIFF 881 kb)
12890_2018_587_MOESM5_ESM.tif
Additional file 6: Figure S3. ROC curves for the PSI, CURB-65 and APACHE-II to predict secondary outcomes in CAP patients with COPD. (A) ROC curves for the PSI, CURB-65 and APACHE-II to predict need for ICU admission in CAP patients with COPD. (B) ROC curves for the PSI, CURB-65 and APACHE-II to predict need for NIMV in CAP patients with COPD. ROC curve, receiver operating characteristic curve; ICU, intensive care unit; NIMV, non-invasive mechanical ventilation AUC, area under the curve; Se, Sensitivity; Sp, Specificity; CI, confidence interval. (TIFF 901 kb)
12890_2018_587_MOESM6_ESM.tif
Literatur
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