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Prognosis after Intensive Care for COPD Exacerbation in Relation to Long-Term Oxygen Therapy : A Nationwide Cohort Study

Nyström, Helena LU ; Ekström, Magnus LU orcid ; Berkius, Johan ; Ström, Axel ; Walther, Sten LU and Inghammar, Malin LU (2023) In COPD: Journal of Chronic Obstructive Pulmonary Disease 20(1). p.64-70
Abstract

Decisions to admit or refuse admission to intensive care for acute exacerbations of COPD (AECOPD) can be difficult, due to an uncertainty about prognosis. Few studies have evaluated outcomes after intensive care for AECOPD in patients with chronic respiratory failure requiring long-term oxygen therapy (LTOT). In this nationwide observational cohort study, we investigated survival after first-time admission for AECOPD in all patients aged ≥40 years admitted to Swedish intensive care units between January 2008 and December 2015, comparing patients with and without LTOT. Among the 4,648 patients enrolled in the study, 450 were on LTOT prior to inclusion. Respiratory support data was available for 2,631 patients; 73% of these were treated... (More)

Decisions to admit or refuse admission to intensive care for acute exacerbations of COPD (AECOPD) can be difficult, due to an uncertainty about prognosis. Few studies have evaluated outcomes after intensive care for AECOPD in patients with chronic respiratory failure requiring long-term oxygen therapy (LTOT). In this nationwide observational cohort study, we investigated survival after first-time admission for AECOPD in all patients aged ≥40 years admitted to Swedish intensive care units between January 2008 and December 2015, comparing patients with and without LTOT. Among the 4,648 patients enrolled in the study, 450 were on LTOT prior to inclusion. Respiratory support data was available for 2,631 patients; 73% of these were treated with noninvasive ventilation (NIV) only, 17% were treated with immediate invasive ventilation, and 10% were intubated after failed attempt with NIV. Compared to patients without LTOT, patients with LTOT had higher 30-day mortality (38% vs. 25%; p < 0.001) and one-year mortality (70% vs. 43%; p < 0.001). Multivariable logistic and Cox regression models adjusted for age, sex and SAPS3 score confirmed higher mortality in LTOT, odds ratio for 30-day mortality was 1.8 ([95% confidence interval] 1.5–2.3) and hazard ratio for one-year mortality was 1.8 (1.6–2.0). In summary, although need for LTOT is a negative prognostic marker for survival after AECOPD requiring intensive care, a majority of patients with LTOT survived the AECOPD and 30% were alive after one year.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
AECOPD, COPD exacerbation, ICU, intensive care, Long-term oxygen therapy, LTOT
in
COPD: Journal of Chronic Obstructive Pulmonary Disease
volume
20
issue
1
pages
64 - 70
publisher
Taylor & Francis
external identifiers
  • pmid:36656666
  • scopus:85146977686
ISSN
1541-2555
DOI
10.1080/15412555.2022.2106840
language
English
LU publication?
yes
id
91557057-7063-4f93-9401-36a417d404ea
date added to LUP
2023-02-14 14:55:39
date last changed
2024-04-18 18:48:24
@article{91557057-7063-4f93-9401-36a417d404ea,
  abstract     = {{<p>Decisions to admit or refuse admission to intensive care for acute exacerbations of COPD (AECOPD) can be difficult, due to an uncertainty about prognosis. Few studies have evaluated outcomes after intensive care for AECOPD in patients with chronic respiratory failure requiring long-term oxygen therapy (LTOT). In this nationwide observational cohort study, we investigated survival after first-time admission for AECOPD in all patients aged ≥40 years admitted to Swedish intensive care units between January 2008 and December 2015, comparing patients with and without LTOT. Among the 4,648 patients enrolled in the study, 450 were on LTOT prior to inclusion. Respiratory support data was available for 2,631 patients; 73% of these were treated with noninvasive ventilation (NIV) only, 17% were treated with immediate invasive ventilation, and 10% were intubated after failed attempt with NIV. Compared to patients without LTOT, patients with LTOT had higher 30-day mortality (38% vs. 25%; p &lt; 0.001) and one-year mortality (70% vs. 43%; p &lt; 0.001). Multivariable logistic and Cox regression models adjusted for age, sex and SAPS3 score confirmed higher mortality in LTOT, odds ratio for 30-day mortality was 1.8 ([95% confidence interval] 1.5–2.3) and hazard ratio for one-year mortality was 1.8 (1.6–2.0). In summary, although need for LTOT is a negative prognostic marker for survival after AECOPD requiring intensive care, a majority of patients with LTOT survived the AECOPD and 30% were alive after one year.</p>}},
  author       = {{Nyström, Helena and Ekström, Magnus and Berkius, Johan and Ström, Axel and Walther, Sten and Inghammar, Malin}},
  issn         = {{1541-2555}},
  keywords     = {{AECOPD; COPD exacerbation; ICU; intensive care; Long-term oxygen therapy; LTOT}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{64--70}},
  publisher    = {{Taylor & Francis}},
  series       = {{COPD: Journal of Chronic Obstructive Pulmonary Disease}},
  title        = {{Prognosis after Intensive Care for COPD Exacerbation in Relation to Long-Term Oxygen Therapy : A Nationwide Cohort Study}},
  url          = {{http://dx.doi.org/10.1080/15412555.2022.2106840}},
  doi          = {{10.1080/15412555.2022.2106840}},
  volume       = {{20}},
  year         = {{2023}},
}