Risk Factors Predicting in Hospital Mortality Among Intubated Patients with Exacerbation of Chronic Obstructive Pulmonary Disease Associated with Ventilation-Associated Pneumonia

Abstract

Approximately every fourth patients with acute exacerbation of chronic obstructive pulmonary disease (AE COPD) will require intensive care unit (ICV) admission with further mechanical ventilation (MV) and therefore with high risk of development ventilator- associated pneumonia (VAP). VAP is the commonest ICU infection and results in increased morbidity/ mortality. The study was aimed to learn risk factors predicting in- hospital mortality among patients with AE COPD associated with VAP and to evaluate the modifiable risk factors in term on reduction of mortality. This retrospective study involved patients with AE of COPD who required MV and admitted in respiratory care unit at a University teaching Hospital from January 2017 to December 2022 various baseline demographic and clinical features were compared between patients with VAP and without VAP. Although various baseline demographic and clinical features were compared between survivors and non-survivors with VAP. The study included 164 intubated patients with AE of COPD with age of 60.42+ 8.44 years, 48 patients developed VAP. Multivariable analysis showed that severe sepsis/septic shock, pulmonary complications such as bilateral and multi-lobar lung infiltrates, malnutrition, concomitnant bronchiectasis and history of previous hospitalization were independent predictors in-hospital mortality in intubated COPD patients associated with VAP with odds ratio (95%) confidence interval of 3.74(1.04-7.69; p= 0.004), 4.26 (0.48-9.24: p= 0.002), 2.89(1.01- 5.96: p=0.012), 2.48 (1.14-5.41; p= 0.019), 3.26 ( 1.46-7.52;p= 0.01, respectively). Acinotebacter baumannii was the most common causative organism (n= 21: 43.7%) and was frequent finding among non-survivors with VAP.(p=0.001). All infections releated to Acinotebacter baumannii were multidrug resistant (MDR). Our retrospective study provide to clinicans and especially to ICU department physicians a tool approach to identify the mortality rosk of VAP complicated the intubated COPD patients. We found a high burden of concominant bronchiectasis releated to in hospital mortality and several other predictors associated with fatal outcomes, which could help identife found a high burden of concominant bronchiectasis releated to in hospital mortality and several other predictors associated with fatal outcomes, which could help identify patients who might benefit from adequate, early amprical antibiotic treatment, as well as, determine prognosis. Although prevention of malnutrition and exacerbations leading to hospitalization of COPD patients may associated with decreased fatal outcomes. Our findings should be validated by studies with larger samples of patients.