Outcomes and Resource Utilization Among Patients Admitted to the Intensive Care Unit Following Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Author:

Warwick Madeleine1ORCID,Fernando Shannon M.23ORCID,Aaron Shawn D.456,Rochwerg Bram78,Tran Alexandre59ORCID,Thavorn Kednapa56,Mulpuru Sunita456,McIsaac Daniel I.5610,Thompson Laura H.6,Tanuseputro Peter561112,Kyeremanteng Kwadwo261113ORCID,

Affiliation:

1. Division of Respirology and Sleep Medicine, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

2. Division of Critical Care, Department of Medicine, University of Ottawa, Ontario, Canada

3. Department of Emergency Medicine, University of Ottawa, Ontario, Canada

4. Division of Respiratory Medicine, Department of Medicine, University of Ottawa, Ontario, Canada

5. School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada

6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada

7. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada

8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

9. Department of Surgery, University of Ottawa, Ontario, Canada

10. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada

11. Division of Palliative Care, Department of Medicine, University of Ottawa, Ontario, Canada

12. Bruyère Research Institute, Ottawa, Ontario, Canada

13. Institut du Savoir Montfort, Ottawa, Ontario, Canada

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) is a common condition, accounting for a significant number of intensive care unit (ICU) admissions. However, little is known about outcomes and costs among ICU patients admitted with acute exacerbations of COPD (AECOPD). We studied predictors of inhospital mortality and costs of ICU admissions for AECOPD. Methods: Data were obtained from a prospectively maintained registry from 2 ICUs from 2011 to 2016, including adult patients (age ≥ 18) with an ICU discharge diagnosis of AECOPD. The primary outcome was hospital mortality. Secondary outcomes included ICU length of stay, resource utilization, total hospital costs, and cost per survivor. Results: We included 390 patients, of which 27.2% died in hospital. Independent predictors of inhospital mortality included age (odds ratio [OR]: 1.95, CI: 1.58-2.67) and the presence of clinical frailty (OR: 4.12, CI: 2.26-6.95). The mean total hospital costs were Can$35 059, with a cost per survivor of Can$48 191. Factors associated with increased cost included transfer from an inpatient setting, severity of illness, and previous ICU admission. Conclusions: Approximately a quarter of patients admitted to ICU with AECOPD died during hospitalization, and these patients accrued significant costs. This study identifies important factors associated with poor outcome in this at-risk population, which has value in risk stratification and patient or family discussions addressing goals of care.

Publisher

SAGE Publications

Subject

Critical Care and Intensive Care Medicine

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