Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort

Unveiling the Prognostic Power of HRR in ICU-Admitted COPD Patients: A MIMIC-IV Database Study

Objective

This study sought to examine the potential relationship between Hemoglobin/Red Cell Distribution Width Ratio (HRR) and the all-cause mortality risk in critically ill patients with chronic obstructive pulmonary disease (COPD).

Patients and Methods

In a retrospective analysis of the MIMIC-IV database, patients were divided into two groups based on a specific HRR threshold. Propensity score matching (PSM) was employed to address covariate imbalances. Logistic regression models was used to examine the association between HRR and mortality. A restricted cubic spline (RCS) model was employed to visualize the association between HRR and mortality. Receiver Operating Characteristic (ROC) curves were utilized to assess the predictive capability of HRR, and Decision Curve Analysis (DCA) was conducted for clinical evaluation. Furthermore, subgroup analyses were performed to explore potential variations within specific cohorts.

Results

A comprehensive analysis identified a total of 1,061 patients. The threshold value established for HRR is 5.395 g/L/%. Following the application of PSM, the matched cohort comprised 544 patients. Both the original and matched cohorts exhibited higher rates of all-cause mortality and extended hospital stays among individuals with low HRRs. Logistic regression analyses demonstrated that HRR is an independent risk factor of mortality. The RCS analysis demonstrated a significant linear relationship between HRR and mortality. The ROC curves yielded values of 0.58 for the original cohort and 0.60 for the matched cohort. DCA analysis indicated that HRR is clinically valuable. Subgroup analyses further validated the robustness of these core findings.

Conclusion

A lower HRR is positively associated with all-cause mortality in critically ill patients with COPD.

Effect of pneumonia on the outcomes of acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

To assess the effect of pneumonia on the risk of mortality and other clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

PubMed, EMBASE and Scopus were screened for observational cohort and case-control studies that reported outcomes in AECOPD patients with and without pneumonia. Pooled effect sizes were reported as relative risks (RR) or hazard ratio (HR) for categorical outcomes and as weighted mean difference (WMD) for continuous outcomes. The primary outcome was mortality. Secondary outcomes were risk of admission to intensive care unit (ICU), need for assisted ventilation and readmission as well as duration of stay at the hospital. The certainty of the evidence was assessed using the GRADE approach.

RESULTS

Thirteen studies were included. AECOPD patients with pneumonia had significantly higher risk of in-hospital mortality (RR 2.29, 95% CI: 1.40, 3.73), mortality at 1 month (RR 1.84, 95% CI: 1.09, 3.13), and 1 year or more of follow-up (HR 2.30, 95% CI: 1.15, 4.61) compared to AECOPD patients without pneumonia. Pneumonia was associated with significantly higher risk of admission to ICU (RR 2.79, 95% CI: 1.47, 5.28), need for assisted ventilation (RR 2.02, 95% CI: 1.52, 2.67), and longer hospital stay (in days) (WMD 3.31, 95% CI: 2.33, 4.29). The risk of readmission was comparable in the two groups of patients (RR 1.07, 95% CI: 0.97, 1.19). The overall quality of evidence for the outcomes was judged to be "Low".

CONCLUSION

Pneumonia during acute exacerbation of COPD may lead to increases in both short-term and long-term mortality as well as increased hospital stay, need for ventilatory support and admission to ICU. Our findings suggest the need for close monitoring, early intervention, and long-term follow-up, to improve the outcomes in AECOPD patients with concurrent pneumonia.