Journal of Medical and Surgical Intensive Care Medicine 2016 , Vol 7, Issue 3
Predictors of Mortality of Older Cases with Acute Respiratory Failure Due to Chronic Obstructive Pulmonary Disease Exacerbation Admitted to Intensive Care Units
Şebnem Çalık 1 , Selma Tosun 1 , Alpay Arı 1 , Ezgi Direnç Külünk 2 , Zeki Tuncel Tekgül 2 , Nurcan Doğan 3 , Emine Yazıcı 4
1İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, İzmir, Türkiye
2İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İzmir, Türkiye
3İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Sağlık Bakım Hizmetleri Müdürlüğü, İzmir, Türkiye
4İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, İzmir, Türkiye
DOI : 10.5152/dcbybd.2017.1281

Objective: Aim of this study was to investigate retrospectively, the intensive care mortality rates and predictors of mortality in patients over 65 years who were admitted to intensive care units of a training and research hospital with acute respiratory failure due to chronic obstructive pulmonary disease (COPD).

Material and Methods: One hundred seventeen cases who were admitted between 1 January 2009 - 1 May 2016 were enrolled in this retrospective study. Patients data were collected from hospital’s electronic data management system and analyzed with computer based statistical calculation program SPSS 21. Comparison of measurable data with normal distribution was made by t-test. Mann Whitney U-test was performed to compare parameters without normal distribution. Chi-square test was used to compare qualitative data. Multivariable logistic regression analysis was performed for parameters to determine risk factors for mortality. For all analyzes, p<0,05 was accepted significant.

Results: Mean age of the patients included in the study was 75.9±6.4. Fifty of the cases (42,7%) were women. Of the cases, 93 (79,4%) were accepted from the emergency department, 17 (14,5%) from another center and 7 (6,1%) from the clinic. The mean length of stay in intensive care unit was 28.6±32.2 days. Most common comorbidities were hypertension (39.3%), chronic renal failure (17.9%) and diabetes mellitus (17.1%). Forty-one (35%) of the cases had Glasgow Coma Score <8 at the admission to the intensive care unit. The mean APACHE II Score was 26.4±7.3 and the intensive care mortality rate was 50 percent. Age of the patients (p=0.012), Glasgow Coma Score <8 (p=0.005) and vazopressor requirement (p<0.001) were found to be statistically significant in univariate analysis. Glasgow Coma Score (p=0.001) and vazopressor requirement (p<0.001) were found to be significant in the multivariate logistic regression analysis. The causes of death were ventilator related pneumonia/sepsis in 47 (79.7%), heart failure in 9 (15.3%), myocardial infarction in 2 (3.4%), and pneumothorax in 1 (1.6%).

Conclusion: Considering the increase in the geriatric population, the Glasgow Coma Score and vasopressor requirement seem to be two useful parameters for predicting prognosis of patients with acute exacerbation of COPD in this age group.

Keywords : Artificial ventilation, geriatrics, survival