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Predictors of Mortality in Patients with Acute Respiratory Failure secondary to Chronic Obstructive Airway Disease admitted to Intensive Care Unit: A One Year Study FREE TO VIEW

Amit Banga, MD*; J. N. Pande, MD; G. C. Khilnani, MD, FCCP
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All India Institute of Medical Sciences, New Delhi, India


Chest. 2004;126(4_MeetingAbstracts):751S. doi:10.1378/chest.126.4_MeetingAbstracts.751S
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PURPOSE:  Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) commonly require hospitalization and admission to intensive care unit (ICU). Data on predictors of outcome of these patients from developing countries is sparse. This study was carried out to elucidate the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients.

METHODS:  Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including acute physiology score (APS) and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality.

RESULTS:  Fifty-two patients survived to hospital discharge (63.4%). APS at the time of admission to ICU {odds ratio (95 % CI): 1.5 (1.2-1.7); p<0.001} and serum albumin (done within 24 hours of admission) {odds ratio (95 % CI): 0.1 (0.03-0.4); p=0.001} were independent predictors of mortality. An equation, constructed using the adjusted odds ratio for the two parameters {score=(0.278 X APS) –(2.17 X SA)}, had an area under the ROC curve of 91.3% (Figure). For the choice of cut-off, sensitivity, specificity, positive and negative predictive value for predicting outcome was 90%, 86.5%, 79.4% and 93.7%.

CONCLUSION:  APS at admission and SA levels within 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

CLINICAL IMPLICATIONS:  Outcome of patients with exacerbation of COPD is determined by the severity of acute insult (reflected by APS) and the extent of malnutrition/severity of underlying illness (reflected by SA levels).

DISCLOSURE:  A. Banga, None.

Tuesday, October 26, 2004

12:30 PM- 2:00 PM




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