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Original Research: Critical Care |

Impact of COPD in the Outcome of ICU-Acquired Pneumonia With and Without Previous IntubationCOPD and ICU-Acquired Pneumonia

Mariano Rinaudo, MD; Miquel Ferrer, MD, PhD; Silvia Terraneo, MD; Francesca De Rosa, MD; Rogelio Peralta, MD; Laia Fernández-Barat, PhD; Gianluigi Li Bassi, MD, PhD; Antoni Torres, MD, PhD
Author and Funding Information

From the Servei de Pneumologia (Drs Rinaudo, Ferrer, Terraneo, De Rosa, Peralta, Fernández-Barat, Li Bassi, and Torres), Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; the Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028) (Drs Ferrer, Fernández-Barat, Li Bassi, and Torres), Barcelona, Spain; and the Department of Pathophysiology and Transplantation (Drs Terraneo and De Rosa), Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy.

CORRESPONDENCE TO: Miquel Ferrer, MD, PhD, UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; e-mail: miferrer@clinic.ub.es


Part of this article has been presented in abstract form at the European Respiratory Society Annual Congress, September 7-11, 2013, Barcelona, Spain, and the American Thoracic Society, May 17-22, 2013, Philadelphia, Pennsylvania.

FUNDING/SUPPORT: This study was supported by the Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) [Grant 2009-SGR-911], ICREA Academia 2013, Juan de la Cierva 2012 [Grant JCI-2012-14801], Ministerio de Economía y Competitividad, Plan Nacional I+D [Grant SAF2012-33744], Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-Instituto de Salud Carlos III (ISCiii), and a European Respiratory Society (ERS) Fellowship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1530-1538. doi:10.1378/chest.14-2005
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BACKGROUND:  COPD seems related to poor outcome in patients with ventilator-associated pneumonia (VAP). However, many patients in the ICU with COPD do not require intubation but can also develop pneumonia in the ICU. We, therefore, compared the characteristics and outcomes of patients with ICU-acquired pneumonia (ICUAP) with and without underlying COPD.

METHODS:  We prospectively assessed the characteristics, microbiology, systemic inflammatory response, and survival of 279 consecutive patients with ICUAP clustered according to underlying COPD or not. The primary end point was 90-day survival.

RESULTS:  Seventy-one patients (25%) had COPD. The proportion of VAP was less frequent in patients with COPD: 30 (42%) compared with 126 (61%) in patients without COPD (P = .011). Patients with COPD were older; were more frequently men, smokers, and alcohol abusers; and more frequently had previous use of noninvasive ventilation. The rate of microbiologic diagnosis was similar between groups, with a higher rate of Aspergillus species and a lower rate of Enterobacteriaceae in patients with COPD. We found lower levels of IL-6 and IL-8 in patients with COPD without previous intubation. The 90-day mortality was higher in patients with COPD (40 [57%] vs 74 [37%] in patients without COPD, P = .003). Among others, COPD was independently associated with decreased 90-day survival in the overall population (adjusted hazard ratio, 1.94; 95% CI, 1.11-3.40; P = .020); this association was observed only in patients with VAP but not in those without previous intubation.

CONCLUSIONS:  COPD was independently associated with decreased 90-day survival in patients with VAP but not in those without previous intubation.

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