The prognostic factors of in-hospital death among patients with pneumonic COPD acute exacerbation

Abstract Purpose: Pneumonic acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) is associated with worse outcomes compared with non-pneumonic COPD-AE. Currently, only one study has been evaluated the prognostic factors of pneumonic COPD-AE; the study is limited by sample size, and ignoring heterogeneity of the treatment strategy. Thus, we aimed to include more patients and explore the more focused prognostic factors of patients with pneumonic COPD-AE who were treated with systemic steroids. Patients and methods: This multicentered retrospective cohort study was conducted across five acute hospitals in Japan. Hospitalized patients ≥ 40 years of age with pneumonic COPD-AE who were administered systemic corticosteroids during hospitalization were included. Patients with other causes of respiratory failure (heart failure, pneumothorax, asthma exacerbation, and obstructive pneumonia), daily systemic steroids users, and patients who were not treated with systemic steroids were excluded. The following potential prognostic factors were selected in advance based on the existing clinical prediction models: age (> 70 years), eosinophilic count ( ≥ 0.05 × 109 /L), blood urea nitrogen (> 7 mmol/L), respiratory rate (≥ 30/min), diastolic blood pressure (≤ 60 mmHg), and altered mental status. Multivariate logistic regression was conducted to determine whether the potential prognostic factors were associated with in-hospital death.Results: After excluding 897 patients based on the exclusion criteria, 669 patients with pneumonic COPD-AE who were administered systemic corticosteroids were included. The in-hospital mortality rate was 5.1 %; the median age was 78.0; 15 patients were intubated; and the median length of hospital was 12 days. Altered mental status was associated with mortality (odds ratio, 4.47; 95% confidence intervals, 2.00 to 10.00]) and a high eosinophil count was associated with a lower risk of mortality (odds ratio, 0.19; 95% confidence intervals: 0.06 to 0.56).Conclusion: Altered mental status may be the prognostic factor of in-hospital death among patients with pneumonic COPD-AE who are receive systemic corticosteroids. Moreover, high eosinophilia may be a prognostic factor for lower in-hospital mortality in hospital among these patients.