HOSPITAL AND 1-YEAR SURVIVAL OF PATIENTS ADMITTED TO INTENSIVE-CARE UNITS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Objective.-To describe outcomes and identify variables associated with hospital and 1-year survival for patients admitted to an intensive ca re unit (ICU) with an acute exacerbation of chronic obstructive pulmon ary disease (COPD). Design.-Prospective, multicenter, inception cohort study. Setting.-Forty-two ICUs at 40 US hospitals. Patients.-A total of 362 admissions for COPD exacerbation selected from the Acute Physio logy and Chronic Health Evaluation (APACHE) III database of 17 440 ICU admissions. Measurements and Results.-Hospital mortality for the 362 admissions was 24%, For the 167 patients aged 65 years or older, morta lity was 30% at hospital discharge, 41% at 90 days, 47% at 180 days, a nd 59% at 1 year, Median survival for all patients was 224 days, and m edian survival for the patients who died within 1 year was 30.5 days, On multiple regression analysis, variables associated with hospital mo rtality included age, severity of respiratory and nonrespiratory organ system dysfunction, and hospital length of stay before ICU admission, Development of nonrespiratory organ system dysfunction was the major predictor of hospital mortality (60% of total explanatory power) and 1 80-day outcomes (54% of explanatory power), Respiratory physiological variables (respiratory rate, serum pH, PaCO2, PaO2, and alveolar-arter ial difference in partial pressure of oxygen [PAO(2)-PaO2]) indicative of advanced dysfunction were more strongly associated with 180-day mo rtality rates (22% of explanatory power) than hospital death rates (4% of explanatory power), After controlling for severity of illness, mec hanical ventilation at ICU admission was not associated with either ho spital mortality or subsequent survival. Conclusions.-Patients with CO PD admitted to an ICU for an acute exacerbation have a substantial hos pital mortality (24%), For patients aged 65 years or older, mortality doubles in 1 year from 30% to 59%, Hospital and longer-term mortality is closely associated with development of nonrespiratory organ system dysfunction; severity of the underlying respiratory function substanti ally influences mortality following hospital discharge, The need for m echanical ventilation at ICU admission did not influence either short- or long-term outcomes, Physicians should be aware of these relationsh ips when making treatment decisions or evaluating new therapies.