The impact of COPD on ICU mortality in patients with ventilator-associated pneumonia

SummaryObjectiveTo determine the impact of COPD on intensive care unit (ICU) mortality in patients with VAP.MethodsThis prospective observational study was performed in a mixed ICU during a 3-year period. Eligible patients received mechanical ventilation for >48 h and met criteria for microbiologically confirmed VAP. Risk factors for ICU mortality were determined using univariate and multivariable analyses.ResultsTwo hundred and fifteen patients with microbiologically confirmed VAP were included. Most VAP episodes were late-onset (88%), and Pseudomonas aeruginosa was the most frequently isolated bacterium (39% of VAP episodes).ICU mortality was significantly lower in non-COPD patients (n = 150) compared to COPD patients (n = 65) (43.3% vs 60%, p = 0.027, OR [95% CI] = 1.96 [1.8–3.54]). Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 25 (15–42) and 30 (18–48), whereas in COPD patients were 31 (19–45) and 36 (20–48) (p > 0.05). The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage IV) patients (p = 0.001 and p = 0.02, respectively). Multivariable analysis identified COPD [OR (95% CI) 2.58 (1.337–5)], SAPS II [1.024 (1.006–1.024)] and presence of shock at VAP diagnosis [3.72 (1.88–7.39)] as independent risk factors for ICU mortality.ConclusionCOPD, SAPS II, and shock at VAP diagnosis are independently associated with ICU mortality in patients who present VAP