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      International Journal of COPD (submit here)

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      Association Between Comorbid Chronic Obstructive Pulmonary Disease and Prognosis of Patients Admitted to the Intensive Care Unit for Non-COPD Reasons: A Retrospective Cohort Study


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          Background and Aim

          Chronic obstructive pulmonary disease (COPD) is a rather common comorbid condition among patients admitted to the intensive care unit (ICU), while evidence of how this comorbidity affects prognosis is limited. This study aimed to investigate the associations between COPD comorbidity and prognoses of patients who were admitted to the ICU for non-COPD reasons, and to examine whether the associations varied between different types of ICU.


          A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission in the database were enrolled as study participants but those with a primary diagnosis of COPD were excluded. The primary endpoint was 28-day mortality after ICU admission and multivariable Cox regression analyses were employed to assess the associations between COPD comorbidity and the study endpoints. Different adjusting models including a propensity score were used to adjust potential confounders.


          A total of 29,499 patients were enrolled finally, among which 3,332 patients (11.30%) were comorbid with COPD. A higher 28-day mortality was observed among patients with COPD than those without COPD (13.90% versus 8.07%, P<0.001), but there was no statistically significant difference in the proportion of patients who needed mechanical ventilation on the first day after ICU admission between the two groups. Multivariable Cox regression analyses found a significant association between COPD comorbidity and 28-day mortality (adjusted hazard ratio=1.32, 95% confidence interval=1.19–1.47, P<0.0001). The associations were broadly consistent among patients admitted to different types of ICU, but a much higher estimate was observed in patients admitted to cardiac surgery recovery unit (adjusted hazard ratio=2.03, 95% confidence interval=1.44–2.86, P<0.0001).


          Comorbid COPD increased the risk of 28-day mortality among patients admitted to the ICU for non-COPD reasons, especially for those admitted to the cardiac surgery recovery unit.

          Most cited references15

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          A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.

          To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality. The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries. The 13,152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded. Vital status at hospital discharge. The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P = .883 and P = .104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample. The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units.
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            Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease

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              The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016

              Summary Background India has 18% of the global population and an increasing burden of chronic respiratory diseases. However, a systematic understanding of the distribution of chronic respiratory diseases and their trends over time is not readily available for all of the states of India. Our aim was to report the trends in the burden of chronic respiratory diseases and the heterogeneity in their distribution in all states of India between 1990 and 2016. Methods Using all accessible data from multiple sources, we estimated the prevalence of major chronic respiratory diseases and the deaths and disability-adjusted life-years (DALYs) caused by them for every state of India from 1990 to 2016 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016. We assessed heterogeneity in the burden of chronic obstructive pulmonary disease (COPD) and asthma across the states of India. The states were categorised into four groups based on their epidemiological transition level (ETL). ETL was defined as the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We also assessed the contribution of risk factors to DALYs due to COPD. We compared the burden of chronic respiratory diseases in India against the global average in GBD 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings The contribution of chronic respiratory diseases to the total DALYs in India increased from 4·5% (95% UI 4·0–4·9) in 1990 to 6·4% (5·8–7·0) in 2016. Of the total global DALYs due to chronic respiratory diseases in 2016, 32·0% occurred in India. COPD and asthma were responsible for 75·6% and 20·0% of the chronic respiratory disease DALYs, respectively, in India in 2016. The number of cases of COPD in India increased from 28·1 million (27·0–29·2) in 1990 to 55·3 million (53·1–57·6) in 2016, an increase in prevalence from 3·3% (3·1–3·4) to 4·2% (4·0–4·4). The age-standardised COPD prevalence and DALY rates in 2016 were highest in the less developed low ETL state group. There were 37·9 million (35·7–40·2) cases of asthma in India in 2016, with similar prevalence in the four ETL state groups, but the highest DALY rate was in the low ETL state group. The highest DALY rates for both COPD and asthma in 2016 were in the low ETL states of Rajasthan and Uttar Pradesh. The DALYs per case of COPD and asthma were 1·7 and 2·4 times higher in India than the global average in 2016, respectively; most states had higher rates compared with other locations worldwide at similar levels of Socio-demographic Index. Of the DALYs due to COPD in India in 2016, 53·7% (43·1–65·0) were attributable to air pollution, 25·4% (19·5–31·7) to tobacco use, and 16·5% (14·1–19·2) to occupational risks, making these the leading risk factors for COPD. Interpretation India has a disproportionately high burden of chronic respiratory diseases. The increasing contribution of these diseases to the overall disease burden across India and the high rate of health loss from them, especially in the less developed low ETL states, highlights the need for focused policy interventions to address this significant cause of disease burden in India. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                07 February 2020
                : 15
                : 279-287
                [1 ]Department of Respiratory Medicine, The 910th Hospital of People’s Liberation Army , Quanzhou, People’s Republic of China
                [2 ]Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, People’s Republic of China
                Author notes
                Correspondence: Qingui Chen Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University , No. 58 Zhongshan Road 2, Guangzhou510080, People’s Republic of ChinaTel +86-135 8044 2523 Email chqgui@mail2.sysu.edu.cn
                Author information
                © 2020 Huang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 28 December 2019
                : 21 January 2020
                Page count
                Figures: 2, Tables: 3, References: 22, Pages: 9
                Original Research

                Respiratory medicine
                chronic obstructive pulmonary disease,comorbidity,intensive care units,prognosis,risk factors


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