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28-Day Mortality and Prognostic Factors in COPD Patients with Sepsis: A Retrospective Study Using eICU-CRD Database
Ailing Zhu1, Wei Sun2, Dehai Ge1
1Department of Respiratory Medicine, Nanjing Meishan Hospital, Nanjing, 210041, People's Republic of China.
Background:
Chronic obstructive pulmonary disease (COPD) is the third leading global cause of death, and concurrent sepsis markedly increases short-term mortality, making early identification of high-risk patients clinically essential. This retrospective study, based on the multi-center eICU-CRD database, sought to identify independent predictors of 28-day all-cause mortality and develop a combined prognostic model for intensive care unit (ICU) patients complicated with both COPD and sepsis.
Methods:
A total of 1814 eligible patients (49.4% male, mean age 70.03 ± 11.20 years) from 208 US ICUs (2014-2015) were included. Baseline demographic, vital, laboratory, blood gas and organ function data within 24 h of admission were collected. Univariate and multivariate Cox regression screened independent prognostic factors, and ROC curves evaluated predictive performance of single markers and the integrated model.
Results:
28-day mortality among sepsis-COPD patients was 9.2% (166/1814). After adjusting for confounding variables, the sequential organ failure assessment (SOFA) score was proven to independently affect mortality (HR = 1.19, 95% CI 1.08-1.30, P < 0.001). In contrast, pH (HR = 0.08, 95% CI 0.01-0.96) and body mass index (BMI) (HR = 0.96, 95% CI 0.932-0.998) showed protective effects. All included predictors had area under the curve (AUC) values between 0.57 and 0.67, and the SOFA score achieved the maximum predictive performance. A combined risk model integrating these variables achieved an AUC of 0.70 (95% CI 0.65-0.75, P < 0.001), showing satisfactory discriminatory power. At a threshold value of 0.166 for predictive probability, the model obtained 0.514 sensitivity and 0.791 specificity.
Conclusion:
Higher SOFA, lower pH and lower BMI independently predict worse 28-day survival in ICU COPD-sepsis patients. This integrated model exhibits moderate discriminative ability and can serve as an auxiliary tool for rapid risk screening among ICU patients.
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