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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.
Summary
Higher SOFA scores and lower pH and BMI predict worse survival in intensive care unit (ICU) patients with chronic obstructive pulmonary disease (COPD) and sepsis. A combined model aids in rapid risk screening for these high-risk patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Disease
Background:
- Chronic obstructive pulmonary disease (COPD) is a leading cause of death globally.
- Sepsis in COPD patients significantly increases short-term mortality.
- Early identification of high-risk COPD patients with sepsis is crucial.
Purpose of the Study:
- Identify independent predictors of 28-day mortality in ICU patients with COPD and sepsis.
- Develop a combined prognostic model for risk stratification.
- Evaluate the predictive performance of identified factors and the integrated model.
Main Methods:
- Retrospective study using the multi-center eICU-CRD database (208 US ICUs, 2014-2015).
- Included 1814 eligible patients with COPD and sepsis.
- Collected demographic, vital, laboratory, blood gas, and organ function data within 24 hours of admission.
- Utilized Cox regression for prognostic factor screening and ROC curves for performance evaluation.
Main Results:
- 28-day mortality was 9.2% in sepsis-COPD patients.
- Higher Sequential Organ Failure Assessment (SOFA) score independently predicted mortality (HR=1.19).
- Lower pH (HR=0.08) and lower Body Mass Index (BMI) (HR=0.96) demonstrated protective effects.
- A combined risk model integrating SOFA, pH, and BMI achieved an AUC of 0.70.
Conclusions:
- Higher SOFA, lower pH, and lower BMI are independent predictors of 28-day mortality in ICU COPD-sepsis patients.
- The integrated model shows moderate discriminative ability for risk screening.
- This model can serve as an auxiliary tool for rapid risk assessment in clinical practice.
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