Prognosis after Intensive Care for COPD Exacerbation in Relation to Long-Term Oxygen Therapy: A Nationwide Cohort Study

Abstract

Decisions to admit or refuse admission to intensive care for acute exacerbations of COPD (AECOPD) can be difficult, due to an uncertainty about prognosis. Few studies have evaluated outcomes after intensive care for AECOPD in patients with chronic respiratory failure requiring long-term oxygen therapy (LTOT). In this nationwide observational cohort study, we investigated survival after first-time admission for AECOPD in all patients aged ≥40 years admitted to Swedish intensive care units between January 2008 and December 2015, comparing patients with and without LTOT. Among the 4,648 patients enrolled in the study, 450 were on LTOT prior to inclusion. Respiratory support data was available for 2,631 patients; 73% of these were treated with noninvasive ventilation (NIV) only, 17% were treated with immediate invasive ventilation, and 10% were intubated after failed attempt with NIV. Compared to patients without LTOT, patients with LTOT had higher 30-day mortality (38% vs. 25%; p < 0.001) and one-year mortality (70% vs. 43%; p < 0.001). Multivariable logistic and Cox regression models adjusted for age, sex and SAPS3 score confirmed higher mortality in LTOT, odds ratio for 30-day mortality was 1.8 ([95% confidence interval] 1.5–2.3) and hazard ratio for one-year mortality was 1.8 (1.6–2.0). In summary, although need for LTOT is a negative prognostic marker for survival after AECOPD requiring intensive care, a majority of patients with LTOT survived the AECOPD and 30% were alive after one year.

Keywords:

• Long-term oxygen therapy
• LTOT
• intensive care
• ICU
• COPD exacerbation
• AECOPD

Acknowledgements

Participant informed consent are not required for register-based epidemiological research in Sweden.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

The study was approved by the Regional Ethics Committee in Lund, Sweden (Dnr 2016/29). This study was part of a project supported by grants from the Swedish Research Council under Grant number 2018-06921, the Swedish Heart Lung Foundation, the Swedish Government Research Grant (ALF), the Crafoord Foundation, and Region Västerbotten. Magnus Ekström was supported by an unrestricted grant from the Swedish Research Council (Dnr: 2019-02081). Crafoordska Stiftelsen (the Crafoord Foundation); Hjärt-Lungfonden (the Swedish Heart Lung Foundation); Vetenskapsrådet (the Swedish Research Council). The funders played no role in the design of the study, data collection or analysis, decision to publish, or preparation of the article.