1–year mortality in hospitalized patients with an acute exacerbation of COPD on the pulmonary ward compared to the ICU

Background: Some patients hospitalized on the pulmonary ward due to an acute exacerbation of Chronic Obstructive Pulmonary Disease (ACOPD) will receive non-invasive ventilation (NIV) additional to regular treatment. Another group of patients with ACOPD needs to be treated in the Intensive Care Unit (ICU). We studied whether there was a difference in 1-year mortality between these groups. Methods: A retrospective study was performed in hospitalized patients with an ACOPD in 2012. The 1-year-mortality was analyzed using a multivariate Cox proportional hazard model in which FEV1 at admission, prior hospital admission and change in need of homecare were taken into account. A Kaplan-Meier curve was made. Results: The 1-year mortality for patients with standard treatment (N = 154) was 12,3%, for standard treatment + NIV on the pulmonary ward 41,5% (N = 41) and for ICU admission 29,4% (N = 34) . The 1-year-mortality was significantly increased in patients treated with NIV and in patients treated on the ICU compared to patients with standard treatment, with hazard ratios (HR) of respectively 2.9 and 2.2. Also previous admission for ACOPD in the last year and change in need for homecare increased the mortality risk with an HR of respectively 1,2 and 2.9. Conclusion: 1-Year mortality is significantly higher in COPD patient admitted to hospital when non-invasive or invasive ventilation is needed.