Intubated Patients with acute Exacerbations of chronic Obstructive Pulmonary Disease: What is Common risk factor for poor patient outcome?

Background: Approximately every fourth patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) will require intensive care unit (ICU) admission with further mechanical ventilation (MV) and therefore with high risk for development ventilator- associated pneumonia (VAP). Aim: The study was aimed to learn risk factors predicting in-hospital mortality among patients with AE COPD associated with VAP and to evaluate the modifiable risk factors in term on improvement of patient outcomes. Methods: This study included patients with AE of COPD who required MV and admitted in respiratory and critical care medicine unit at university teaching hospital from January 2017 to December 2022 and the various baseline demographic and clinical features were compared between patients with- and without VAP. Results: The study included 164 intubated patients with AE of COPD with age of 60.4+\_8.4 years, in 48 patients have developed VAP.Multivariable analysis showed severe sepsis/septick shock at admission, pulmonary complication as ARDS with PaO2/FIO2 <200, malnutrition,concominant bronchiectasis and history of previous hospitalization were independent predictors in-hospital mortality .OD for septic shock was 3.74(1.04- 7.69) .p=0.004; for ARDS with PaO2/FiO2<200 was 1.26(0.48-9.24).r =0.002;for malnutrition 2.89(1.01-5.96), p=0.012 for concominant BE 2.48(1.14-5.41),p=0.019; and for previously frequent hospitalization was 3.26(1.46-7.52).p=0.01, respectively. Acinotebacterbaumannii(n=21/43.7\%) was frequent finding among non-survivors with VAP(p=0.001) and all infections related to this pathogens were multi-drug-resistant (MDR). Pseudomonas aeruginosa was common in patients with concominant BE (p=0.001). Conclusions: We found several predictors associated with fatal outcomes, which could be help identify patients who might benefit from adequate early empirical antibiotic treatment, as well as determine prognosis. Prevention of malnutrition and severe exacerbations leading hospitalization of COPD patients may associated with decreased fatal outcomes.