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Title: Characteristics and Outcomes of Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Australia and New Zealand.
Austin Authors: Berenyi, Freya;Steinfort, Daniel P;Ali Abdelhamid, Yasmine;Bailey, Michael J;Pilcher, David V;Bellomo, Rinaldo ;Finnis, Mark E;Young, Paul J;Deane, Adam M
Affiliation: Royal Melbourne Hospital, 90134, Department of Medicine, Melbourne, Victoria, Australia
Wellington Hospital, Intensive Care Unit, Wellington, New Zealand
Medical Research Institute of New Zealand, Wellington, New Zealand
The University of Melbourne, 2281, Centre for Integrated Critical Care , Melbourne, Victoria, Australia
Royal Adelaide Hospital, Department of Critical Care Services, Adelaide, South Australia, Australia
University of Adelaide, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
Monash University Department of Medicine at Alfred Medical Research and Education Precinct, 235347, Melbourne, Victoria, Australia
Royal Melbourne Hospital, 90134, Intensive Care Unit , Melbourne, Victoria, Australia
The University of Melbourne, 2281, Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Intensive Care
The Alfred Hospital, The Department of Intensive Care Medicine and Hyperbaric Medicine, Prahran, Victoria, Australia
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia
Alfred Hospital, Intensive Care Department, Melbourne, Victoria, Australia
Royal Melbourne Hospital, 90134, Intensive Care Unit, Melbourne, Victoria, Australia
Royal Melbourne Hospital, Respiratory & Sleep Medicine, Parkville, Victoria, Australia
Issue Date: Jun-2020 2020-03-05
Publication information: Annals of the American Thoracic Society 2020; 17(6): 736-745
Abstract: The characteristics and outcomes of patients presenting with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring Intensive Care Unit (ICU) admission are poorly understood and there is sparse epidemiological data. The objectives were to describe epidemiology and outcomes of patients admitted to ICU with COPD and to evaluate whether outcomes varied over time. We studied adult ICU admissions across Australia and New Zealand between 2005 and 2017 with a diagnosis of AECOPD and used an admission diagnosis of asthma as comparator for trends over time. We measured changes in characteristics and outcomes over time using logistic regression, adjusting for illness severity using the Australian New Zealand Risk of Death (ANZROD) model. We studied 31,991 admissions with AECOPD and 11,096 with asthma. Mean (SD) age for AECOPD patients was 68·3 (11·2) years, with 35·4% mechanically ventilated. For patients with AECOPD the proportion of deaths in ICU was 8·7% and in hospital was 15·4% of admissions, with the proportion of 69·2% discharged home and 5·6% discharged to a high level care facility. During the study period, the proportion of ICU admissions with AECOPD per 10,000 admissions decreased at an annual rate of 2·0 (95% CI 0·8 to 3·2) (p=0·009) but their admission rate per million population increased annually by 4·5 (95% CI 3·7 to 5·3) (p<0·0001). There was a linear reduction in mortality for AECOPD but not for asthma admissions (odds ratio annual decline: AECOPD 0·94 [0·93-0·95] and asthma 1·01 [0·97-1·05]; p=0·001) and an increase in AECOPD admissions discharged to home (odds ratio annual increase: 1·04 [1·03-1·05] vs. 1·01 [0·99-1·03]; p=0·01). The reduction in mortality was sustained after adjusting for illness severity. Across Australia and New Zealand the rate of ICU admissions due to AECOPD is increasing but mortality rates are decreasing, with a corresponding increase in the home discharge rates.
DOI: 10.1513/AnnalsATS.201911-821OC
ORCID: 0000-0002-8939-7985
PubMed URL: 32135066
Type: Journal Article
Appears in Collections:Journal articles

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