Estimation of Predictors of Mortality in Patients with Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Admitted in Tertiary Care Center.

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and an increased chronic inflammatory response in the airways to noxious particles and gases. More than 10 million individuals in the United States (US) are affected with COPD, the fourth largest cause of mortality. Globally 250 million individuals are affected by COPD. D-dimer, C-reactive protein (CRP), acute physiology and chronic health evaluation (APACHE) II score, and hypoalbuminemia have significant correlation with morbidity, mortality, and risk stratification of hospitalized COPD patients with acute respiratory failure (ARF). The purpose of this study is to assess how well D-dimer, CRP, APACHE II score, and hypoalbuminemia predict death in COPD with ARF.

Materials and methods: A hospital-based prospective research (observational study) was conducted in a tertiary care center. The research was carried out from 1st February 2021, until 1st November 2022. The patients (sample size = 60; 35 survived and 25 died) were taken for detailed personal history, occupational history, chest X-ray, arterial blood gas (ABG) analysis, and thorough clinical examination to identify evidence of COPD. Our study included D-dimer, CRP, APACHE II score, and hypoalbuminemia in hospitalized COPD patients.

Results: In our study, the median D-dimer levels for patients who lived and died were 1,012.34 and 7,222.64, respectively, with a p-value < 0.001. Patients who survived had a mean CRP of 3.56, whereas those who were dead had a value of 12.62. The mean serum albumin levels among survived and dead patients were 3.23 and 2.22, respectively. The mean APACHE II score in survived and dead patients were 9.91 and 28.48, respectively. The APACHE II score has sensitivity and specificity of 96 and 91.4%, respectively, with a critical cutoff of >19. Hypoalbuminemia has sensitivity and specificity of 96 and 65.7%, with a critical cutoff of <3.

Conclusion: High levels of CRP, an elevated APACHE II score, elevated levels of D-dimer, and lower levels of serum albumin are all independently related to an increased risk of in-hospital mortality.