Factors Associated with Initial Treatment Failure in Inpatients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Cohort Study.

Purpose: Some patients do not respond to initial therapy for exacerbation of chronic obstructive pulmonary disease (ECOPD), resulting in treatment failure that requires antimicrobial changes or advanced therapies. Appropriate treatment is possible if patients at a high risk of treatment failure at the start of treatment are properly identified. Therefore, this study examined the factors associated with initial treatment failure in patients with ECOPD.

Patients and methods: We conducted a cohort study involving patients with ECOPD admitted to our hospital. The primary outcome was initial treatment failure, defined as a composite of treatment intensification for ECOPD and in-hospital mortality. Uni- and multivariate analyses were performed to identify the factors associated with initial treatment failure.

Results: The analysis included data of 152 patients with a mean age of 76±8 years (mean±standard deviation); 81% of them were male patients. Treatment failure occurred in 26 (17%) patients. These included nine, two, one, and 14 patients who changed antimicrobial agents, received additional non-invasive positive pressure ventilation therapy due to non-improvement or symptom exacerbation, received additional invasive positive pressure ventilation therapy, and died in the hospital, respectively. Using multivariable analysis, home oxygen therapy (odds ratio, 5.335; 95% confidence interval, [1.542-18.457]), neutrophil count ≥7000 cells/µL (3.550; [1.007-12.519]), and acidemia (3.129; [1.009-9.698]) were significant factors associated with treatment failure. In patients treated with narrow-spectrum antibiotics as the initial antibacterial therapy, the treatment failure rate in patients receiving home oxygen therapy was significantly higher than in those receiving none.

Conclusion: Home oxygen therapy, high neutrophil count, and acidemia on admission were risk factors for treatment failure. Particularly, patients receiving home oxygen therapy were at a higher risk of treatment failure with the use of narrow-spectrum antibiotics.