Hypercapnic Failure in Acute Exacerbated COPD Patients: Severe Airflow Limitation As an Early Warning Signal

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Jan 8

PMID 36615058

Authors

Achim Grunewaldt

Norbert Fritsch

Gernot Rohde

Affiliations

Soon will be listed here.

Abstract

Background: Hypercapnic failure is a severe complication of COPD disease progression, which is associated with a high morbidity and mortality. The aim of this study was to examine the association of comorbidity and clinical risk factors with the development of hypercapnia in acute exacerbated COPD patients.

Methods: In this retrospective monocentric cohort study, we examined the influence of the clinical parameters and the comorbidity of hospitalized patients with the acute exacerbation of COPD on the development of hypercapnia by performing multivariate logistic regression and a receiver operating characteristic analysis.

Results: In total, 275 patient cases with COPD exacerbation were enrolled during the period from January 2011 until March 2015, where 104 patients (37.8%) with hypercapnia were identified. The logistic regression analysis revealed severe airflow limitation (decreased FEV1) as the main factor associated with the development of hypercapnia. In the ROC analysis, we determined an FEV1 of 42.12%, which was predicted with a sensitivity of 82.6% and specificity of 55%, and an absolute value of FEV1 of 0.8 L, with a sensitivity of 0.62 and specificity of 0.79 as the cut off points, respectively. We could not verify an association with the patient's condition or the laboratory surrogate parameters of organ failure.

Conclusion: Severe airflow limitation is an important risk factor that is associated with hypercapnic failure in acute exacerbated COPD patients. Validation in prospective cohorts is warranted and should focus on more intensive monitoring of these at-risk patients.

References

Rhodes K, Jenkins M, De Nigris E, Aurivillius M, Ouwens M . Relationship between risk, cumulative burden of exacerbations and mortality in patients with COPD: modelling analysis using data from the ETHOS study. BMC Med Res Methodol. 2022; 22(1):150. PMC: 9134588. DOI: 10.1186/s12874-022-01616-7. View

Sprooten R, Rohde G, Janssen M, Cobben N, Wouters E, Franssen F . Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure. Clin Respir J. 2020; 14(12):1144-1152. PMC: 7756413. DOI: 10.1111/crj.13251. View

Mapel D . Renal and hepatobiliary dysfunction in chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2013; 20(2):186-93. DOI: 10.1097/MCP.0000000000000024. View

Andre S, Conde B, Fragoso E, Boleo-Tome J, Areias V, Cardoso J . COPD and Cardiovascular Disease. Pulmonology. 2018; 25(3):168-176. DOI: 10.1016/j.pulmoe.2018.09.006. View

Casas-Mendez F, Abadias M, Yuguero O, Bardes I, Barbe F, de Batlle J . Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality. PLoS One. 2018; 13(12):e0208847. PMC: 6294427. DOI: 10.1371/journal.pone.0208847. View

Gantzhorn E, Prior T, Hilberg O . Long-term non-invasive ventilation for stable chronic hypercapnic COPD. Eur Clin Respir J. 2019; 6(1):1644893. PMC: 6691917. DOI: 10.1080/20018525.2019.1644893. View

Dave C, Wharton S, Mukherjee R, Faqihi B, Stockley R, Turner A . Development and Relevance of Hypercapnia in COPD. Can Respir J. 2021; 2021:6623093. PMC: 7920710. DOI: 10.1155/2021/6623093. View

Csoma B, Vulpi M, Dragonieri S, Bentley A, Felton T, Lazar Z . Hypercapnia in COPD: Causes, Consequences, and Therapy. J Clin Med. 2022; 11(11). PMC: 9181664. DOI: 10.3390/jcm11113180. View

Budweiser S, Meyer K, Jorres R, Heinemann F, Wild P, Pfeifer M . Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases. Eur J Clin Nutr. 2007; 62(3):436-43. DOI: 10.1038/sj.ejcn.1602708. View

10.

Casalino-Matsuda S, Wang N, Ruhoff P, Matsuda H, Nlend M, Nair A . Hypercapnia Alters Expression of Immune Response, Nucleosome Assembly and Lipid Metabolism Genes in Differentiated Human Bronchial Epithelial Cells. Sci Rep. 2018; 8(1):13508. PMC: 6131151. DOI: 10.1038/s41598-018-32008-x. View

11.

Kyle U, Janssens J, Rochat T, Raguso C, Pichard C . Body composition in patients with chronic hypercapnic respiratory failure. Respir Med. 2005; 100(2):244-52. DOI: 10.1016/j.rmed.2005.04.019. View

12.

ODonnell D, DArsigny C, Fitzpatrick M, Webb K . Exercise hypercapnia in advanced chronic obstructive pulmonary disease: the role of lung hyperinflation. Am J Respir Crit Care Med. 2002; 166(5):663-8. DOI: 10.1164/rccm.2201003. View

13.

Duarte-de-Araujo A, P Teixeira , Hespanhol V, Correia-de-Sousa J . Characterisation of morbidity in a COPD hospital cohort. Pulmonology. 2019; 25(4):200-207. DOI: 10.1016/j.pulmoe.2019.02.010. View

14.

Fazekas A, Aboulghaith M, Kriz R, Urban M, Breyer M, Breyer-Kohansal R . Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation. Wien Klin Wochenschr. 2018; 130(19-20):561-568. PMC: 6209011. DOI: 10.1007/s00508-018-1364-6. View

15.

Huang B, Yang Y, Zhu J, Liang Y, Zhang H, Tian L . Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: results from a multicenter atrial fibrillation registry study. J Am Med Dir Assoc. 2014; 15(8):576-81. DOI: 10.1016/j.jamda.2014.04.009. View

16.

AbdelHalim H, AboElNaga H . Is Renal Impairment an Anticipated COPD Comorbidity?. Respir Care. 2016; 61(9):1201-6. DOI: 10.4187/respcare.04516. View

17.

Bikov A, Lange P, Anderson J, Brook R, Calverley P, Celli B . FEV is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease. Int J Chron Obstruct Pulmon Dis. 2020; 15:1135-1142. PMC: 7247606. DOI: 10.2147/COPD.S242809. View

18.

Zwaans W, Mallia P, van Winden M, Rohde G . The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease—a systematic review. J Clin Virol. 2014; 61(2):181-8. PMC: 7106508. DOI: 10.1016/j.jcv.2014.06.025. View

19.

Yong S, Leem A, Kim Y, Park M, Chang J, Kim S . Hepatic Fibrosis Assessed Using Fibrosis-4 Index Is Predictive of All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2020; 15:831-839. PMC: 7173842. DOI: 10.2147/COPD.S242863. View

20.

Greulich T, Weist B, Koczulla A, Janciauskiene S, Klemmer A, Lux W . Prevalence of comorbidities in COPD patients by disease severity in a German population. Respir Med. 2017; 132:132-138. DOI: 10.1016/j.rmed.2017.10.007. View