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* From the Pulmonary and Critical Care Division, New England Medical Center, Tufts University School of Medicine, Boston, MA.
Correspondence to: Scott K. Epstein, MD, FCCP, New England Medical Center, Box 369, 750 Washington St, Boston, MA 02111; e-mail: SEpstein{at}lifespan.org
Introduction: Accurate outcomes data and predictors of outcomes are fundamental to the effective care of patients with COPD and in guiding them and their families through end-of-life decisions.
Design: We conducted a retrospective cohort study of 166 patients using prospectively gathered data in patients with COPD who required mechanical ventilation for acute respiratory failure of diverse etiologies.
Results: The
in-hospital mortality rate for the entire cohort was 28% but fell to
12% for patients with a COPD exacerbation and without a comorbid
illness. Univariate analysis showed a higher mortality rate among those
patients who required > 72 h of mechanical ventilation (37% vs 16%;
p < 0.01), those without previous episodes of mechanical ventilation
(33% vs 11%; p < 0.01), and those with a failed extubation attempt
(36% vs 7%; p = 0.0001). With multiple logistical regression,
higher acute physiology score measured 6 h after the onset of
mechanical ventilation, presence of malignancy, presence of APACHE
(acute physiology and chronic health evaluation) II-associated
comorbidity, and the need for mechanical ventilation 
72 h were
independent predictors of poor outcome.
Conclusions: We conclude that among variables available within the first 6 h of mechanical ventilation, the presence of comorbidity and a measure of the severity of the acute illness are predictors of in-hospital mortality among patients with COPD and acute respiratory failure. The occurrence of extubation failure or the need for mechanical ventilation beyond 72 h also portends a worse prognosis.
Key Words: COPD • extubation • mechanical ventilation • outcomes analysis • weaning
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