28-Day Mortality and Prognostic Factors in COPD Patients with Sepsis: A Retrospective Study Using eICU-CRD Database.
Chronic obstructive pulmonary disease (COPD) is the third leading global cause of death, and concurrent sepsis markedly increases short-term mortality, making early identification of high-risk patients clinically essential. This retrospective study, based on the multi-center eICU-CRD database, sought to identify independent predictors of 28-day all-cause mortality and develop a combined prognostic model for intensive care unit (ICU) patients complicated with both COPD and sepsis.
A total of 1814 eligible patients (49.4% male, mean age 70.03 ± 11.20 years) from 208 US ICUs (2014-2015) were included. Baseline demographic, vital, laboratory, blood gas and organ function data within 24 h of admission were collected. Univariate and multivariate Cox regression screened independent prognostic factors, and ROC curves evaluated predictive performance of single markers and the integrated model.
28-day mortality among sepsis-COPD patients was 9.2% (166/1814). After adjusting for confounding variables, the sequential organ failure assessment (SOFA) score was proven to independently affect mortality (HR = 1.19, 95% CI 1.08-1.30, P < 0.001). In contrast, pH (HR = 0.08, 95% CI 0.01-0.96) and body mass index (BMI) (HR = 0.96, 95% CI 0.932-0.998) showed protective effects. All included predictors had area under the curve (AUC) values between 0.57 and 0.67, and the SOFA score achieved the maximum predictive performance. A combined risk model integrating these variables achieved an AUC of 0.70 (95% CI 0.65-0.75, P < 0.001), showing satisfactory discriminatory power. At a threshold value of 0.166 for predictive probability, the model obtained 0.514 sensitivity and 0.791 specificity.
Higher SOFA, lower pH and lower BMI independently predict worse 28-day survival in ICU COPD-sepsis patients. This integrated model exhibits moderate discriminative ability and can serve as an auxiliary tool for rapid risk screening among ICU patients.
A total of 1814 eligible patients (49.4% male, mean age 70.03 ± 11.20 years) from 208 US ICUs (2014-2015) were included. Baseline demographic, vital, laboratory, blood gas and organ function data within 24 h of admission were collected. Univariate and multivariate Cox regression screened independent prognostic factors, and ROC curves evaluated predictive performance of single markers and the integrated model.
28-day mortality among sepsis-COPD patients was 9.2% (166/1814). After adjusting for confounding variables, the sequential organ failure assessment (SOFA) score was proven to independently affect mortality (HR = 1.19, 95% CI 1.08-1.30, P < 0.001). In contrast, pH (HR = 0.08, 95% CI 0.01-0.96) and body mass index (BMI) (HR = 0.96, 95% CI 0.932-0.998) showed protective effects. All included predictors had area under the curve (AUC) values between 0.57 and 0.67, and the SOFA score achieved the maximum predictive performance. A combined risk model integrating these variables achieved an AUC of 0.70 (95% CI 0.65-0.75, P < 0.001), showing satisfactory discriminatory power. At a threshold value of 0.166 for predictive probability, the model obtained 0.514 sensitivity and 0.791 specificity.
Higher SOFA, lower pH and lower BMI independently predict worse 28-day survival in ICU COPD-sepsis patients. This integrated model exhibits moderate discriminative ability and can serve as an auxiliary tool for rapid risk screening among ICU patients.
Authors
Zhu Zhu, Sun Sun, Ge Ge, Zhang Zhang, Zhang Zhang, Hu Hu, Zhong Zhong, Wang Wang, Liu Liu
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