Respiratory Infection Triggering Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease

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Background: Data are scarce on respiratory infections during severe acute exacerbation of chronic obstructive pulmonary disease (COPD). This study aimed to investigate respiratory infection patterns in the intensive care unit (ICU) and identify variables associated with infection type and patient outcome. Methods: A retrospective, single-centre cohort study. All patients admitted (2015– 2021) to our ICU for severe acute exacerbation of COPD were included. Logistic multivariable regression analysis was performed to predict factors associated with infection and assess the association between infection and outcome. Results: We included 473 patients: 288 (60.9%) had respiratory infection and 139 (29.4%) required invasive mechanical ventilation. Eighty-nine (30.9%) had viral, 81 (28.1%) bacterial, 34 (11.8%) mixed, and 84 (29.2%) undocumented infections. Forty-seven (9.9%) patients died in the ICU and 67 (14.2%) in hospital. Factors associated with respiratory infection were temperature (odds ratio [+1°C]=1.43, P= 0.008) and blood neutrophils (1.07, P= 0.002). Male sex (2.21, P= 0.02) and blood neutrophils were associated with bacterial infection (1.06, P= 0.04). In a multivariable analysis, pneumonia (cause-specific hazard=1.75, P= 0.005), respiratory rate (1.17, P =0.04), arterial partial pressure of carbon-dioxide (1.08, P= 0.04), and lactate (1.14, P= 0.02) were associated with the need for invasive MV. Age (1.03, P= 0.03), immunodeficiency (1.96, P= 0.02), and altered performance status (1.78, P= 0.002) were associated with hospital mortality. Conclusions: Respiratory infections, 39.9% of which were bacterial, were the main cause of severe acute exacerbation of COPD. Body temperature and blood neutrophils were single markers of infection. Pneumonia was associated with the need for invasive mechanical ventilation but not with hospital mortality, as opposed to age, immunodeficiency, and altered performance status. Plain Language Summary: - This study investigates the prevalence, characteristics, and impact on outcomes of different types of respiratory infections triggering severe acute exacerbations of COPD.- Our retrospective cohort study of 473 critically ill patients found that respiratory infections, of which 39.9% were bacterial, were the main cause of severe exacerbation.- The type of infection (viral, bacterial, or mixt) was not associated with the need for invasive mechanical ventilation or mortality.- Early identification of the infectious agent is crucial for implementing effective therapy; however, the type of infection was not associated with the main outcomes. Keywords: pneumonia, infection, COPD, mechanical ventilation, mortality

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