Predictors of Outcome in Patients with Dyspnoea of Pulmonary Origin admitted to a Respiratory Intensive Care Unit: A Prospective Observational Study from Eastern India

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Introduction: Dyspnoea is one of the most common presenting complaints in the Respiratory Intensive Care Unit (RICU). It reflects a wide spectrum of underlying pulmonary conditions with varying severity and outcomes. Early identification of clinical and laboratory predictors can aid in risk stratification and management planning in critically ill patients. Aim: To evaluate the demographic and clinical profiles, initial Arterial Blood Gas (ABG) findings, and factors associated with short-term outcomes in patients with pulmonary-origin dyspnoea admitted to the RICU. Materials and Methods: A prospective observational study with follow-up until ICU discharge was conducted in the RICU of the College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India from December 2023 to 2024. A total of 76 patients presenting with dyspnoea of pulmonary origin were enrolled. Demographic parameters, presenting symptoms, primary diagnosis, microbiological findings, comorbidities, neurological status, initial ABG parameters, oxygen or ventilatory support, and outcomes were recorded. Patients with non pulmonary causes of dyspnoea were excluded. Data were analysed using Statistical Package for the Social Sciences (SPSS) statistical software (Version 26.0), employing appropriate statistical methods. A p-value <0.05 was considered as statistically significant. Results: Of the 76 patients included, 67.1% were male, with a mean age of 59.5±11.74 years. Hypertension and diabetes mellitus were the most common co-morbidities, and obstructive airway disease was the predominant diagnosis (55.3%). Non survivors were significantly older (p-value=0.041) and more likely to have altered sensorium {Richmond Agitation Sedation Scale (RASS) < +1; p-value <0.0001}, Acinetobacter baumannii infection (p-value <0.0001), metabolic and mixed acidosis (p-value <0.0001), initial arterial pH ≤7.20 (p-value=0.044), septic shock (p-value <0.0001), Acute Respiratory Distress Syndrome (ARDS) (p-value=0.001), ventilator-associated pneumonia (p-value=0.001), and massive haemoptysis (p-value=0.008). The requirement for Invasive Mechanical Ventilation (IMV) was the strongest predictor of mortality (p-value <0.0001). On bivariate logistic regression analysis, age {Odds Ratio (OR) 1.07, p-value=0.007), RASS < +1 (OR 7.29, p-value <0.0001}, Acinetobacter baumannii infection (OR 30.00, p-value=0.002), metabolic acidosis (OR 7.13, p-value <0.0001), and mechanical ventilation (OR 304.5, p-value <0.0001) were significantly associated with mortality. On multivariate analysis, metabolic acidosis (OR 6.67, p-value=0.005), mechanical ventilation (OR 68.47, p-value <0.0001), and RICU stay <6 days or >12 days (OR 1.18, p-value=0.015) independently predicted poor outcomes. Conclusion: Older age, lower RASS scores, gram-negative infection, severe acidosis, and the need for invasive mechanical ventilation were associated with increased mortality. Early identification of these adverse prognostic markers and timely intervention may improve outcomes in RICU patients presenting with dyspnoea of pulmonary origin.