Impacts of Comorbid Chronic Obstructive Pulmonary Disease and Congestive Heart Failure on Prognosis of Critically Ill Patients

Figures & data

Figure 1 Inclusion of the study subjects.

Abbreviations: ICU, intensive care unit; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure.

Table 1 Characteristics of the Study Subjects

Variables	All Subjects (n=29,589)	Without COPD or CHF (n=20,507)	COPD (n=1575)	CHF (n=6190)	With COPD and CHF (n=1317)	P value
Age (years)	65.75 (52.78–77.66)	61.29 (48.81–74.09)	70.74 (62.41–78.45)	74.66 (63.00–83.24)	75.78 (67.56–82.31)	<0.001
Male	16,835 (56.90%)	11,973 (58.38%)	873 (55.43%)	3302 (53.34%)	687 (52.16%)	<0.001
Ethnicity						<0.001
White	21,143 (71.46%)	14,429 (70.36%)	1221 (77.52%)	4492 (72.57%)	1001 (76.01%)
Black	2278 (7.70%)	1630 (7.95%)	69 (4.38%)	511 (8.26%)	68 (5.16%)
Asian	711 (2.40%)	561 (2.74%)	21 (1.33%)	117 (1.89%)	12 (0.91%)
Hispanic/Latino	950 (3.21%)	763 (3.72%)	25 (1.59%)	143 (2.31%)	19 (1.44%)
Other	4507 (15.23%)	3124 (15.23%)	239 (15.17%)	927 (14.98%)	217 (16.48%)
Type of admission						<0.001
Elective	5276 (17.83%)	3926 (19.14%)	316 (20.06%)	886 (14.31%)	148 (11.24%)
Urgent	24,313 (82.17%)	16,581 (80.86%)	1259 (79.94%)	5304 (85.69%)	1169 (88.76%)
SOFA on admission	4 (2–6)	3 (2–5)	4 (2–6)	4 (3–7)	4 (2–6)	<0.001
SAPS II on admission	33 (25–42)	31 (23–40)	35 (28–44)	38 (30–46)	38 (32–46)	<0.001
Mechanical ventilation on first day	14,399 (48.66%)	10,003 (48.78%)	834 (52.95%)	2928 (47.30%)	634 (48.14%)	<0.001
Renal replacement therapy on first day	812 (2.74%)	468 (2.28%)	28 (1.78%)	266 (4.30%)	50 (3.80%)	<0.001
Sepsis	1914 (6.47%)	1152 (5.62%)	110 (6.98%)	557 (9.00%)	95 (7.21%)	<0.001
Comorbidities
Cardiac arrhythmias	8783 (29.68%)	4451 (21.70%)	480 (30.48%)	3167 (51.16%)	685 (52.01%)	<0.001
Valvular disease	5070 (17.13%)	2423 (11.82%)	189 (12.00%)	2062 (33.31%)	396 (30.07%)	<0.001
Pulmonary circulation disorder	2038 (6.89%)	907 (4.42%)	112 (7.11%)	803 (12.97%)	216 (16.40%)	<0.001
Hypertension	16,156 (54.60%)	10,600 (51.69%)	959 (60.89%)	3803 (61.44%)	794 (60.29%)	<0.001
Uncomplicated diabetes	5960 (20.14%)	3682 (17.95%)	360 (22.86%)	1569 (25.35%)	349 (26.50%)	<0.001
Complicated diabetes	1747 (5.90%)	926 (4.52%)	56 (3.56%)	647 (10.45%)	118 (8.96%)	<0.001
Renal failure	3564 (12.05%)	1644 (8.02%)	166 (10.54%)	1432 (23.13%)	322 (24.45%)	<0.001
Liver disease	2052 (6.94%)	1607 (7.84%)	103 (6.54%)	284 (4.59%)	58 (4.40%)	<0.001
Metastatic cancer	1756 (5.93%)	1366 (6.66%)	145 (9.21%)	195 (3.15%)	50 (3.80%)	<0.001
Obesity	1602 (5.41%)	1003 (4.89%)	117 (7.43%)	370 (5.98%)	112 (8.50%)	<0.001

Abbreviations: COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; SOFA, Sequential Organ Failure Assessment; SAPS II, Simplified Acute Physiology Score.

Table 2 Clinical Outcomes of the Study Subjects

Variables	All Subjects (n=29,589)	Without COPD or CHF (n=20,507)	COPD (n=1575)	CHF (n=6190)	With COPD and CHF (n=1317)	P-value
28-day mortality	2549 (8.61%)	1419 (6.92%)	185 (11.75%)	735 (11.87%)	210 (15.95%)	<0.001
90-day mortality	4063 (13.73%)	2236 (10.90%)	275 (17.46%)	1213 (19.60%)	339 (25.74%)	<0.001
ICU mortality	880 (2.97%)	490 (2.39%)	54 (3.43%)	271 (4.38%)	65 (4.94%)	<0.001
Hospital mortality	1961 (6.63%)	1092 (5.33%)	123 (7.81%)	606 (9.79%)	140 (10.63%)	<0.001
Length of ICU stay (days)	2.42 (1.58–4.46)	2.22 (1.47–4.01)	2.61 (1.59–4.85)	3.05 (1.88–5.44)	3.08 (1.88–6.01)	<0.001
Length of hospital stay (days)	7.82 (4.98–13.00)	7.20 (4.68–12.08)	8.01 (5.26–13.00)	9.24 (6.02–14.97)	9.60 (6.07–15.16)	<0.001

Abbreviations: COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; ICU, intensive care unit.

Figure 2 Kaplan–Meier curves for survival after ICU admission.

Abbreviations: ICU, intensive care unit; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure.

Table 3 Associations Between Comorbid COPD and/or CHF and Clinical Outcomes

Outcome	Crude		Adjust Model I		Adjust Model II
	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value
28-day mortality
Without COPD or CHF	Reference		Reference		Reference
COPD	1.74 (1.49–2.03)	<0.0001	1.37 (1.17–1.60)	<0.0001	1.25 (1.07–1.46)	0.0046
CHF	1.76 (1.61–1.92)	<0.0001	1.25 (1.14–1.37)	<0.0001	1.18 (1.07–1.30)	0.0012
With COPD and CHF	2.40 (2.08–2.78)	<0.0001	1.64 (1.41–1.90)	<0.0001	1.55 (1.33–1.80)	<0.0001
90-day mortality
Without COPD or CHF	Reference		Reference		Reference
COPD	1.67 (1.47–1.89)	<0.0001	1.30 (1.15–1.48)	<0.0001	1.21 (1.07–1.37)	0.0031
CHF	1.88 (1.75–2.01)	<0.0001	1.33 (1.23–1.43)	<0.0001	1.25 (1.16–1.35)	<0.0001
With COPD and CHF	2.55 (2.28–2.86)	<0.0001	1.73 (1.55–1.95)	<0.0001	1.64 (1.46–1.85)	<0.0001

Notes: Model I was adjusted for age and sex; model II was adjusted for age, sex, type of admission; ethnicity, SOFA, SAPS II, sepsis, mechanical ventilation on first day, renal replacement therapy on first day, and comorbidities including cardiac arrhythmias, valvular disease, pulmonary circulation disorder, hypertension, uncomplicated diabetes, complicated diabetes, renal failure, liver disease, metastatic cancer, and obesity.

Abbreviations: COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; HR, hazard ratio; CI, confidence interval.