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Sepsis Multiplies In-Hospital Mortality Risk In COPD
Although slightly fewer than 1% of hospitalizations for chronic obstructive pulmonary disease (COPD) are complicated by sepsis, this complication increases the risk for in-hospital mortality fivefold, investigators who studied a representative national sample found.
Among nearly 7 million hospitalizations in which the primary diagnosis was COPD, about 65,000 (0.93%) patients experienced sepsis as a complication. In all, 31% of COPD patients with sepsis were discharged from the hospital to another care facility, and 19% died in the hospital.
COPD has been associated with increased risk for sepsis because of the use of corticosteroids, underlying comorbidities and, potentially, impaired barrier function, the authors note.
Researchers identified 6,940,615 hospitalizations where the primary diagnosis was COPD; in 64,748 of those cases, sepsis was a complication. As noted, the in-hospital death rate was 19% for patients with COPD and sepsis and the rate of discharge to other facilities was 31%. Investigators saw that the adjusted odds for in-hospital mortality remained stable over time, and discharge to facilities increased significantly.
Predictors of in-hospital mortality among patients with sepsis included increasing age, white ethnicity, treatment in the Northeast region, disseminated intravascular coagulation, pneumococcal infection, congestive heart failure, and renal failure.
A COPD specialist who was not involved in the study told Medscape Medical News that sepsis is an uncommon but severe complication for patients with COPD and those with other severe illnesses.
Additional insight from Dr. Nair: There are levels that infection can affect people, from simple infection to sepsis to septic shock. For instance, if you had a respiratory infection with only lung symptoms such as cough and phlegm (such as a COPD exacerbation), that would be a simple infection. If infection starts to affect other areas of the body distant to the infection site, then the infection has progressed to sepsis.
Symptoms include change of mental status (agitated or drowsy), shivering, both fever and low temperature, rapid breathing, high heart rate, and low urine volume. When one then goes on to have consistently low blood pressure and ongoing organ dysfunction, that is septic shock.
Many people with COPD are at the baseline more fragile physically, making it harder to ward off and stand up to infections. They are often older than 65 and can have some degree of immune compromise. All these factors make fighting off serious infection more difficult for patients with COPD compared with the average population – which is not a true surprise. This is one reason being in the best shape possible is so important when it comes to fighting infection. If you can’t do this on your own, then pulmonary rehabilitation is a good way to start.
To read the full report, visit Medscape.
