Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
J Intensive Care Med. 2020 Mar;35(3):251-256. doi: 10.1177/0885066617739561. Epub 2017 Nov 1.
The effect of anemia on patients with chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation for acute respiratory failure is unknown.
To examine the association between anemia (hemoglobin <12 g/dL) and 90-day and overall mortality in patients with COPD having acute respiratory failure requiring invasive mechanical ventilation.
Retrospective study of patients admitted to a quaternary referral medical intensive care unit (ICU) between October 2007 and December 2012 with a diagnosis of COPD and requiring invasive mechanical ventilation for acute respiratory failure of any cause.
We identified 1107 patients with COPD who required invasive mechanical ventilation for acute respiratory failure. Mean age was 64.2 ± 12.7 years; 563 (50.9%) were females. The mean Acute Physiology and Chronic Health Evaluation III score at ICU admission was 80.5 ± 29.3. The median duration of mechanical ventilation was 35.7 hours (interquartile range: 20.0-54.0). In all, 885 (79.9%) patients were anemic (Hb < 12g/dL) on ICU admission, and 312 patients (28.2%) received blood transfusion during their ICU stay. A total of 351 inhospital deaths were recorded, the majority (n = 320) occurring in the ICU. The 90-day mortality, though lower in the nonanemic patients compared to the patients with anemia, was not statistically significant (35.6% vs 44.9%; hazard ratio [HR] [95% confidence interval; CI] = 1.16 [0.91 -1.48], = .22). The overall mortality was lower in the nonanemic patients compared to patients with anemia (HR [95% CI] = 0.68 [0.55-0.83], < .001). There was a 5% decrease in risk of death for every unit increase in hemoglobin ( = .01). There was no difference in terms of both 90-day and overall mortality in patients who received blood transfusions compared to patients who did not receive any transfusion.
Critically ill patients with COPD requiring invasive mechanical ventilation for acute respiratory failure without anemia on admission had a better overall survival when compared to those with anemia. No difference was noted in the 90-day mortality. Further studies are needed to determine the impact of the trajectory of hemoglobin on mortality.
贫血对接受有创机械通气治疗的慢性阻塞性肺疾病（COPD）急性呼吸衰竭患者的影响尚不清楚。
研究贫血（血红蛋白<12g/dL）与 COPD 患者因急性呼吸衰竭需要有创机械通气治疗后 90 天和总体死亡率之间的相关性。
回顾性研究 2007 年 10 月至 2012 年 12 月期间入住一家四级转诊医疗重症监护病房（ICU）的因 COPD 急性呼吸衰竭而需要有创机械通气治疗的患者，研究对象为任何病因所致急性呼吸衰竭。
我们共纳入 1107 名因 COPD 急性呼吸衰竭需要有创机械通气治疗的患者，患者的平均年龄为 64.2±12.7 岁，563 名（50.9%）为女性。入 ICU 时急性生理学与慢性健康状况评分系统Ⅲ（APACHE Ⅲ）的平均评分为 80.5±29.3。机械通气的中位时间为 35.7 小时（四分位间距：20.0-54.0）。共有 885 名（79.9%）患者在入住 ICU 时存在贫血（Hb<12g/dL），312 名（28.2%）患者在 ICU 期间接受了输血治疗。共记录到 351 例院内死亡，其中多数（n=320）发生在 ICU。与贫血患者相比，非贫血患者的 90 天死亡率较低，但差异无统计学意义（35.6%比 44.9%；危险比[HR]（95%置信区间[CI]）=1.16（0.91-1.48），=0.22）。与贫血患者相比，非贫血患者的总体死亡率较低（HR（95%CI）=0.68（0.55-0.83），<0.001）。血红蛋白每增加 1 单位，死亡风险降低 5%（=0.01）。与未输血的患者相比，输血患者的 90 天和总体死亡率均无差异。需要进一步的研究来确定血红蛋白水平变化对死亡率的影响。
