Puechoultres Pauline, Jamme Matthieu, Abi-Abdallah Georges, Diop Sylvain, Legriel Stéphane, Ferré Alexis
Intensive Care Unit, Versailles Hospital, Le Chesnay, France.
Intensive Care Unit, West Parisian Private Hospital, Ramsay-Générale de Santé, Trappes, France.
Int J Chron Obstruct Pulmon Dis. 2025 Jun 18;20:1995-2009. doi: 10.2147/COPD.S502019. eCollection 2025.
Data on withholding life-support (WLS) decisions during acute exacerbations of chronic obstructive pulmonary disease (COPD) in the intensive care unit (ICU) are scarce. This study aimed to identify factors associated with these decisions and their impact on mortality.
We conducted a monocentric retrospective cohort study on all patients admitted to our ICU between 2015 and 2021 for a severe acute exacerbation of COPD. Logistic multivariable regression analysis was performed.
We included 463 patients of whom 128 (27.6%) had a decision of withholding of care. The 3-months mortality was 49.2% and 4.8% in the WLS group and in the no WLS group, respectively. Forty-eight patients (10.4%) had advanced healthcare directives. In multivariable analysis, factors associated with a decision of WLS were higher age (odds ratio [+10 years] = 1.93, < 0.001), immunodeficiency (OR = 3.07, < 0.001), higher Performance Status (PS) score (OR [+1 point] = 2.10, < 0.001), long-term oxygen therapy (OR = 4.11, < 0.001) and shock after ICU admission (OR = 2.43, = 0.01). In multivariate analysis, factors significantly associated with 3-month mortality included decision of WLS during ICU (OR = 22.98, < 0.001) and invasive mechanical ventilation (OR = 2.72, p < 0.001).
Approximately 30% of COPD patients underwent a decision to withhold life-sustaining treatment. Higher age, immunosuppression, increased PS score, and long-term oxygen therapy were significantly associated with this decision. Nearly half of the patients died within three months following a withholding of care decision.
关于重症监护病房（ICU）中慢性阻塞性肺疾病（COPD）急性加重期停止维持生命治疗（WLS）决策的数据很少。本研究旨在确定与这些决策相关的因素及其对死亡率的影响。
我们对2015年至2021年间因COPD严重急性加重入住我院ICU的所有患者进行了单中心回顾性队列研究。进行了多变量逻辑回归分析。
我们纳入了463例患者，其中128例（27.6%）有停止治疗的决策。WLS组和非WLS组的3个月死亡率分别为49.2%和4.8%。48例患者（10.4%）有预先医疗指示。在多变量分析中，与WLS决策相关的因素包括年龄较大（优势比[每增加10岁]=1.93，<0.001）、免疫缺陷（OR=3.07，<0.001）、较高的体能状态（PS）评分（OR[每增加1分]=2.10，<0.001）、长期氧疗（OR=4.11，<0.001）和入住ICU后休克（OR=2.43，=0.01）。在多变量分析中，与3个月死亡率显著相关的因素包括ICU期间的WLS决策（OR=22.98，<0.001）和有创机械通气（OR=2.72，p<0.001）。
约30%的COPD患者接受了停止维持生命治疗的决策。年龄较大、免疫抑制、PS评分增加和长期氧疗与该决策显著相关。近一半的患者在停止治疗决策后的三个月内死亡。
