Therapeutic advances in respiratory disease · 2026
Hypercapnia is associated with an increased risk of ICU admission and reduced inflammatory responses in AECOPD patients with severe pneumonia.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Mou Shan, Cai Qi, Xu Wei, Wang Xiaohao, Mao Lei, Li Lijuan, Zhang Li, Zhang Yan
Аннотация
BACKGROUND: Hypercapnia is linked to a poor prognosis in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and severe community-acquired pneumonia (SCAP), and reduced early anti-inflammatory capacity in SCAP. However, its impact on AECOPD+SCAP patients remains unclear.
OBJECTIVES: To assess hypercapnia's effects on inflammatory responses and short-term outcomes in AECOPD+SCAP patients.
DESIGN: This retrospective, dual-center study included 185 hospitalized AECOPD+SCAP patients from January 2014 to June 2025.
METHODS: Patients were stratified by PaCO2 levels on the day of admission: hypercapnia (>45 mmHg), normocapnia (35-45 mmHg), and hypocapnia (<35 mmHg). Data were collected on clinical data, biomarkers (procalcitonin [PCT], C-reactive protein [CRP], lactate and red cell distribution width coefficient of variation [RDW-CV]) and 30-day survival.
RESULTS: The three groups had similar invasive mechanical ventilation needs and in-hospital and 30-day mortality. Hypercapnic patients (especially with acidosis) had a higher intensive care unit (ICU) admission risk than normocapnic patients. The hypercapnia group had lower PCT, CRP and lactate levels versus the hypocapnia group (p < 0.05), while RDW-CV showed no significant intergroup differences(p > 0.05). Such trends persisted in ICU-admitted patients, largely independent of acidosis and were unaffected by prior systemic corticosteroid therapy. Multivariate analysis indicated hypercapnia, PaO2/FiO2, lactate, and RDW-CV could independently predict ICU admission. The nomogram incorporating these predictors showed good discriminatory ability (area under the curve = 0.72), comparable to pneumonia severity scores (CURB-65, PSI, SMART-COP, and Quick SOFA), with clinical utility confirmed by calibration and decision curve analyses.
CONCLUSION: Hypercapnia in AECOPD+SCAP patients could indicate higher ICU admission risk (especially in cases of acidosis) and impaired early anti-inflammatory responses, which are largely independent of acidosis. The combination of hypercapnia, RDW-CV, PaO2/FiO2 ratio, and lactate levels can help to identify patients requiring intensive care.
OBJECTIVES: To assess hypercapnia's effects on inflammatory responses and short-term outcomes in AECOPD+SCAP patients.
DESIGN: This retrospective, dual-center study included 185 hospitalized AECOPD+SCAP patients from January 2014 to June 2025.
METHODS: Patients were stratified by PaCO2 levels on the day of admission: hypercapnia (>45 mmHg), normocapnia (35-45 mmHg), and hypocapnia (<35 mmHg). Data were collected on clinical data, biomarkers (procalcitonin [PCT], C-reactive protein [CRP], lactate and red cell distribution width coefficient of variation [RDW-CV]) and 30-day survival.
RESULTS: The three groups had similar invasive mechanical ventilation needs and in-hospital and 30-day mortality. Hypercapnic patients (especially with acidosis) had a higher intensive care unit (ICU) admission risk than normocapnic patients. The hypercapnia group had lower PCT, CRP and lactate levels versus the hypocapnia group (p < 0.05), while RDW-CV showed no significant intergroup differences(p > 0.05). Such trends persisted in ICU-admitted patients, largely independent of acidosis and were unaffected by prior systemic corticosteroid therapy. Multivariate analysis indicated hypercapnia, PaO2/FiO2, lactate, and RDW-CV could independently predict ICU admission. The nomogram incorporating these predictors showed good discriminatory ability (area under the curve = 0.72), comparable to pneumonia severity scores (CURB-65, PSI, SMART-COP, and Quick SOFA), with clinical utility confirmed by calibration and decision curve analyses.
CONCLUSION: Hypercapnia in AECOPD+SCAP patients could indicate higher ICU admission risk (especially in cases of acidosis) and impaired early anti-inflammatory responses, which are largely independent of acidosis. The combination of hypercapnia, RDW-CV, PaO2/FiO2 ratio, and lactate levels can help to identify patients requiring intensive care.
Предметные рубрики MeSH
AgedAged, 80 and overFemaleHumansMaleMiddle AgedBiomarkersC-Reactive ProteinCommunity-Acquired PneumoniaDisease ProgressionHospital MortalityHypercapniaIntensive Care UnitsPatient AdmissionPrognosisPulmonary Disease, Chronic ObstructiveRespiration, ArtificialRetrospective StudiesRisk FactorsSeverity of Illness IndexTime FactorsChina