| Title: |
Withholding of Life-Sustaining Treatment and Mortality in ICU Patients with Severe Acute COPD Exacerbations : A Retrospective French Cohort |
| Authors: |
Puechoultres, Pauline; Jamme, Matthieu; Abi-Abdallah, Georges; Diop, Sylvain; Legriel, Stéphane; Ferré, Alexis |
| Contributors: |
Centre Hospitalier de Versailles André Mignot (CHV); Ramsay Générale de Santé - Hôpital Privé La Louvière; Direction de la recherche, des études, de l’évaluation et des statistiques Paris (DREES); Ministère des Solidarités et de la Santé Paris, France; Hôpital Européen Georges Pompidou APHP (HEGP); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO); Hôpital Marie-Lannelongue; Centre de recherche en épidémiologie et santé des populations (CESP); Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse; AP-HP. Université Paris Saclay-AP-HP. Université Paris Saclay-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay |
| Source: |
ISSN: 1178-2005 ; International Journal of Chronic Obstructive Pulmonary Disease ; https://hal.science/hal-05237532 ; International Journal of Chronic Obstructive Pulmonary Disease, 2025, Volume 20, pp.1995-2009. ⟨10.2147/copd.s502019⟩. |
| Publisher Information: |
CCSD |
| Publication Year: |
2025 |
| Collection: |
Université de Versailles Saint-Quentin-en-Yvelines: HAL-UVSQ |
| Subject Terms: |
[SDV]Life Sciences [q-bio] |
| Description: |
International audience ; 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, p < 0.001), immunodeficiency (OR = 3.07, p < 0.001), higher Performance Status (PS) score (OR [+1 point] = 2.10, p < 0.001), long-term oxygen therapy (OR = 4.11, p < 0.001) and shock after ICU admission (OR = 2.43, p = 0.01). In multivariate analysis, factors significantly associated with 3-month mortality included decision of WLS during ICU (OR = 22.98, p < 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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40551759; PUBMED: 40551759 |
| DOI: |
10.2147/copd.s502019 |
| Availability: |
https://hal.science/hal-05237532; https://hal.science/hal-05237532v1/document; https://hal.science/hal-05237532v1/file/COPD-502019-withholding-of-life-sustaining-treatment-and-mortality-in-ic.pdf; https://doi.org/10.2147/copd.s502019 |
| Rights: |
https://creativecommons.org/licenses/by-nc/4.0/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.93BAAD43 |
| Database: |
BASE |