About this trial

COPD is one of the leading causes of morbidity, mortality and health care utilisation worldwide. Currently, COPD is the third leading cause of death worldwide and is therefore a major public health problem. Projections show an increase in the prevalence and burden of COPD in the coming decades due to ageing populations and continued exposure to risk factors.

In patients with COPD, mortality due to exacerbations is about 35%. Exacerbations represent the most important respiratory event in the history of this chronic disease and are of major socio-economic interest (about 50-75% of healthcare expenditure in this disease).

In the most severe cases, COPD exacerbations lead to respiratory distress with hypercapnic ventilatory acidosis requiring ventilatory support. These most severe episodes are common, accounting for 20% of exacerbations and are a signal of advanced disease, with a high risk of future hospitalisations and a limited long-term prognosis.

Despite progress in management, the mortality of these severe acute exacerbations is around 15% in the ICU and 20% in hospital. The long-term prognosis following hospitalisation for an acute exacerbation of COPD is poor with a 5-year mortality of around 50%. On the one hand, the means and treatments likely to improve the prognosis of these patients are of great medical and socio-economic interest, on the other hand, it seems important to identify the elements that may be associated with management failure and to treat them where appropriate.

Thus, improving scientific knowledge thanks to prospective data, evaluating the different characteristics and prognosis of patients hospitalised for a severe acute exacerbation of COPD seems, in the 21st century, a major axis in order to continue to optimise the individual management of these patients but also collectively, given the COPD public health burden.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age ≥ 40 years old

COPD documented or strongly suspected

Chronic respiratory symptoms (dyspnoea, cough and/or sputum)

Exposure to a known risk factor for COPD (such as tobacco smoke)

Disqualifiers

Known asthma (according to the criteria of the international "Global Initiative for Asthma" guidelines)

Patient refusal to participate (information note, application for non-opposition)

Trial population

Patients admitted to ICU, a step-unit or respiratory care unit for a severe acute exacerbation of COPD

Trial design

Design model

Cohort

Time perspective

Prospective

Treatments tested in this trial

Not listed

Trial groups

No trial groups listed

Trial outcomes

Primary outcomes

1

ICU survival

vital status at ICU discharge

Time frame

immediately after hospitalization in ICU

2

Day 90 survival

vital status at day 90

Time frame

90 days after ICU admission

Secondary outcomes

1

One-year survival

Rate of survivors and non-survivors will be assessed at one year To better understand the one-year survival outcome, numerous factors will be assessed for an association with one-year survival: Demographic characteristics and chronic comorbidities; COPD severity; performans status; chronic use of long term oxygen therapy, systemic steroids or homecare non-invasive ventilation; previous intubation for COPD exacerbation; type of triggering factors of COPD exacerbation; type of treatment used during ICU stay (systemic steroids, intravenous bronchodilators, non-invasive ventilation and invasive ventilation); decision of withholding and withdrawal of care during ICU and hospital stay; further COPD exacerbation between hospital discharge and one year outcome; further COPD exacerbation requiring hospitalization between hospital discharge and one year outcome. We will perform descriptive analysis and multivariate analysis with odds ratio for each factor

Time frame

one year after ICU admission

2

Factors associated with ICU mortality

Numerous factors will be assessed for an association with ICU mortality: Demographic characteristics and chronic comorbidities; COPD severity; performans status; chronic use of long term oxygen therapy, systemic steroids or homecare non-invasive ventilation; previous intubation for COPD exacerbation; type of triggering factors of COPD exacerbation; vital parameters at ICU admission (temperature, heart rate, mean arterial pressure, respiratory rate, coma glasgow scale); SAPS 2; arterial blood gaz results prameters at ICU admission; biological sample results at ICU admission; type of treatment used during ICU stay (systemic steroids, intravenous bronchodilators, non-invasive ventilation and invasive ventilation). We will perform descriptive analysis and multivariate analysis with odds ratio for each factor

Time frame

immediately after hospitalization in ICU

3

Factors associated with hospital mortality

Numerous factors will be assessed for an association with hospital mortality: Demographic characteristics and chronic comorbidities; COPD severity; performans status; chronic use of long term oxygen therapy, systemic steroids or homecare non-invasive ventilation; previous intubation for COPD exacerbation; type of triggering factors of COPD exacerbation; vital parameters at ICU admission (temperature, heart rate, mean arterial pressure, respiratory rate, coma glasgow scale); SAPS 2; arterial blood gaz results prameters at ICU admission; biological sample results at ICU admission; type of treatment used during ICU stay (systemic steroids, intravenous bronchodilators, non-invasive ventilation and invasive ventilation). We will perform descriptive analysis and multivariate analysis with odds ratio for each factor

Time frame

immediately after hospital discharge

4

Factors associated with the need for invasive mechanical ventilation

Numerous factors will be assessed for an association with invasive mechanical ventlation: Demographic characteristics and chronic comorbidities; COPD severity; performans status; chronic use of long term oxygen therapy, systemic steroids or homecare non-invasive ventilation; previous intubation for COPD exacerbation; type of triggering factors of COPD exacerbation; vital parameters at ICU admission (temperature, heart rate, mean arterial pressure, respiratory rate, coma glasgow scale); SAPS 2; arterial blood gaz results prameters at ICU admission; biological sample results at ICU admission; type of treatment before ICU admission (systemic steroids, non-invasive ventilation) and type of treatment used during ICU stay (systemic steroids, intravenous bronchodilators, non-invasive ventilation). We will perform descriptive analysis and multivariate analysis with odds ratio for each factor

Time frame

immediately after the intervention named invasive mechanical ventilation

COPD-ICU Multicentre Prospective Observational Register

About this trial

Eligibility criteria

Qualifiers

Disqualifiers

Trial population

Trial design

Treatments tested in this trial

Trial groups

Trial outcomes

Primary outcomes

Secondary outcomes

Other outcomes

Sponsors and contacts