Abstract Introduction Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with high morbidity and mortality. However, national outcomes in the modern era remain incompletely defined. Identifying demographic and clinical predictors of in-hospital mortality may enhance prognostication and guide critical care resource allocation. Methods A retrospective cross-sectional analysis was performed using the 2021 National Inpatient Sample (NIS). Adult patients (≥18 years) with COPD exacerbation (ICD-10 J441) who underwent IMV (ICD-10-PCS 5A19*) were included. Survey discharge weights (DISCWT) were applied to derive national estimates. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS) and total hospital charges. Multivariable logistic regression was conducted to identify independent predictors of mortality, adjusting for age, sex, race, insurance type, income quartile, comorbidity burden, hospital region, and presence of acute respiratory failure (J96*). Model calibration was assessed using the Hosmer-Lemeshow test and discriminatory performance with the area under the receiver operating characteristic curve (AUC). Results A total of 76, 680 unweighted hospitalizations were identified (weighted national estimate ≈ several hundred thousand). The mean age was 67 ± 13 years, and 57% were female. The median total hospital charge was 647, 000 (interquartile range IQR 1. 09 million). In-hospital mortality occurred in 28. 4% of cases. After adjustment, female sex was independently associated with lower mortality (adjusted odds ratio aOR 0. 79; p 0. 001). Compared with Medicare, Medicaid (aOR 0. 61; p 0. 001), private insurance (aOR 0. 86; p 0. 001), and self-pay (aOR 0. 60; p 0. 001) were associated with decreased odds of death. Hispanic (aOR 1. 63; p 0. 001) and “Other” race categories (aOR 1. 23; p = 0. 038) had higher mortality compared with White patients. The presence of acute respiratory failure correlated with lower mortality (aOR 0. 29; p 0. 001), likely reflecting coding heterogeneity. The model showed good calibration (Hosmer-Lemeshow p = 0. 76) and moderate discrimination (AUC = 0. 72). Discussion Nearly one-third of patients with COPD exacerbations requiring IMV died during hospitalization. Mortality risk varied by sex, race, and payer status, suggesting disparities in access, treatment intensity, and underlying disease burden. The inverse association between acute respiratory failure coding and mortality underscores variability in administrative case definitions. Modern outcomes appear consistent with historic reports despite advances in ventilatory management. Conclusion Invasive mechanical ventilation for COPD exacerbations continues to carry high mortality, with significant demographic and socioeconomic disparities. Efforts targeting equitable access to early critical care and improved coding standardization are warranted to reduce preventable deaths. This abstract is funded by: None
Levy et al. (Fri,) studied this question.