Abstract Background Acute respiratory distress syndrome (ARDS) is the major cause of mortality in patients with community-acquired pneumonia(CAP). However, it is not clear yet the incidence of ARDS in patients with COPD whom developed CAP. Objective Was to determine the risk factors for development ARDS secondary to CAP in COPD patients with differential inflammatory type of the disease. Methods It was restrospective study from university hospital and have been investigated by radiological,microbiological ,and biochemistry analysis. In all patients have been used conventional oxygen therapy (COT) with further using of CPAP and HFNO and mechanical ventilation (MV) if there were indications to that. Results 126 patients with COPD exacerbations whom developed CAP and in 39 patients of them(30.96) developed ARDS.The patients with COPD complicated with CAP and ARDS were older(p 0.001),male gender(p 0.001) and concominant bronchiectasis(OR 3.440.98-7.22;p0.001).This group patients also was characterized with non-Th2-type inflammation COPD phenotype and with more severe clinical features of ARDS(OR 4.78088-9.66;p0.0004).In patients with Th2 -type inflammation the incidence of ARDS was lower with more mild clinical features of ARDS(PaO2/FiO2 between 200 and 300).The response to the HFNO was hgier in Th2-type inflammation COPD phenotype patients and it was result for just 3 intubated patients in this group compared to 20 intubated patients in non-Th2-type inflammation patients group(OR3.541.32-7.21;p0.001).Risk factors for development of ARDS in patients were: septic shock at the time of admissionof patietns(p 0.001);previous ICU admission (p 0.001);high SOFA score (p 0.002);and gram -negative multidrug bactera(MDRB) (OR 4.22079-9.42;p0.0004).Duration of mechanical ventilation was significantly lower in Th2-type inflammation COPD (2.481.02-5.28;p0.004).30-day mortality rate was higher in non-Th2-type inflammation phenotype COPD complicated with CAP and ARDS(40.7% vs 8.3%;p0.003). Conclusions ARDS is common complication of CAP in COPD patients.However,the phenotype of COPD may indicated to the severity and incidence of ARDS developed in COPD patients with CAP.More high incidence with more severe and high mortality rate of ARDS occurs in non-Th2-type inflammation COPD complicated with CAP.Our findings suggested that type-Th2-inflammataion in COPD complicated with CAP may protect patients from dvelopment of ARDS . This abstract is funded by: None
Sadigov et al. (Fri,) studied this question.