PURPOSE: Factors determining in-hospital mortality of patients ventilated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of this study was to assess the correlation between acute phase proteins [High sensitivity C-reactive protein (CRP) and prealbumin (PA)] and mortality in ventilated patients with COPD.
METHODS: We evaluated 336 COPD patients with AECOPD and on invasive mechanical ventilation. Detailed clinical evaluation was done daily. Concentrations of CRP and PA were measured on admission, 3rd, 8th and 16th day.
RESULTS: During this study; 237 patients were discharged and 99 died. The difference between the two groups in CRP and PA was significant at admission, 3rd, 8th day and 16th day. In non survivors; there was a significant increase in CRP values with a significant decrease in PA with time (P<0.001). In-hospital mortality was significantly associated with lower arterial oxygen tension, higher arterial carbon dioxide tension, lower arterial oxygen saturation, lower body mass index and longer hospital stay.

CONCLUSIONS: CRP levels in patients who died were significantly higher on admission, 3rd, 8th and 16th day. A fall in CRP levels on follow up indicated a significantly better prognosis. An increase in the prealbumin level was observed in survivors.
CLINICAL IMPLICATIONS: Persistently high CRP and low prealbumen in COPD patients on ventilator are associated with poor prognosis. Aggressive treatment of systemic inflammation and malnutrition may improve prognosis. Prediction of survival status may be enhanced by considering arterial oxygen tension, arterial carbon dioxide tension, albumin, body mass index and duration of hospitalization.