Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis

• Published in: International journal of chronic obstructive pulmonary disease Vol. 17; pp. 371 - 382
• Main Authors: Martinez-García, Miguel Angel, Rigau, David, Barrecheguren, Miriam, García-Ortega, Alberto, Nuñez, Alexa, Oscullo Yepez, Grace, Miravitlles, Marc
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2022; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Aged; Bias; bronchial colonization; bronchial infection; Bronchitis, Chronic - complications; Chronic obstructive pulmonary disease; Clinical outcomes; copd; Disease Progression; exacerbations; Health aspects; Humans; Infection; Infections; Lung diseases, Obstructive; Medical prognosis; Medical research; Medicine, Experimental; Meta-analysis; Mortality; Original Research; outcomes; Patients; Pharmaceutical industry; prognosis; Pseudomonas aeruginosa; Pulmonary Disease, Chronic Obstructive; Quality of Life; Spain; Switzerland; Systematic review; Switzerland; Spain; bronchial colonization; bronchial infection; outcomes; exacerbations; mortality; prognosis; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S346294

Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular (PA) in respiratory samples on the prognosis of COPD is unclear. We conducted a systematic review of prognostic studies including patients with isolation of PA in sputum in stable state or during exacerbations of COPD. The main outcomes were all-cause mortality, respiratory mortality, and number and severity of future exacerbations. Data were expressed as hazard ratio (HR) (95% confidence interval [CI]) whenever possible. Of 2773 studies, eight were finally included (23,228 individuals). The mean age ranged from 65.5 to 73 years. Six studies reported data for all-cause mortality. The adjusted risk of death was almost double in patients with PA isolation (HR 1.95, 95% CI, 1.34 to 2.84; quality of evidence moderate). Patients with PA isolation showed a three times higher adjusted risk of readmission at 30 days after discharge (OR 3.60, 95% CI, 3.60 to 12.03, 1 study; quality of evidence very low), and more than double adjusted risk of death and hospitalization at two years (HR 2.80, 95% CI, 2.20 to 3.56, 1 study; quality of evidence very low). There is moderate certainty that the isolation of PA in sputum is associated with an adjusted increased risk of death in patients with COPD.