Severe COPD Exacerbators Requiring Multiple ICU Admissions Over Time: Insights of a French Cohort

Alexis Ferré,1 Nassim Sahki,2 Pauline Puechoultres,1 Sylvain Diop,3 Georges Abi-Abdallah,4,5 Stéphane Legriel1,6 1Intensive Care Unit, Versailles Hospital, Le Chesnay, France; 2DRCI, Versailles Hospital, Le Chesnay, France; 3Department of Anesthesiology and Intensive care, Marie Lannelongue Hospital, Le Plessis Robinson, France; 4Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France; 5IThEM, INSERM, Université de Paris Descartes, Paris, France; 6CESP, INSERM, Université Paris-Saclay et UVSQ, Villejuif, FranceCorrespondence: Alexis Ferré, Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, Le Chesnay, 78150, France, Email [email protected]: Data on COPD patients who experience multiple intensive care unit (ICU) admissions for severe acute exacerbations (AECOPD) are scarce. We aimed to describe and compare patients’ characteristics by recurrent admission status and to identify factors associated with recurrent ICU-level exacerbations.Methods: We conducted a single-centre, retrospective cohort study including all patients admitted to our ICU between 2015 and 2022 for a severe AECOPD. Patients with more than one ICU admission during the study period were classified as “recurrent exacerbator” phenotype. Multivariable regression and competing-risk models were used.Results: We included 328 patients who had a total of 445 admissions. Seventy-two (22.0%) patients had multiple ICU admissions. Compared with non-recurrent patients, recurrent exacerbators were younger (median 67 vs 70 years, p=0.037), had a lower prevalence of impaired Performance Status (13.9% vs 25.8%, p=0.035), and had higher blood eosinophil counts (0.06 vs 0.04 G/L, p=0.025). One-year mortality was similar between groups (18.1% vs 18.4%, p=0.95). In multivariate model, factors independently associated with recurrent severe exacerbation were long-term oxygen therapy (HR = 1.79, p=0.045) and initial blood eosinophil count (HR per +0.1 G/L = 1.10, p< 0.001). A Performance Status ≥ 3 was inversely associated with recurrence (HR per point = 0.41, p=0.030).Conclusion: Patients with recurrent ICU admission for severe COPD exacerbations were younger and had higher blood eosinophil counts than those with a single admission. These findings may suggest that phenotyping—including blood eosinophils—could help stratify the risk of recurrent severe exacerbations and personalised treatment.Keywords: COPD, exacerbation, mortality, exacerbator, phenotype