Abstract Rationale Sepsis outcomes are influenced by comorbid conditions. Patients with chronic obstructive pulmonary disease (COPD) are chronically exposed to systemic inflammation and inhaled or systemic corticosteroids, which may modulate immune responses during infection. This study aimed to investigate whether COPD affects epidemiological trends and mortality in intensive care unit (ICU) patients with sepsis. Methods This retrospective cohort, tertiary chest diseases hospital, single-center study included adults admitted to a respiratory ICU with sepsis between January 2017 and December 2024. Demographics, comorbidities, laboratory findings, and outcomes were recorded. The primary endpoint was ICU mortality. Joinpoint regression assessed annual changes in COPD prevalence among sepsis cases. Mortality predictors were identified using binary logistic regression (Forward LR), including only dichotomous variables. Results A total of 4244 patients were included; 2812 (66.3%) survived and 1432 (33.7%) died. Compared with survivors, non-survivors were older and had higher rates of ARDS, acute renal failure, malignancy, interstitial lung disease (ILD), and tuberculosis, whereas COPD was significantly more frequent among survivors (78.1% vs 21.9%; p 0.001). Non-survivors also exhibited higher leukocyte counts, neutrophil-to-lymphocyte ratios, procalcitonin, CRP, LDH, renal dysfunction markers, and coagulation abnormalities, while lymphocyte percentage, platelet count, and PLT/MPV ratio were lower (all p 0.001). In multivariable analysis, COPD was independently associated with lower mortality (OR 0.66; 95% CI 0.55-0.79; p 0.001). Age ≥85 years, male sex, acute renal failure, malignancy, ILD, ARDS, and COVID-19 were associated with increased mortality. Joinpoint regression demonstrated a significant decline in the proportion of COPD among sepsis admissions from 2017 to 2021 (APC −15.47%; p = 0.013), followed by a non-significant increase from 2021 to 2025 (APC +3.99%; p = 0.44) (Figure 1). Conclusions COPD was associated with lower mortality and showed a decreasing temporal trend among ICU sepsis patients, suggesting a distinct clinical phenotype. The observed decline in COPD prevalence may be related to improvements in maintenance inhaler therapies—such as combination bronchodilator and anti-inflammatory agents—which could attenuate excessive immune responses during sepsis. Although this mechanism was not evaluated in our study, it warrants future physio-pathologic and translational research. Figure 1. Joinpoint regression showing annual percent change in COPD prevalence among ICU sepsis admissions (2017-2025), with a significant decline until 2021 followed by a non-significant increase. This abstract is funded by: None
Karakurt et al. (Fri,) studied this question.
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