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. 2024 Oct 20;14(1):159.
doi: 10.1186/s13613-024-01394-z.

Predicting outcomes in patients with exacerbation of COPD requiring mechanical ventilation

Obaid Alzaabi  1 , Emmanuel Guerot  2 , Benjamin Planquette  3 , Jean-Luc Diehl  2 , Thibaud Soumagne  3
Affiliations

Predicting outcomes in patients with exacerbation of COPD requiring mechanical ventilation

Obaid Alzaabi et al. Ann Intensive Care. .

Abstract

Background: Acute exacerbations of COPD (AECOPD) are common and significantly contribute to mortality in patients with COPD. Prognostic scores can assist clinicians in making tailored decisions to manage AECOPD. In the current study, we therefore aimed to evaluate the performance of the Noninvasive Ventilation Outcomes (NIVO) score, originally designed to assess in-ICU mortality, in predicting 1 year mortality and NIV failure in AECOPD.

Methods: This retrospective study analyzed data from patients hospitalized for AECOPD requiring mechanical ventilation between January 1st, 2018, and December 31st, 2022. Mortality was assessed at the end of ICU stay and 1 year after admission, while NIV failure was defined as intubation or death without intubation.

Results: Among 302 ICU admissions of COPD patients, 190 patients with AECOPD requiring mechanical ventilation were included. Of these, 44 (23%) died in the ICU, 62 out of 184 (34%) failed NIV, and 78 (41%) died within 1 year of admission. Patients who died in ICU or experienced NIV failure had more severe COPD and more impaired blood gas parameters at admission. The NIVO score demonstrated an AUC of 0.68 in predicting 1-year mortality and an AUC of 0.85 in predicting NIV failure. A NIVO score over 7 was associated with higher 1-year mortality and NIV failure (HR of 4.4 [1.8-10.9] and 41.6 [5.6-307.9], respectively).

Conclusion: Beyond predicting in-ICU mortality, the NIVO-score is a reliable tool in predicting 1-year mortality and NIV failure in AECOPD.

Keywords: COPD; Exacerbation; Mechanical ventilation; Mortality; Outcome.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves of NIVO, DECAF and SOFA scores for in-ICU mortality (A) and 1-year mortality (B). Area under the ROC curve (AUC) values are also given
Fig. 3
Fig. 3
Kaplan–Meier estimates of overall survival in patients with low (0–2), moderate (3–4), high (5–6) and very high risk (7–9) of mortality according to NIVO score (A) and among the subgroup of patients (n = 147) who were still alive at day 30 of admission (B)
Fig. 4
Fig. 4
Kaplan–Meier estimates of NIV failure (A) and proportion of NIV failure (B) in patients with low (0–2), moderate (3–4), high (5–6) and very high risk (7–9) according to NIVO score
See this image and copyright information in PMC

References

    1. WHO. Chronic obstructive pulmonary disease (COPD). https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pul...).
    1. Ferkol T, Schraufnagel D. The global burden of respiratory disease. Ann Am Thorac Soc. 2014;11(3):404–6. - PubMed
    1. Halpin DM, Decramer M, Celli B, Kesten S, Liu D, Tashkin DP. Exacerbation frequency and course of COPD. Int J Chron Obstruct Pulmon Dis. 2012;7:653–61. 10.2147/COPD.S34186. - PMC - PubMed
    1. Molinari N, Briand C, Vachier I, Malafaye N, Aubas P, Georgescu V, Roche N, Chanez P, Bourdin A. Hospitalizations for COPD exacerbations: trends and determinants of death. COPD. 2015;12(6):621–7. 10.3109/15412555.2015.1007931. - PubMed
    1. Keegan MT, Soares M. What every intensivist should know about prognostic scoring systems and risk-adjusted mortality. Rev Bras Ter Intensiva. 2016;28(3):264–9. 10.5935/0103-507X.20160052. - PMC - PubMed

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