Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations

Pier Paolo SAINAGHI, Davide COLOMBO, Azzurra Re, Mattia BELLAN, DANIELE SOLA, Piero Emilio Balbo, Mauro Campanini, Francesco DELLA CORTE, Paolo Navalesi, Mario PIRISI

Research output: Contribution to journalArticlepeer-review

Abstract

Non-invasive ventilation (NIV) delivered in an intensive care unit (ICU) has become the cornerstone in the treatment of patients with severe chronic obstructive pulmonary disease (COPD) exacerbations. A trend towards managing these patients in non-ICU setting has emerged in recent years, although out-of-hospital survival by this approach and how to prognosticate it is unknown. We aimed to investigate these issues. We consecutively recruited 100 patients (49 males; median age 82 years) who received NIV treatment for acute respiratory failure due to COPD exacerbation in non-ICU medical wards of our hospital, between November 2008 and July 2012. We assessed survival (both in-hospital and out-of-hospital) of all these patients, and analyzed baseline parameters in a Cox proportional hazards model to develop a prognostic score. The median survival in the study population was 383 days (240–980). Overall survival rates were 71.0, 65.3, and 52.7 % at 1, 3, and 12 months, respectively. Age >85 years, a history of heart disorders and a neutrophil count ≥10 × 109 were associated with higher mortality at Cox’s analysis (χ2 = 35.766, p = 0.0001), and were used to build a prognostic score (NC85). The presence of two or more factors determined the deepest drop in survival (when NC85 ≥2, mortality at 1, 3, and 12 was 60.7, 70.4, and 77.2 %, respectively, while when NC85 = 0 were 4.0, 4.0, and 14.0 %). A simple model, based on three variables (age, neutrophil count and history of heart disease), accurately predicts survival of COPD patients receiving NIV in a non-ICU setting.

Original languageEnglish
Pages (from-to)969-975
Number of pages7
JournalInternal and Emergency Medicine
Volume11
Issue number7
DOIs
Publication statusPublished - 2016

Keywords

  • COPD exacerbations
  • Emergency Medicine
  • Internal Medicine
  • Non-ICU setting
  • Non-invasive ventilation
  • Risk stratification

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