Could age-adjusted Charlson comorbidity index predict outcomes in patients submitted to noninvasive ventilation?

Abstract

Background: Comorbidities are thought to have prognostic impact on outcomes of patients submitted to noninvasive ventilation (NIV). Aims and Objectives: Determine if age-adjusted Charlson comorbidity index (ACCI) could predict outcomes in patients undergoing NIV due to acute respiratory failure. Methods: Patients admitted to an intermediate care unit of a general hospital in 2015-2016, with respiratory failure submitted to NIV, were prospective evaluated comparing patient’s characteristics and outcomes according to low/high ACCI. Each comorbidity composing the index was tested as predictor of in-hospital mortality and 30-day mortality and readmission. NIV failure was defined as need for invasive mechanical ventilation and/or death. Results: One hundred and seventy-seven patients were enrolled. Mean ACCI score was 5.4±2.5 points. Comparing patients with ACCI>5 with ACCI≤5, the former were older (78.2±9.8 vs. 68.6±13.3, p 5 patients (OR 0.50, 95% CI 0.26-0.96, p=0.036). No differences were found in length of stay, time on NIV, NIV complications or failure, and 30-day hospital readmission. None of the single comorbidities was predictive of NIV failure when adjusted to sex and age. Chronic pulmonary disease was associated with 30-day hospital readmission (OR 2.67, 95% CI 1.06-6.89, p=0.037). Mortality within 30 days after discharge related to mild (OR 21.14, 95% CI 1.38-323.22, p=0.028) and moderate to severe liver disease (OR 16.00, 95% CI 1.08-238.30, p=0.044). Conclusion: ACCI is not a good predictor for short-term outcomes in patients acutely submitted to NIV.