Abstract
BackgroundIntermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context.ObjectiveThe objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction.DesignCohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting.PatientsThe study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013.Key ResultsThe observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power.ConclusionsThese results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care.
Highlights
Non-Invasive Ventilation (NIV) reduces in-hospital mortality in selected patients with acute respiratory failure (ARF) [1,2,3,4]
Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power. These results suggest that Simplified Acute Physiology Score (SAPS) II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care
Significant differences in Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II scores have been found between survivors and non-survivors who underwent NIV due to acute lung injury (ALI) [9], acute respiratory distress syndrome (ARDS) [10], COPD exacerbation [11], acute pulmonary edema (APE) [12], interstitial lung disease [13] and acute myasthenia gravis [14]
Summary
Non-Invasive Ventilation (NIV) reduces in-hospital mortality in selected patients with acute respiratory failure (ARF) [1,2,3,4]. Indications and success of this ventilation mode depend on ARF etiology, the evolution in the first hours of the PaO2/FiO2 ratio, pH, pCO2 and the respiratory rate [5,6,7]. For this reason, initiation of NIV in ARF should be done under continuous surveillance [5]. Initiation of NIV in ARF should be done under continuous surveillance [5] In this context, Intermediate Care Units (ImCU) may offer a suitable alternative to the intensive care unit (ICU), due to the availability of non-invasive monitoring and specialized staff and nursing dedication [8]. The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context
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