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 82years) 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 383days (240-980). Overall survival rates were 71.0, 65.3, and 52.7% at 1, 3, and 12months, respectively. Age>85years, a history of heart disorders and a neutrophil count≥10×10(9) were associated with higher mortality at Cox's analysis (χ (2)=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.
Published Version
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