Predicting outcomes in patients with exacerbation of COPD
requiring mechanical ventilation
Annals of
Intensive Care volume 14, Article number: 159, Published: 20
October 2024
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.