by Jun Duan,
Shengyu Wang, Ping Liu, Xiaoli Han, Yao Tian, Fan Gao, Jing Zhou, Junhuan Mou,
Qian Qin, Jingrong Yu, Linfu Bai, Lintong Zhou and Rui Zhang
Annals of Intensive Care volume 9,
Article number: 108 (2019)
Background
Early
identification of noninvasive ventilation (NIV) failure is a promising strategy
for reducing mortality in chronic obstructive pulmonary disease (COPD)
patients. However, a risk-scoring system is lacking.
Methods
To
develop a scale to predict NIV failure, 500 COPD patients were enrolled in a
derivation cohort. Heart rate, acidosis (assessed by pH), consciousness
(assessed by Glasgow coma score), oxygenation, and respiratory rate (HACOR)
were entered into the scoring system. Another two groups of 323 and 395
patients were enrolled to internally and externally validate the scale,
respectively. NIV failure was defined as intubation or death during NIV.
Results
Using
HACOR score collected at 1–2 h of NIV to predict NIV failure, the area
under the receiver operating characteristic curves (AUC) was 0.90, 0.89, and
0.71 for the derivation, internal-validation, and external-validation cohorts,
respectively. For the prediction of early NIV failure in these three cohorts,
the AUC was 0.91, 0.96, and 0.83, respectively. In all patients with HACOR
score > 5, the NIV failure rate was 50.2%. In these patients, early
intubation (< 48 h) was associated with decreased hospital mortality
(unadjusted odds ratio = 0.15, 95% confidence interval 0.05–0.39, p < 0.01).
Conclusions
HACOR
scores exhibited good predictive power for NIV failure in COPD patients,
particularly for the prediction of early NIV failure (< 48 h). In
high-risk patients, early intubation was associated with decreased hospital
mortality.
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