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Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations

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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 82 years) 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 383 days (240–980). Overall survival rates were 71.0, 65.3, and 52.7 % at 1, 3, and 12 months, respectively. Age >85 years, a history of heart disorders and a neutrophil count ≥10 × 109 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.

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Authors and Affiliations

  1. Internal Medicine Department, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, C.so Mazzini 18, 28100, Novara, Italy

    Pier Paolo Sainaghi, Daniele Sola, Piero Emilio Balbo, Mauro Campanini, Francesco Della Corte & Mario Pirisi

  2. Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy

    Davide Colombo, Azzurra Re, Mattia Bellan, Francesco Della Corte, Paolo Navalesi & Mario Pirisi

  3. Anesthesia and Intensive Care, Sant’Andrea Hospital, ASL VC, Vercelli, Italy

    Paolo Navalesi

  4. CRRF Mons. L. Novarese, Moncrivello, VC, Italy

    Paolo Navalesi

Authors
  1. Pier Paolo Sainaghi
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  2. Davide Colombo
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  3. Azzurra Re
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  4. Mattia Bellan
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  5. Daniele Sola
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  6. Piero Emilio Balbo
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  7. Mauro Campanini
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  8. Francesco Della Corte
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  9. Paolo Navalesi
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  10. Mario Pirisi
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Correspondence to Pier Paolo Sainaghi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sainaghi, P.P., Colombo, D., Re, A. et al. Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations. Intern Emerg Med 11, 969–975 (2016). https://doi.org/10.1007/s11739-016-1473-z

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  • DOI: https://doi.org/10.1007/s11739-016-1473-z

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