TY - JOUR
T1 - Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure
AU - Sprooten, Roy T. M.
AU - Rohde, Gernot G. U.
AU - Janssen, Marlou T. H. F.
AU - Cobben, Nicolle A. M.
AU - Wouters, Emiel F. M.
AU - Franssen, Frits M. E.
N1 - Publisher Copyright:
© 2020 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd
PY - 2020/12
Y1 - 2020/12
N2 - Introduction The effectiveness of non-invasive mechanical ventilation (NIV) in the management of COPD patients suffering from acute respiratory failure (ARF) as a consequence of exacerbation of the disease, is well established. However, data on long-term outcomes and their predictors, including the individual response to NIV, are scarce. Objectives To investigate predictors for short- and long-term mortality in this study population. Methods A retrospective cohort study was performed including all patients admitted to the Medium Respiratory Care Unit of Maastricht University Medical Center in Maastricht, the Netherlands, with hospitalized exacerbation of COPD (H-ECOPD) with ARF requiring NIV for the first time between January 2009 and December 2011. An extensive number of potential predictors of outcomes, including the response to NIV, were determined on admission and during hospitalization. Univariate and multivariate logistic regression was used for statistical analysis. Results Seventy-eight consecutive patients with moderate to severe COPD (mean age 71.0 +/- 10.7 years; 48.7% males) were included; In-hospital, 1-year and 2-year mortality rates were 14.1%, 43.6% and 56.4%, respectively. Independent risk factors for 2-year mortality were: advanced age (odds ratio(OR) 1.025; confidence interval (CI) 1.002-1.049;P = 0.037), prolonged NIV use more than 8 days (OR:1.054;CI:1.006-1.104;P = 0.027) and no successful response to NIV (OR:2.392;CI:1.297-4.413;P = 0.005). Conclusion Patients with an H-ECOPD requiring NIV for the first time, constitute a severely ill patient group with high in-hospital and 2-year mortality. This study identified advanced age, NIV use more than 8 days and unsuccessful response to NIV as clinical important independent predictors for long-term mortality.
AB - Introduction The effectiveness of non-invasive mechanical ventilation (NIV) in the management of COPD patients suffering from acute respiratory failure (ARF) as a consequence of exacerbation of the disease, is well established. However, data on long-term outcomes and their predictors, including the individual response to NIV, are scarce. Objectives To investigate predictors for short- and long-term mortality in this study population. Methods A retrospective cohort study was performed including all patients admitted to the Medium Respiratory Care Unit of Maastricht University Medical Center in Maastricht, the Netherlands, with hospitalized exacerbation of COPD (H-ECOPD) with ARF requiring NIV for the first time between January 2009 and December 2011. An extensive number of potential predictors of outcomes, including the response to NIV, were determined on admission and during hospitalization. Univariate and multivariate logistic regression was used for statistical analysis. Results Seventy-eight consecutive patients with moderate to severe COPD (mean age 71.0 +/- 10.7 years; 48.7% males) were included; In-hospital, 1-year and 2-year mortality rates were 14.1%, 43.6% and 56.4%, respectively. Independent risk factors for 2-year mortality were: advanced age (odds ratio(OR) 1.025; confidence interval (CI) 1.002-1.049;P = 0.037), prolonged NIV use more than 8 days (OR:1.054;CI:1.006-1.104;P = 0.027) and no successful response to NIV (OR:2.392;CI:1.297-4.413;P = 0.005). Conclusion Patients with an H-ECOPD requiring NIV for the first time, constitute a severely ill patient group with high in-hospital and 2-year mortality. This study identified advanced age, NIV use more than 8 days and unsuccessful response to NIV as clinical important independent predictors for long-term mortality.
KW - Chronic obstructive pulmonary disease
KW - exacerbations
KW - mortality
KW - non-invasive positive pressure ventilation
KW - response
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - ACUTE EXACERBATIONS
KW - MECHANICAL VENTILATION
KW - OUTCOMES
KW - SURVIVAL
KW - RISK
KW - ICU
U2 - 10.1111/crj.13251
DO - 10.1111/crj.13251
M3 - Article
C2 - 32780940
SN - 1752-6981
VL - 14
SP - 1144
EP - 1152
JO - Clinical Respiratory Journal
JF - Clinical Respiratory Journal
IS - 12
ER -