Predicting outcomes in patients with exacerbation of COPD requiring mechanical ventilation.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-10-20 DOI:10.1186/s13613-024-01394-z
Obaid Alzaabi, Emmanuel Guerot, Benjamin Planquette, Jean-Luc Diehl, Thibaud Soumagne
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Abstract

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.

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预测需要机械通气的慢性阻塞性肺病恶化患者的预后。
背景:慢性阻塞性肺病急性加重(AECOPD)很常见,并严重影响慢性阻塞性肺病患者的死亡率。预后评分可帮助临床医生做出有针对性的决定,以管理 AECOPD。因此,在本研究中,我们旨在评估无创通气结果(NIVO)评分在预测 AECOPD 患者 1 年死亡率和无创通气失败方面的表现:这项回顾性研究分析了2018年1月1日至2022年12月31日期间因AECOPD住院并需要机械通气的患者数据。死亡率在入住 ICU 结束时和入院 1 年后进行评估,而 NIV 失败定义为插管或未插管死亡:在 302 名入住重症监护室的慢性阻塞性肺病患者中,有 190 名 AECOPD 患者需要进行机械通气。其中 44 人(23%)死于重症监护室,184 人中 62 人(34%)NIV 失败,78 人(41%)在入院后 1 年内死亡。在重症监护室死亡或 NIV 失败的患者有更严重的慢性阻塞性肺病,入院时血气参数受损更严重。NIVO 评分预测 1 年死亡率的 AUC 为 0.68,预测 NIV 失败的 AUC 为 0.85。NIVO评分超过7分与较高的1年死亡率和NIV失败率相关(HR分别为4.4 [1.8-10.9]和41.6 [5.6-307.9]):结论:除了预测重症监护室内的死亡率外,NIVO 评分还是预测 AECOPD 患者 1 年死亡率和 NIV 失败的可靠工具。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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