title: Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations.
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 × 10(9) 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.
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy. pierpaolo.sainaghi@med.uniupo.it.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Sainaghi
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Colombo
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Azzurra
authors.initials: A
authors.lastname: Re
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Bellan
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sola
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.
authors.forename: Piero Emilio
authors.initials: PE
authors.lastname: Balbo
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Campanini
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.|Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Corte
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.|Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy.|CRRF Mons. L. Novarese, Moncrivello, VC, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
authors.affiliation: Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.|Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pirisi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008297:Male; D063087:Noninvasive Ventilation / Q000401:mortality / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data; D016019:Survival Analysis
keywords: COPD exacerbations; Non-ICU setting; Non-invasive ventilation; Risk stratification