Early prediction of noninvasive ventilation failure in COPD patients: derivation, internal validation, and external validation of a simple risk score

Jun Duan, Shengyu Wang, Ping Liu, Xiaoli Han, Yao Tian, Fan Gao, Jing Zhou, Junhuan Mou, Qian Qin, Jingrong Yu, Linfu Bai, Lintong Zhou, Rui Zhang, Jun Duan, Shengyu Wang, Ping Liu, Xiaoli Han, Yao Tian, Fan Gao, Jing Zhou, Junhuan Mou, Qian Qin, Jingrong Yu, Linfu Bai, Lintong Zhou, Rui Zhang

Abstract

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.

Keywords: COPD exacerbations; Critical care; Noninvasive ventilation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
HACOR scores in patients with NIV success and failure from initiation to 24 h of NIV. Pts patients, NIV noninvasive ventilation, HACOR heart rate, acidosis, consciousness, oxygenation, and respiratory rate
Fig. 2
Fig. 2
NIV failure rates in patients with different HACOR scores. Pts patients, NIV noninvasive ventilation, HACOR heart rate, acidosis, consciousness, oxygenation, and respiratory rate

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