The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction
Introduction Exacerbation of COPD complicated by respiratory acidaemia is the commonest indication for noninvasive ventilation (NIV). The NIV outcomes (NIVO) score offers the best estimate of survival for those ventilated. Unfortunately, two-thirds of cases of COPD are unrecognised, and patients may...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2024-11-01
|
| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/10/6/00193-2024.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841537072696918016 |
|---|---|
| author | Nicholas D. Lane Tom M. Hartley John Steer Stephen C. Bourke |
| author_facet | Nicholas D. Lane Tom M. Hartley John Steer Stephen C. Bourke |
| author_sort | Nicholas D. Lane |
| collection | DOAJ |
| description | Introduction
Exacerbation of COPD complicated by respiratory acidaemia is the commonest indication for noninvasive ventilation (NIV). The NIV outcomes (NIVO) score offers the best estimate of survival for those ventilated. Unfortunately, two-thirds of cases of COPD are unrecognised, and patients may present without COPD having been confirmed by spirometry.
Methods
In the 10-centre NIVO validation study there was no pre-admission spirometry in 111 of 844 consecutive patients (termed “clinical diagnosis” patients). We compared the performance of the NIVO, DECAF and CURB-65 scores for in-hospital mortality in the clinical diagnosis cohort. Usual clinical practice was not influenced, but confirmation of COPD in the year following discharge was captured.
Results
In the clinical diagnosis cohort, in-hospital mortality was 19.8% and rose incrementally across the NIVO risk categories, consistent with the NIVO validation cohort. NIVO showed good discrimination in the clinical diagnosis cohort: area under the receiver operating curve 0.724, versus 0.79 in the NIVO validation cohort. At 1 year after discharge, 41 of 89 clinical diagnosis patients had undertaken diagnostic spirometry; 33 of 41 had confirmation of airflow obstruction (forced expiratory volume in 1 s/(forced) vital capacity <0.7), meaning the diagnosis of COPD was incorrect in 19.5% of cases.
Discussion
These data support the use of the NIVO score in patients with a “clinical diagnosis” of COPD. NIVO can help guide shared decision-making, assess risk-adjusted outcomes by centre and challenge prognostic pessimism. Accurate diagnosis is critical to ensure that acute and long-term treatment is optimised; this study highlights failings in the follow-up of such patients. |
| format | Article |
| id | doaj-art-71ee6b3869514b138e34163ca33e18b1 |
| institution | Kabale University |
| issn | 2312-0541 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj-art-71ee6b3869514b138e34163ca33e18b12025-01-14T09:50:21ZengEuropean Respiratory SocietyERJ Open Research2312-05412024-11-0110610.1183/23120541.00193-202400193-2024The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstructionNicholas D. Lane0Tom M. Hartley1John Steer2Stephen C. Bourke3 Department of Respiratory Medicine, The Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Introduction Exacerbation of COPD complicated by respiratory acidaemia is the commonest indication for noninvasive ventilation (NIV). The NIV outcomes (NIVO) score offers the best estimate of survival for those ventilated. Unfortunately, two-thirds of cases of COPD are unrecognised, and patients may present without COPD having been confirmed by spirometry. Methods In the 10-centre NIVO validation study there was no pre-admission spirometry in 111 of 844 consecutive patients (termed “clinical diagnosis” patients). We compared the performance of the NIVO, DECAF and CURB-65 scores for in-hospital mortality in the clinical diagnosis cohort. Usual clinical practice was not influenced, but confirmation of COPD in the year following discharge was captured. Results In the clinical diagnosis cohort, in-hospital mortality was 19.8% and rose incrementally across the NIVO risk categories, consistent with the NIVO validation cohort. NIVO showed good discrimination in the clinical diagnosis cohort: area under the receiver operating curve 0.724, versus 0.79 in the NIVO validation cohort. At 1 year after discharge, 41 of 89 clinical diagnosis patients had undertaken diagnostic spirometry; 33 of 41 had confirmation of airflow obstruction (forced expiratory volume in 1 s/(forced) vital capacity <0.7), meaning the diagnosis of COPD was incorrect in 19.5% of cases. Discussion These data support the use of the NIVO score in patients with a “clinical diagnosis” of COPD. NIVO can help guide shared decision-making, assess risk-adjusted outcomes by centre and challenge prognostic pessimism. Accurate diagnosis is critical to ensure that acute and long-term treatment is optimised; this study highlights failings in the follow-up of such patients.http://openres.ersjournals.com/content/10/6/00193-2024.full |
| spellingShingle | Nicholas D. Lane Tom M. Hartley John Steer Stephen C. Bourke The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction ERJ Open Research |
| title | The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction |
| title_full | The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction |
| title_fullStr | The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction |
| title_full_unstemmed | The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction |
| title_short | The noninvasive ventilation outcomes score in patients requiring NIV for COPD exacerbation without prior evidence of airflow obstruction |
| title_sort | noninvasive ventilation outcomes score in patients requiring niv for copd exacerbation without prior evidence of airflow obstruction |
| url | http://openres.ersjournals.com/content/10/6/00193-2024.full |
| work_keys_str_mv | AT nicholasdlane thenoninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT tommhartley thenoninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT johnsteer thenoninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT stephencbourke thenoninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT nicholasdlane noninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT tommhartley noninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT johnsteer noninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction AT stephencbourke noninvasiveventilationoutcomesscoreinpatientsrequiringnivforcopdexacerbationwithoutpriorevidenceofairflowobstruction |