Predicting in-hospital mortality in a real-world population of ward-based non-invasive ventilation in acute COPD exacerbations.

BACKGROUND: Accurate tools for patient stratification by likely outcome are needed to support complex decision-making and improve acute non-invasive ventilation (NIV) delivery. OBJECTIVES: To evaluate the potential of an emerging NIV outcomes (NIVO) score tool to predict in-hospital mortality to aid its validation in a real-world UK hospital population of ward-based NIV for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). DESIGN: This was a retrospective observational cohort study of all consecutive patient admissions with AECOPD managed with NIV for acute hypercapnic respiratory failure at a teaching hospital. METHODS: Clinical parameters were collected as part of an ongoing quality improvement project. Patients were grouped based on their survival status at hospital discharge. First admission of each patient was included in the analysis. NIV failure, defined as NIV withdrawal or intubation requirement due to clinical deterioration on NIV, along with in-hospital mortality, was modelled using logistic regression. RESULTS: < 0.0001). CONCLUSION: This study demonstrates that the NIVO score shows promise as a predictive tool for in-hospital mortality in patients with AECOPD receiving ward-based NIV. Furthermore, it suggests that NIVO may be able to support decision-making for enhanced NIV delivery in new clinical pathways to address the growing burden of chronic obstructive pulmonary disease exacerbations.