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.

中文翻译：

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COPD患者无创通气衰竭的早期预测：简单风险评分的派生，内部验证和外部验证。

背景

尽早发现无创通气（NIV）衰竭是降低慢性阻塞性肺疾病（COPD）患者死亡率的一种有前途的策略。但是，缺乏风险评分系统。

方法

为了建立预测NIV失败的量表，将500名COPD患者纳入派生队列。将心率，酸中毒（通过pH评估），意识（通过格拉斯哥昏迷评分评估），氧合和呼吸频率（HACOR）输入评分系统。另外两组分别有323名和395名患者入组，分别从内部和外部验证该量表。NIV失败定义为NIV期间插管或死亡。

结果

使用在NIV 1-2小时时收集的HACOR分数预测NIV失败，在派生，内部验证和外部验证队列中，接收器工作特征曲线（AUC）下的面积分别为0.90、0.89和0.71。为了预测这三个队列的早期NIV失败，AUC分别为0.91、0.96和0.83。在所有HACOR得分> 5的患者中，NIV失败率为50.2％。在这些患者中，早期插管（<48小时）与降低的医院死亡率相关（未经调整的优势比= 0.15，95％置信区间0.05-0.39，p  <0.01）。

结论

HACOR评分显示出对COPD患者NIV失败的良好预测能力，尤其是对早期NIV失败（<48小时）的预测。在高危患者中，早期插管可降低医院死亡率。