COPD: Mortality and Readmissions in Relation to Number of Admissions with Noninvasive Ventilation

TY - JOUR

T1 - COPD

T2 - Mortality and Readmissions in Relation to Number of Admissions with Noninvasive Ventilation

AU - Ankjærgaard, Kasper Linde

AU - Rasmussen, Daniel Bech

AU - Schwaner, Signe Høyer

AU - Andreassen, Helle Frost

AU - Hansen, Ejvind Frausing

AU - Wilcke, Jon Torgny

PY - 2017/1/2

Y1 - 2017/1/2

N2 - In severe COPD, patients having survived acute hypercapnic respiratory failure (AHRF) treated with noninvasive ventilation (NIV) have a high mortality and risk of readmissions. The aim was to analyze the prognosis for patients with COPD having survived AHRF and to assess whether previous admissions with NIV predict new ones.We conducted a retrospective follow-up analysis of 201 patients two years after NIV treatment of AHRF. Comparison of time-to-event in patients previously treated with NIV versus patients with no previous NIV treatment. We found a one-year mortality of 33.8% and high risks of: readmission (53.2%), any event (67.7%), and life-threatening events (49.8%). Patients with previous NIV treatments had an increased hazard ratio for life-threatening events: 1.60, p = 0.023 despite having lower in-hospital mortality than patients with no previous NIV treatment (18.9% vs. 33.1%, p = 0.043). We found that having survived one episode of AHRF considerably worsened the prognosis for the affected patients.The prognosis for patients having survived AHRF with NIV treatment is poor: the prognosis worsens with additional episodes of AHRF. Future research and treatment should focus on patients with repeated episodes of AHRF.

AB - In severe COPD, patients having survived acute hypercapnic respiratory failure (AHRF) treated with noninvasive ventilation (NIV) have a high mortality and risk of readmissions. The aim was to analyze the prognosis for patients with COPD having survived AHRF and to assess whether previous admissions with NIV predict new ones.We conducted a retrospective follow-up analysis of 201 patients two years after NIV treatment of AHRF. Comparison of time-to-event in patients previously treated with NIV versus patients with no previous NIV treatment. We found a one-year mortality of 33.8% and high risks of: readmission (53.2%), any event (67.7%), and life-threatening events (49.8%). Patients with previous NIV treatments had an increased hazard ratio for life-threatening events: 1.60, p = 0.023 despite having lower in-hospital mortality than patients with no previous NIV treatment (18.9% vs. 33.1%, p = 0.043). We found that having survived one episode of AHRF considerably worsened the prognosis for the affected patients.The prognosis for patients having survived AHRF with NIV treatment is poor: the prognosis worsens with additional episodes of AHRF. Future research and treatment should focus on patients with repeated episodes of AHRF.

KW - Aged

KW - Denmark/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Hospital Mortality

KW - Humans

KW - Hypercapnia/etiology

KW - Male

KW - Noninvasive Ventilation/statistics & numerical data

KW - Patient Readmission/statistics & numerical data

KW - Prognosis

KW - Pulmonary Disease, Chronic Obstructive/complications

KW - Recurrence

KW - Respiratory Insufficiency/etiology

KW - Retrospective Studies

U2 - 10.1080/15412555.2016.1181160

DO - 10.1080/15412555.2016.1181160

M3 - Journal article

C2 - 27723369

SN - 1541-2555

VL - 14

SP - 30

EP - 36

JO - COPD - Journal of Chronic Obstructive Pulmonary Disease

JF - COPD - Journal of Chronic Obstructive Pulmonary Disease

IS - 1

ER -