Prediction of Mortality With the Use of Noninvasive Ventilation for Acute Respiratory Failure
Francesca Innocenti, Laura Giordano, S Gualtieri, Arianna Gandini, Lucia Taurino, Monica Nesa, Chiara Gigli, Alessandro Becucci, Alessandro Coppa, Irene Tassinari, Maurizio Zanobetti, Francesca Caldi, Riccardo Pini
Abstract
BACKGROUND: In actuality, it is difficult to obtain an early prognostic stratification for patients with acute respiratory failure treated with noninvasive ventilation (NIV). We tested whether an early evaluation through a predictive scoring system could identify subjects at risk of in-hospital mortality or NIV failure. METHODS: This was a retrospective study, which included all the subjects with acute respiratory failure who required NIV admitted to an emergency department–high-dependence observation unit between January 2014 and December 2017. The HACOR (heart rate, acidosis [by using pH], consciousness [by using the Glasgow coma scale], oxygenation [by using <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">P</mml:mtext> <mml:mrow> <mml:msub> <mml:mrow> <mml:mtext mathvariant="bold">aO</mml:mtext> </mml:mrow> <mml:mtext mathvariant="bold">2</mml:mtext> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> / <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" overflow="scroll"> <mml:mrow> <mml:msub> <mml:mtext mathvariant="bold">F</mml:mtext> <mml:mrow> <mml:msub> <mml:mrow> <mml:mtext mathvariant="bold">IO</mml:mtext> </mml:mrow> <mml:mtext mathvariant="bold">2</mml:mtext> </mml:msub> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> ], respiratory rate) score was calculated before the NIV initiation (T0) and after 1 h (T1) and 24 h (T24) of treatment. The primary outcomes were in-hospital mortality and NIV failure, defined as the need for invasive ventilation. RESULTS: The study population included 644 subjects, 463 with hypercapnic respiratory failure and an overall in-hospital mortality of 23%. Thirty-six percent of all the subjects had NIV as the “ceiling” treatment. At all the evaluations, nonsurvivors had a higher mean ± SD HACOR score than did the survivors (T0, 8.2 ± 4.9 vs 6.1 ± 4.0; T1, 6.6 ± 4.8 vs 3.8 ± 3.4; T24, 5.3 ± 4.5 vs 2.0 ± 2.3 [all P < .001]). These data were confirmed after the exclusion of the subjects who underwent NIV as the ceiling treatment (T0, 8.2 ± 4.9 vs 6.1 ± 4.0 [ P = .002]; T1, 6.6 ± 4.8 vs 3.8 ± 3.4; T24, 5.3 ± 4.5 vs 2.0 ± 3.2 [all P < .001]). At T24, an HACOR score > 5 (Relative Risk [RR] 2.39, 95% CI 1.60–3.56) was associated with an increased mortality rate, independent of age and the Sequential Organ Failure Assessment score. CONCLUSIONS: Among the subjects treated with NIV for acute respiratory failure, the HACOR score seemed to be a useful tool to identify those at risk of in-hospital mortality.