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Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure
  1. C M Chu1,
  2. V L Chan1,
  3. A W N Lin1,
  4. I W Y Wong2,
  5. W S Leung1,
  6. C K W Lai3
  1. 1Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
  2. 2Pulmonary Unit, Haven of Hope Hospital, Hong Kong
  3. 3Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
  1. Correspondence to:
    Dr C M Chu
    Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Kowloon, Hong Kong SAR, China; chucmha.org.hk

Abstract

Background: Non-invasive ventilation (NIV) has been shown to reduce intubation and in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF). However, little information exists on the outcomes following discharge. A study was undertaken to examine the rates of readmission, recurrent AHRF, and death following discharge and the risk factors associated with them.

Methods: A cohort of COPD patients with AHRF who survived after treatment with NIV in a respiratory high dependency unit was prospectively followed from July 2001 to October 2002. The times to readmission, first recurrent AHRF, and death were recorded and analysed against potential risk factors collected during the index admission.

Results: One hundred and ten patients (87 men) of mean (SD) age 73.2 (7.6) years survived AHRF after NIV during the study period. One year after discharge 79.9% had been readmitted, 63.3% had another life threatening event, and 49.1% had died. Survivors spent a median of 12% of the subsequent year in hospital. The number of days in hospital in the previous year (p = 0.016) and a low Katz score (p = 0.018) predicted early readmission; home oxygen use (p = 0.002), APACHE II score (p = 0.006), and a lower body mass index (p = 0.041) predicted early recurrent AHRF or death; the MRC dyspnoea score (p<0.001) predicted early death.

Conclusions: COPD patients with AHRF who survive following treatment with NIV have a high risk of readmission and life threatening events. Further studies are urgently needed to devise strategies to reduce readmission and life threatening events in this group of patients.

  • COPD
  • respiratory failure
  • non-invasive ventilation
  • outcome
  • survival
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    • [View PDF] - Table S1 Univariate analysis of potential risk factors for readmission

      Table S2 Multivariate analysis of potential risk factors for readmission

      Table S3 Univariate analysis of potential risk factors for recurrent life-threatening event (recurrent acute hypercapnic respiratory failure requiring assisted ventilation death)

      Table S4 Multivariate analysis of potential risk factors for recurrent life-threatening event (recurrent acute hypercapnic respiratory failure requiring assisted ventilation death)

      Table S5 Univariate analysis of potential risk factors for post-discharge death

      Table S6 Multivariate analysis of potential risk factors for post-discharge death

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