RT Journal Article
SR Electronic
T1 The Noninvasive Ventilation Outcomes (NIVO) score: prediction of in-hospital mortality in exacerbations of COPD requiring assisted ventilation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2004042
DO 10.1183/13993003.04042-2020
VO 58
IS 2
A1 Tom Hartley
A1 Nicholas D. Lane
A1 John Steer
A1 Mark W. Elliott
A1 Milind P. Sovani
A1 Helen Jane Curtis
A1 Elizabeth R. Fuller
A1 Patrick B. Murphy
A1 Dinesh Shrikrishna
A1 Keir E. Lewis
A1 Neil R. Ward
A1 Chris D. Turnbull
A1 Nicholas Hart
A1 Stephen C. Bourke
YR 2021
UL http://erj.ersjournals.com/content/58/2/2004042.abstract
AB Introduction Acute exacerbations of COPD (AECOPD) complicated by acute (acidaemic) hypercapnic respiratory failure (AHRF) requiring ventilation are common. When applied appropriately, ventilation substantially reduces mortality. Despite this, there is evidence of poor practice and prognostic pessimism. A clinical prediction tool could improve decision making regarding ventilation, but none is routinely used.Methods Consecutive patients admitted with AECOPD and AHRF treated with assisted ventilation (principally noninvasive ventilation) were identified in two hospitals serving differing populations. Known and potential prognostic indices were identified a priori. A prediction tool for in-hospital death was derived using multivariable regression analysis. Prospective, external validation was performed in a temporally separate, geographically diverse 10-centre study. The trial methodology adhered to TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) recommendations.Results Derivation cohort: n=489, in-hospital mortality 25.4%; validation cohort: n=733, in-hospital mortality 20.1%. Using six simple categorised variables (extended Medical Research Council Dyspnoea score 1–4/5a/5b, time from admission to acidaemia >12 h, pH <7.25, presence of atrial fibrillation, Glasgow coma scale ≤14 and chest radiograph consolidation), a simple scoring system with strong prediction of in-hospital mortality is achieved. The resultant Noninvasive Ventilation Outcomes (NIVO) score had area under the receiver operating curve of 0.79 and offers good calibration and discrimination across stratified risk groups in its validation cohort.Discussion The NIVO score outperformed pre-specified comparator scores. It is validated in a generalisable cohort and works despite the heterogeneity inherent to both this patient group and this intervention. Potential applications include informing discussions with patients and their families, aiding treatment escalation decisions, challenging pessimism and comparing risk-adjusted outcomes across centres.The NIVO score was created to predict in-hospital mortality in exacerbations of COPD requiring assisted ventilation. Prospective validation under real-world conditions in 10 UK hospitals shows it easily outperforms existing alternative scores. https://bit.ly/3oKMZdI