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Vol. 46. Issue 8.
Pages 405-410 (January 2010)
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Vol. 46. Issue 8.
Pages 405-410 (January 2010)
Original Article
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Prognosis Following Acute Exacerbation of COPD Treated With Non-invasive Mechanical Ventilation
Pronóstico tras una agudización grave de la EPOC tratada con ventilación mecánica no invasiva
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Jose Echave-Sustaetaa,
Corresponding author
jmechave.mad@quiron.es

Corresponding author.
, Lorena Comeche Casanovaa, Ricardo García Lujána, Javier Sayas Catalana, Agustin Gómez de la Cámarab, Angel López Encuentraa
a Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
b Unidad de Investigación y Epidemiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain
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Abstract
Introduction

Patients with chronic obstructive pulmonary disease (COPD) who survived an acute exacerbation with acute respiratory failure that required non-invasive mechanical ventilation (NIMV) are a group with a poor medium-term prognosis.

Objective

To identify re-admission and mortality rates within one year from discharge and to analyse factors associated with both events in a consecutive series of COPD patients treated with NIMV.

Methods

A cohort of 93 COPD patients who survived an acute exacerbation and who required NIMV was followed up after discharge. Re-admissions due to respiratory causes and survival were measured and the outcomes were analysed against possible factors associated to such events using multivariate Cox proportional risk regression analysis.

Results

Over the year following discharge, 61 patients (66 %) had to be re-admitted into hospital due to respiratory complications. Upon multivariate analysis, a low FEV1 value in stable phase and a high average length of stay were associated independently with a high risk of hospital readmission. The probability of survival at 1 year was 0.695. Age, PaCO2 prior to initiation of NIMV and the number of hospitalisation days in the previous year were associated independently with a high mortality risk.

Conclusions

This group of COPD patients has a high mortality rate and need for re-hospitalisation in the ensuing year following discharge. The variables relating to the severity of the baseline disease and the actual exacerbation have been shown to be associated with these events, and could be applied to this subgroup of patients in specific follow-up programs.

Keywords:
COPD
Non-Invasive mechanical ventilation
Exacerbations
Survival
Resumen
Introducción

Los pacientes con EPOC que sobreviven a una exacerbación grave que necesita ventilación mecánica no invasiva son un grupo de mal pronóstico.

Objetivo: Conocer las tasas de reingreso y mortalidad durante el año siguiente a su alta y analizar los factores asociados a ambos desenlaces.

Métodos

Una cohorte de 93 pacientes con EPOC, que sobrevivieron a una exacerbación de la EPOC que precisó ventilación mecánica no invasiva, fue seguida tras el alta. Se midieron la necesidad de hospitalización por motivos respiratorios y la supervivencia, y se analizaron frente a posibles factores asociados a esos eventos mediante una regresión multivariante de riesgos proporcionales de Cox.

Resultados

Durante el año siguiente al alta, 61 pacientes (66 %) precisaron una nueva hospitalización. En el análisis multivariante, un valor bajo de FEV1 y una elevada estancia media durante la hospitalización se asociaron de forma independiente con un elevado riesgo de reingreso hospitalario. La probabilidad de supervivencia al año fue de 0,695 (IC 95 %: 0,589-0,778). En el análisis multivariante la edad, la PaCO2 antes de iniciar la ventilación mecánica no invasiva y los días de hospitalización en el año previo se asociaron de forma independiente con un elevado riesgo de mortalidad.

Conclusiones

Este grupo de pacientes con EPOC presenta una alta mortalidad y necesidad de rehospitalización en el año siguiente al alta. Las variables estudiadas relacionadas con la gravedad de la enfermedad de base y de la propia agudización demostraron estar asociadas a esos eventos y podrían utilizarse para la aplicación en este subgrupo de pacientes de programas específicos de seguimiento.

Palabras clave:
EPOC
Ventilación mecánica no invasiva
Exacerbaciones
Supervivencia
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