Long-term mortality high after COPD exacerbation requiring ventilation
MedWire News: Long-term mortality rates are high among chronic obstructive pulmonary disease (COPD) patients after their first exacerbation requiring non-invasive ventilation (NIV), study results show.
The team also found that age, body mass index (BMI), and the previous use of oxygen therapy at home were the main predictors of mortality at 5 years in such patients, rather than the severity of respiratory failure at initial presentation for NIV.
Grant Waterer (Royal Perth Hospital, Western Australia) and team studied survival at 1, 2, and 5 years among 100 COPD patients (56% men) who were treated with NIV for the first time between 1999 and 2003. The patients had an average age of 70 years and their mean FEV1 was 37% of the predicted value at the time of initial NIV.
Overall, 72% of the patients were still alive at 1 year. However, this percentage had fallen significantly to 52% at 2 years and 26% at 5 years.
The most common causes of death among the patients were respiratory failure secondary to COPD (56.8%) and cardiovascular events (25.7%).
Duration of NIV use, which ranged from 1 to 14 days, was not correlated with survival, readmissions for NIV, nor was the time interval between first and second admissions requiring NIV.
Indeed, 60% of patients who survived for at least 2 years were readmitted within the first year compared with 52% of those who died within 2 years of the index event.
The only predictors of mortality at 5 years were advanced age, BMI, and use of oxygen at home.
Waterer and team conclude in the journal Respirology: “The 2- and 5-year mortality rates for patients with COPD surviving their first episode of respiratory failure requiring NIV are high.
“Physiological measures of the severity of respiratory failure at presentation do not predict subsequent survival and nor does the time interval between first and second admissions requiring NIV.”
“Age, BMI, and prior need for domiciliary oxygen are the main predictors of mortality at 5 years.”
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By Mark Cowen