Survival following acute exacerbations of COPD requiring ventilation
Research type
Research Study
Full title
Derivation of a novel scoring system to predict inpatient mortality in exacerbations of chronic obstructive pulmonary disease requiring assisted ventilation.
IRAS ID
174869
Contact name
Stephen Bourke
Contact email
Sponsor organisation
Northumbria Healthcare NHS Foundation Trust
Duration of Study in the UK
1 years, 2 months, 31 days
Research summary
Chronic obstructive pulmonary disease is a common chronic lung disease. Acute exacerbations (AECOPD) are the second commonest reason for hospital admission in the UK. Severe exacerbations resulting in respiratory failure are associated with high in-hospital mortality, which is reduced 2-3 fold by the use of non-invasive ventilation (NIV).
Unfortunately the national COPD audit showed that of 26% of patients who met the criteria for ventilation, only 12% received it. In part, this reflects difficulty accurately predicting outcome and widespread prognostic pessimism. Decisions about suitability for ventilation should be informed by reliable estimates of the patients’ chance of surviving the acute event and subsequent outcomes. Clinicians are unduly pessimistic; the CAOS study showed that actual six-month survival was four-fold better than predicted in the patients with the lowest predicted survival. Most survivors would choose ventilation again. Conversely, NIV is sometimes used in patients with little chance of recovery in whom alternative palliation would be more appropriate. Of importance, prognostic tools outperform clinicians’ estimates in most settings.
We will assess outcomes following AECOPD requiring ventilation and develop a simple bedside prognostic tool for in-hospital mortality. To inform longer-term outcomes, monitoring of readmission and mortality data will continue to one year. From pilot data (n=199), we are confident of strong performance. Following initial derivation, in a linked project the tool will be prospectively validated across multiple sites with assessment of in-hospital survival and survival, QoL, performance status and readmissions over one year. Clinical application of the tool should increase the appropriate use of ventilation, improving survival, and identify patients at risk of poor outcome, informing care planning including palliative care.
Patient, carer and public groups have reviewed the study, providing strong support and useful insights. A patient/public project group will support the study, including dissemination of results, facilitated by the British Lung Foundation.REC name
North West - Liverpool Central Research Ethics Committee
REC reference
15/NW/0389
Date of REC Opinion
29 Apr 2015
REC opinion
Favourable Opinion