TY - JOUR
T1 - A scoring system derived from electronic health records to identify patients at high risk for noninvasive ventilation failure
AU - Stefan, Mihaela S.
AU - Priya, Aruna
AU - Pekow, Penelope S.
AU - Steingrub, Jay S.
AU - Hill, Nicholas S.
AU - Lagu, Tara
AU - Raghunathan, Karthik
AU - Bhat, Anusha G.
AU - Lindenauer, Peter K.
N1 - Funding Information:
Dr. Stefan was supported by grant K01HL114631 from the National Heart Lung and Blood Institute. Dr Lindenauer was supported by grant K24HL132008 from the National Heart Lung and Blood Institute. The funder had no role in data collection, management, analysis; study design, conduct, or interpretation of study findings; or the preparation, review, or approval of the manuscript submitted for publication.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Objective: To develop and validate a clinical risk prediction score for noninvasive ventilation (NIV) failure defined as intubation after a trial of NIV in non-surgical patients. Design: Retrospective cohort study of a multihospital electronic health record database. Patients: Non-surgical adult patients receiving NIV as the first method of ventilation within two days of hospitalization. Measurement: Primary outcome was intubation after a trial of NIV. We used a non-random split of the cohort based on year of admission for model development and validation. We included subjects admitted in years 2010–2014 to develop a risk prediction model and built a parsimonious risk scoring model using multivariable logistic regression. We validated the model in the cohort of subjects hospitalized in 2015 and 2016. Main results: Of all the 47,749 patients started on NIV, 11.7% were intubated. Compared with NIV success, those who were intubated had worse mortality (25.2% vs. 8.9%). Strongest independent predictors for intubation were organ failure, principal diagnosis group (substance abuse/psychosis, neurological conditions, pneumonia, and sepsis), use of invasive ventilation in the prior year, low body mass index, and tachypnea. The c-statistic was 0.81, 0.80 and 0.81 respectively, in the derivation, validation and full cohorts. We constructed three risk categories of the scoring system built on the full cohort; the median and interquartile range of risk of intubation was: 2.3% [1.9%–2.8%] for low risk group; 9.3% [6.3%–13.5%] for intermediate risk category; and 35.7% [31.0%–45.8%] for high risk category. Conclusions: In patients started on NIV, we found that in addition to factors known to be associated with intubation, neurological, substance abuse, or psychiatric diagnoses were highly predictive for intubation. The prognostic score that we have developed may provide quantitative guidance for decision-making in patients who are started on NIV.
AB - Objective: To develop and validate a clinical risk prediction score for noninvasive ventilation (NIV) failure defined as intubation after a trial of NIV in non-surgical patients. Design: Retrospective cohort study of a multihospital electronic health record database. Patients: Non-surgical adult patients receiving NIV as the first method of ventilation within two days of hospitalization. Measurement: Primary outcome was intubation after a trial of NIV. We used a non-random split of the cohort based on year of admission for model development and validation. We included subjects admitted in years 2010–2014 to develop a risk prediction model and built a parsimonious risk scoring model using multivariable logistic regression. We validated the model in the cohort of subjects hospitalized in 2015 and 2016. Main results: Of all the 47,749 patients started on NIV, 11.7% were intubated. Compared with NIV success, those who were intubated had worse mortality (25.2% vs. 8.9%). Strongest independent predictors for intubation were organ failure, principal diagnosis group (substance abuse/psychosis, neurological conditions, pneumonia, and sepsis), use of invasive ventilation in the prior year, low body mass index, and tachypnea. The c-statistic was 0.81, 0.80 and 0.81 respectively, in the derivation, validation and full cohorts. We constructed three risk categories of the scoring system built on the full cohort; the median and interquartile range of risk of intubation was: 2.3% [1.9%–2.8%] for low risk group; 9.3% [6.3%–13.5%] for intermediate risk category; and 35.7% [31.0%–45.8%] for high risk category. Conclusions: In patients started on NIV, we found that in addition to factors known to be associated with intubation, neurological, substance abuse, or psychiatric diagnoses were highly predictive for intubation. The prognostic score that we have developed may provide quantitative guidance for decision-making in patients who are started on NIV.
KW - Acute respiratory failure
KW - Intubation
KW - Mechanical ventilation
KW - Predictive score
KW - noninvasive ventilation failure
UR - http://www.scopus.com/inward/record.url?scp=85100555963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100555963&partnerID=8YFLogxK
U2 - 10.1186/s12890-021-01421-w
DO - 10.1186/s12890-021-01421-w
M3 - Article
C2 - 33546651
AN - SCOPUS:85100555963
VL - 21
JO - BMC Pulmonary Medicine
JF - BMC Pulmonary Medicine
SN - 1471-2466
IS - 1
M1 - 52
ER -