Five-year outcome in COPD patients after their first episode of acute exacerbation treated with non-invasive ventilation

Background and objective: Little is known about long-term survival of patients surviving the first episode of type II respiratory failure requiring non-invasive ventilation (NIV). We aimed to determine the 1-, 2- and 5-year survival, cause of death and potential prognostic indicators in this patient cohort. Methods: We retrospectively identified 100 sequential COPD patients (mean age 70, mean FEV(1) 37% predicted) treated with NIV for the first time. Mortality and data on hospital morbidity and potential prognostic factors were collected from patient records and a State Health Data Linkage Service. Results: Survival at 1, 2 and 5 years was 72%, 52% and 26%, respectively. Respiratory failure secondary to COPD was the commonest cause of death (56.8%), followed by cardiovascular events (25.7%). Readmission rate at 1 year was 60% for those who survived 2 years or more and 52% for those deceased within 2 years. Recurrent respiratory failure requiring NIV was observed in 31% of the cohort. Only advance age (P = 0.04), BMI (P = 0.014) and prior domiciliary oxygen use (P = 0.03) correlated with death within 5 years. Severity of respiratory failure did not correlate with mortality. Conclusions: 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.