Rehospitalization Rates And Mortality Factors Of Chronic Respiratory Failure Patients Using Home-Based NIV Due To Chronic Obstructive and Restrictive Lung Diseases

Background: There is an increasing use of noninvasive mechanical ventilation (NIV) at home for chronic respiratory failure due to restrictive and obstructive pulmonary diseases. No adequate studies reporting hospital readmissions or effect of NIV therapy on the clinical prognosis of these diseases. This study aimed to evaluate hospital readmission, mortality rates in patients with home-based NIV. Methods: Retrospective cohort study investigated patients with obstructive (chronic obstructive pulmonary disease, (COPD) and restrictive lung diseases (obesity hypoventilation syndrome and kyphoscoliosis) using NIV at home. Accordingly, the characteristics of NIV, hospital readmission, and mortality rates were compared. Results: Out of 286 home based NIV patients due to chronic respiratory failure, 201 (70%) had COPD and 85 (30%) had restrictive lung disease. In obstructive group the risk of hospital admission was decreased while baseline FEV1 increased (HR = 0.139, 95% CI = 0.022–0.887, p = .003). No risk factors for hospital admission were found in restrictive lung diseases. The number of intensive care unit (ICU) admissions in the COPD group was higher than that in the restrictive group (27% vs. 11%, p = 0.002). ICU admissions was higher in the COPD group according to Kaplan–Meier analysis of ICU admission (p = .026). Mortality rates were similar in both groups. Previous diagnosis of COPD (HR = 6.004, 95% CI = 1.281–28.140, p = .023), ICU admission (HR = 3.921, 95% CI = 1.348–11.046, p = .012), and elevated HCO ₃ values (HR= 1.287, 95% CI = 1.043–1.589, p = .019) were associated with an increased risk of mortality. Conclusion : While no risk factors were found for re-admission in restrictive lung disease, the progressive nature of COPD may play an important role in the management of chronic respiratory failure. Addressing these factors may have a favorable impact on mortality and morbidity.