GIÁ TRỊ CỦA THANG ĐIỂM NEWS2 TRONG TIÊN LƯỢNG THÔNG KHÍ KHÔNG XÂM LẤN, THỞ MÁY XÂM LẤN VÀ TỬ VONG NỘI VIỆN Ở BỆNH NHÂN ĐỢT CẤP BỆNH PHỔI TẮC NGHẼN MẠN TÍNH

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a group of lung diseases characterized by persistent airflow obstruction. Acute exacerbation of COPD is a worsening of the condition that increases hospitalization rates, affects quality of life, and raises the risk of mortality. Currently, several scoring systems are used in clinical to assess the risk of non-invasive ventilation, invasive ventilation and death in these patients. The NEWS2 scoring system (National Early Warning Score 2) includes the following factors: respiratory rate, SpO2 (used for normal patients/used for patients with respiratory failure with hypercapnia), room air or supplemental oxygen, systolic blood pressure, pulse, level of consciousness, and temperature. This scoring system is used to stratify the risk of severe progression and to make appropriate intervention decisions for patients at the time of initial admission. Objectives: Evaluate the value of the NEWS2 scoring system in predicting non-invasive ventilation, invasive ventilation and in-hospital mortality in patients with acute exacerbations of COPD. Subject and Method: Design a prospective cohort study conducted on patients diagnosed with acute exacerbations of COPD admitted to the Emergency Department and subsequently treated in the Respiratory Department at Cho Ray Hospital from December 2023 to June 2024. We calculate the NEWS2 score at the time of admission and monitor the outcomes: non-invasive ventilation, invasive mechanical ventilation, and mortality/severe outcome. Result: Our study included 116 patients with acute exacerbations of COPD admitted to the hospital; with 24,1% of patients requiring non-invasive ventilation; 34,5% requiring invasive ventilation; and a mortality/severe outcome rate of 10,3%. The average NEWS2 score was 6,7 ± 3,2; with a maximum score of 17 and a minimum score of 0. Of the patients; 29,3% were in the low-risk group; 27,6% in the moderate-risk group; and 43,1% in the high-risk group. The rates of non-invasive ventilation for each risk group were: 5,9% in the low-risk group; 31,2% in the moderate-risk group; and 32% in the high-risk group. The rates of invasive ventilation for each risk group were: 0% in the low-risk group, 9,4% in the moderate-risk group, and 74% in the high-risk group. The mortality/severe outcome rates according to the NEWS2 score for each risk group were as follows: 0% in the low-risk group, 0% in the moderate-risk group, and 24% in the high-risk group. The NEWS2 score for predicting the risk of non-invasive ventilation has an AUC of 0.654; p = 0.014; 95% CI: 0.551 – 0.756. The cutoff point of 5 has the highest Youden's J index of J = 0.3, with a sensitivity (Se) of 0.929 and a specificity (Sp) of 0.364. Prediction of the risk of invasive ventilation has an AUC of 0.91; p < 0.001; 95% CI: 0.859 – 0.961. The cutoff point of 7 has the highest Youden's J index of J = 0.754, with a sensitivity (Se) of 0.925 and a specificity (Sp) of 0.829. The prediction of the risk of mortality/severe outcome has an AUC of 0.842; p < 0.001; 95% CI: 0.756 – 0.928. The cutoff point of 7 has the highest Youden's J index of J = 0.635, with a sensitivity (Se) of 1 and a specificity (Sp) of 0.635. Conclusion: The NEWS2 scoring system has the ability to initially predict the risk of mortality/severe outcome, non-invasive ventilation, and invasive ventilation in hospitalized patients with acute exacerbations of COPD.