Comparison of NIVO(Non-Invasive Ventilation Outcomes) score with DECAF and BAP-65 scores in the evaluation of in hospital and 90 day mortality in patients diagnosed with COPD who presented with acute hypercapnic respiratory failure

Introduction and Aim: Chronic Obstructive Pulmonary Disease (COPD) is a major global public health problem characterized by high morbidity and mortality, recurrent exacerbations, and a markedly increased risk of death, particularly when acute hypercapnic respiratory failure develops. Early prediction of mortality risk in these patients is crucial for timely implementation of appropriate therapeutic strategies and accurate planning of intensive care requirements. The aim of this study was to evaluate the prognostic accuracy of the NIVO (Non-Invasive Ventilation Outcomes) score, compared with DECAF and BAP-65 scores, in predicting in-hospital and 90-day mortality among COPD patients admitted with acute hypercapnic respiratory failure. Materials and Methods: This prospective, descriptive, and analytical study was conducted between March 1, 2024, and January 1, 2025, in the 2nd and 3rd level Intensive Care Units of Dicle University Faculty of Medicine, Department of Pulmonology. A total of 100 patients diagnosed with COPD and receiving non-invasive ventilation (NIV) due to acute hypercapnic respiratory failure were included. Demographic, clinical, laboratory, and radiological data were collected, and NIVO, M-NIVO, DECAF, and BAP-65 scores were calculated for each patient. Statistical analyses were performed using IBM SPSS Statistics 27.0. Results: The mean age of the study population was 69.6 ± 10.0 years; 57% were male, 79% had at least one comorbidity, and 40% had a history of COVID-19. Sixty-nine percent of patients were active smokers. According to the GOLD classification, 90% were categorized as Group E, with 52% monitored in the ICU and 48% in the intermediate unit. The in-hospital mortality rate was 23%, and the 90-day mortality rate was 36%. In patients who died, pH (p<0.001) and SpO₂ (p<0.001) levels were significantly lower, while BUN (p=0.001), creatinine (p=0.008), and WBC (p=0.022) levels were higher. Albumin levels were notably lower in the mortality group (p=0.012). Atrial fibrillation (p=0.010), ICU admission (p<0.001), and intubation requirement (p<0.001) were strongly associated with mortality. Among prognostic scores, NIVO, M-NIVO, and DECAF were significantly correlated with mortality (p<0.001), whereas BAP-65 was not (p>0.05). ROC analysis identified M-NIVO as the most discriminative model, with AUC=0.923 for in-hospital and AUC=0.938 for 90-day mortality. Corresponding AUC values for NIVO were 0.885 and 0.880, and for DECAF, 0.751 and 0.686. BAP-65 showed low predictive power and lacked statistical significance. Conclusion: In COPD patients presenting with acute hypercapnic respiratory failure, M-NIVO and NIVO scores demonstrated superior prognostic accuracy compared to DECAF and BAP-65 in predicting both in-hospital and 90-day mortality. Integrating these scores into clinical workflows may facilitate early identification of high-risk patients and enable timely, targeted management strategies. Keywords: COPD, Mortality, Prognostic Score, Noninvasive Ventilation (NIV), NIVO