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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: COPD is a leading cause of morbidity and mortality worldwide.1 The use of noninvasive mechanical ventilation is a preferred modality over invasive ventilation in treating respiratory failure due to COPD. Failure of NIV has been recognized as a contributor to mortality among these patients hence the importance of identifying risk factors for NIV failure. The aim of this study is to determine which factors are associated with NIV failure, mortality and resource utilization in patients with COPD exacerbation. Methods: The Nationwide Inpatient Sample 2014 was utilized to identify a cohort of admissions for COPD exacerbation requiring NIV using ICD-9 codes. Patients with OSA were excluded. Using logistic regression adjusted for patient and hospital characteristics, the relationship between NIV failure, mortality, and other factors were examined. Secondary outcomes were hospital length of stay and total charges. Results: We identified a total of 32010 admissions for COPD exacerbation requiring NIV and 1105 cases of NIV failure (defined as initial NIV followed by invasive mechanical ventilation). Logistic regression analysis showed that congestive heart failure was the only factor associated with higher odds of NIV failure, OR: 6.91 95% CI (5.05–9.46), P < 0.01. Among patients admitted with COPD exacerbation requiring NIV the most important risk factor for mortality was NIV failure, OR: 10.7 95% CI (7.43–15.50) P < 0.01. Other risk factors for mortality were older age, OR: 1.06 95% CI (1.05–1.08) P < 0.01; history of cancer, OR: 2.15 95% CI (1.16–3.97) P: 0.015; Liver disease, OR: 2.85 95% CI (1.31–6.19) P: 0.008. In secondary outcomes, NIV failure caused an increased LOS of 10.32 days, 95% CI (8.47–12.2) P < 0.01 and total charges of $124 171 95% CI (93 302-155 0 41) P < 0.01 Conclusions: A history of CHF was the most important risk factor associated with NIV failure suggesting added complexity to patients with COPD exacerbation. NIV failure was the highest contributor to mortality associated with a significant increase in LOS and cost of hospitalization.