Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD

Abstract

Background Rates of mortality and readmission are high in patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In this population, the prognostic value of the Medical Research Council Dyspnoea Scale (MRCD) is uncertain, and an extended MRCD (eMRCD) scale has been proposed to improve its utility. Coexistent pneumonia is common and, although the CURB-65 prediction tool is used, its discriminatory value has not been reported. Methods Clinical and demographic data were collected on consecutive patients hospitalised with AECOPD. The relationship of stable-state dyspnoea severity to inhospital mortality and 28-day readmission was assessed. The discriminatory value of CURB-65, MRCD and eMRCD, in the prediction of in-hospital mortality, was assessed and compared. Results 920 patients were recruited. 10.4% died inhospital and 19.1% of the 824 survivors were readmitted within 28 days of discharge. During their stable state prior to admission, 34.2% of patients were too breathless to leave the house. Mortality was significantly higher in pneumonic than in non-pneumonic exacerbations (20.1% vs 5.8%, p<0.001). eMRCD was a significantly better discriminator than either CURB-65 or the traditional MRCD scale for predicting in-hospital mortality, and was a stronger prognostic tool than CURB-65 in the subgroup of patients with pneumonic AECOPD. Conclusions The severity of dyspnoea in the stable state predicts important clinical outcomes in patients hospitalised with AECOPD. The eMRCD scale identifies a subgroup of patients at a particularly high risk of inhospital mortality and is a better predictor of mortality risk than CURB-65 in exacerbations complicated by pneumonia. BACKGROUND

Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation

“…Among those with a prospective design, the predictors identified include: a patient's age [23], clinical characteristics such as previous admissions, FEV 1 and pCO 2 [10,24,25,26], the treatments prescribed (e.g. the long-term use of oral corticoids [23,27]) and symptoms or health-related quality of life parameters such as dyspnea, PA and general health status [12,25,27,28]. As it can be seen, our results share some of these variables but add others recorded during follow-up.…”

Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt

“…Currently, in patients hospitalized with AECOPD complicated by consolidation, the CURB-65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age > 65) community acquired pneumonia prognostic score [13] is often used to risk assess and guide antibiotic therapy [14]. However, it has been recently shown that the use of CURB-65 in patients with AECOPD and consolidation is suboptimal [15]. Hence, the Dyspnea, Esinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score was first introduced by Steer et al [1].…”

Evaluation of the Modified Medical Research Council Dyspnea Scale for Predicting Hospitalization and Exacerbation in Japanese Patients with Chronic Obstructive Pulmonary Disease

“…The modified British Medical Research Council (mMRC) scale employing a self-reported questionnaire is useful for assessing dyspnea and disability, and it's reliability has been confirmed (1,5,6). However, evidence of the relationship between the findings of dyspnea and disability and the incidence of hospitalization and exacerbation is limited, although dyspnea is known to be associated with mortality in COPD patients as a whole (7)(8)(9). In the present study, we evaluated the utility of the mMRC scale for predicting mor-tality, hospitalization and exacerbation as a consequence of the level of dyspnea (mMRC scale) and airflow obstruction (spirometric GOLD classification) in Japanese patients with COPD.…”