Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

Abstract

BackgroundLimited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit.MethodsThis was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD.ResultsIn total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better.ConclusionsFive clinical predictors easily available in the ED, and also in the primary care setting, can be used to create a simple and easily obtained score that allows clinicians to stratify patients with eCOPD upon ED arrival and guide the medical decision-making process.

Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital

“…25,28,29 Literature in nondepressed patients with COPD has shown that advanced age, overall medical burden, exercise tolerance, daily physical activity, home oxygen therapy use or noninvasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing are associated with mortality on follow-up. 25,[30][31][32] These findings suggest that overall debility predicts mortality in patients with COPD.…”

Non-invasive ventilation in hypercapnic COPD exacerbation: Predictors of mortality

“…The lack of an association between mortality and the encephalopathy scale and blood gas values deserves to be remarked; however, this finding concurs in part with other studies that evaluated short-and long-term mortality in patients with COPD exacerbations [15,16].…”

Clinical Factors Associated with an Increased Risk of Death at and During Hospitalization for an Acute Exacerbation of COPD (AECOPD) and for a Short Period after Discharge

“…With regards to clinical signs of AECOPD severity, the use of accessory inspiratory [13,15,17] or expiratory muscles [13] , paradoxical breathing [15,17] , cyanosis [13] , lower limb oedema [13] , and impaired neurological status [13,17] , especially with a Glasgow score < 15 [15] were found to be important factors related to mortality of AECOPD patients at and during hospitalization. Moreover, general blood gas alterations [12,14,16,[18][19] , in particular hypercapnia [12,14,19] or hypoxaemia [18,19] , have been found to be strong predictors of mortality.…”

“…Related to the severity of COPD, several factors have been defined as risk factors. In particular, is has been demonstrated that patients with chronic respiratory failure and previous need for longterm home oxygen therapy (LTOT) [16,18] or non-invasive mechanical ventilation [17] , patients with high values at admission of dyspnoea perception [13,15,17,18] , and patients with very severe airflow obstruction (forced expiratory volume in the 1st second, FEV1 ≤ 30 % of predicted) [16,18] have an increased risk of death related to AECOPD.…”

“…This aspect may in fact, be true especially when defining the prognosis of patients and then, adjusting levels of care and treatments, or optimizing timing of discharge and planning a followup visit. With regards to variables influencing survival and related to the general characteristics of patients, age at admission [9,[12][13][14][15][16][17] , particularly in older patients [9,13,16] , has been seen to be an important indicator of poor prognosis during hospitalization [9,[12][13][14][15][16][17] and in the post-discharge period [12,15] . Moreover, the presence of associated comorbidities to COPD [9,12,15,17] , may worsen the prognosis of AECOPD patients; in this context, cardiovascular disease plays a special role [15,16] .…”