Prognostic nomogram for inpatients with asthma exacerbation

Abstract

BackgroundAsthma exacerbation may require a visit to the emergency room as well as hospitalization and can occasionally be fatal. However, there is limited information about the prognostic factors for asthma exacerbation requiring hospitalization, and no methods are available to predict an inpatient’s prognosis. We investigated the clinical features and factors affecting in-hospital mortality of patients with asthma exacerbation and generated a nomogram to predict in-hospital death using a national inpatient database in Japan.MethodsWe retrospectively collected data concerning hospitalization of adult patients with asthma exacerbation between July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination database. We recorded patient characteristics and performed Cox proportional hazards regression analysis to assess the factors associated with all-cause in-hospital mortality. Then, we constructed a nomogram to predict in-hospital death.ResultsA total of 19,684 patients with asthma exacerbation were identified; their mean age was 58.8 years (standard deviation, 19.7 years) and median length of hospital stay was 8 days (interquartile range, 5–12 days). Among study patients, 118 died in the hospital (0.6%). Factors associated with higher in-hospital mortality included older age, male sex, reduced level of consciousness, pneumonia, and heart failure. A nomogram was generated to predict the in-hospital death based on the existence of seven variables at admission. The nomogram allowed us to estimate the probability of in-hospital death, and the calibration plot based on these results was well fitted to predict the in-hospital prognosis.ConclusionOur nomogram allows physicians to predict individual risk of in-hospital death in patients with asthma exacerbation.

Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

“…In patients admitted to intensive care, advanced age, neurological disorders, and tachycardia were clinical features associated with a poor prognosis [12, 13]. Data concerning hospitalized patients were reported by a 2017 Japanese publication [14]. Age (> 70 years), shock, altered consciousness, and infectious lung disease were associated with increased risk of death.…”

Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients

“…Asthma is associated with increased post-operative pulmonary complications, including infection, asthma exacerbation, and acute respiratory failure 35 . Beyond the post-operative period, asthma still remains an immediate threat to life due to pneumonia and/or acute respiratory failure 36 . Hypercholesterolemia was associated with poorer overall survival within this study, but an explanation for these findings remains unclear.…”

Development of a nomogram to estimate the risk of community‐acquired pneumonia in adults with acute asthma exacerbations

“…Community‐acquired pneumonia (CAP) is a common comorbidity in patients with AEs 7–10 . However, there are few studies on adults with AEs and CAP.…”

“…However, there are few studies on adults with AEs and CAP. In previous studies on the prognosis of patients hospitalized for AEs, the prevalence of CAP in adult patients of AEs varied widely, from 7% to 30.0% 9–12 . Moreover, studies have shown pneumonia to be an independent risk factor for death in patients hospitalized for AEs 9,13 .…”