The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease

Abstract

Background In this study, we will derive and validate a prognostic tool to predict in-hospital death based on Chinese acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods Independent predictors of in-hospital death were identified by logistic regression analysis and incorporated into a clinical prediction tool. Results The clinical prediction model was developed with data from 1121 patients and validated with data from 245 patients. The five predictors of in-hospital death from the development cohort (Arrival ward requiring help by wheelchair or medical cart, Arterial oxygenation index, Age, Albumin and Neutrophil count) were combined to form the AAAAN Score. The AAAAN Score achieved good discrimination (AUC = 0.85, 95% CI 0.81–0.89) and calibration (Hosmer-Lemeshow chi-square value was 3.33, p = 0.65). The AAAAN Score, which underwent internal bootstrap validation, also showed excellent discrimination for mortality (AUC = 0.85, 95% CI 0.81 to 0.89) and performed more strongly than other clinical prediction tools. Patients were categorized into 3 risk groups based on the scores: low risk (0–2 points, 0.7% in-hospital mortality), intermediate risk (3–4 points, 4.1% in-hospital mortality), and high risk (5–7 points, 23.4% in-hospital mortality). Predictive performance was confirmed by external validation. Conclusions The AAAAN Score is a prognostic tool to predict in-hospital death in Chinese AECOPD patients.

Development and Validation of an In-Hospital Mortality Prediction Model for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…The established model in this study encompasses the former. Firstly, regarding ANC, consistent with the study conducted by Chen, 10 our results indicate that ANC is an effective predictive factor for the prognosis of AECOPD patients. Secondly, during the acute inflammatory phase, levels of certain negative acute-phase reactants (APRs) decrease, such as albumin (ALB).…”

“…Its predictive role in in-hospital mortality of AECOPD patients has been confirmed in several studies. 10 , 15 , 18 Similar to ALB, BUN is currently regarded as a predictive factor for in-hospital mortality in AECOPD patients. 6 , 23 In the study by Chen et al, 6 the optimal cut-off value for BUN was 7.63, which is very close to the median value of BUN in our death cohort (7.49).…”

“…Firstly, regarding the type of clinical research, we adopted a retrospective study approach, which is consistent with the majority of previous studies. [7][8][9][10] With the development of electronic medical records, clinical data are now more easily stored and accessed. However, due to regional differences in healthcare economic conditions, the types and quantities of variables included in the analysis may vary across different studies.…”

“…The study cohort observed mainly consists of Chinese AECOPD patients, and through analysis of other similar studies, it was found that there is still a lack of research on in-hospital mortality risk prediction models for Chinese AECOPD patients. For example, some previous studies had insufficient effective sample sizes, 8 , 9 while others focused on severely ill patients, 10 which could potentially reduce the accuracy and applicability of the models.…”

“…Several prediction models for in-hospital mortality of AECOPD patients have been proposed previously, but the variables included in their model constructions are not entirely the same. [7][8][9][10] Several factors could underlie this discrepancy, including variations in study populations across different regions, differences in study designs, diverse statistical analysis methods, and constraints on the number of clinical features in studies influenced by local healthcare economics. The study cohort observed mainly consists of Chinese AECOPD patients, and through analysis of other similar studies, it was found that there is still a lack of research on in-hospital mortality risk prediction models for Chinese AECOPD patients.…”