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Original Research: OBSTRUCTIVE LUNG DISEASES |

Validation of a Novel Risk Score for Severity of Illness in Acute Exacerbations of COPDValidation of Risk Score for COPD Exacerbations

Andrew F. Shorr, MD, MPH, FCCP; Xiaowu Sun, PhD; Richard S. Johannes, MD; Ayla Yaitanes, BA; Ying P. Tabak, PhD
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine (Dr Shorr), Washington Hospital Center, Washington, DC; the Department of Clinical Research (Drs Sun, Johannes, and Tabak, and Ms Yaitanes), MedMined Services, CareFusion, Marlborough, MA; and Brigham and Women’s Hospital and Harvard Medical School (Dr Johannes), Boston, MA.

Correspondence to: Andrew F. Shorr, MD, MPH, FCCP, Pulmonary and Critical Care Medicine, Washington Hospital Center, 110 Irving St, NW, Washington, DC 20010; e-mail: andrew.shorr@gmail.com


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1177-1183. doi:10.1378/chest.10-3035
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Background:  Clinicians lack a validated tool for risk stratification in acute exacerbations of COPD (AECOPD). We sought to validate the BAP-65 (elevated BUN, altered mental status, pulse > 109 beats/min, age > 65 years) score for this purpose.

Methods:  We analyzed 34,699 admissions to 177 US hospitals (2007) with either a principal diagnosis of AECOPD or acute respiratory failure with a secondary diagnosis of AECOPD. Hospital mortality and need for mechanical ventilation (MV) served as co-primary end points. Length of stay (LOS) and costs represented secondary end points. We assessed the accuracy of BAP-65 via the area under the receiver operating characteristic curve (AUROC).

Results:  Nearly 4% of subjects died while hospitalized and approximately 9% required MV. Mortality increased with increasing BAP-65 class, ranging from < 1% in subjects in class I (score of 0) to > 25% in those meeting all BAP-65 criteria (Cochran-Armitage trend test z = −38.48, P < .001). The need for MV also increased with escalating score (2% in the lowest risk cohort vs 55% in the highest risk group, Cochran-Armitage trend test z = −58.89, P < .001). The AUROC for BAP-65 for hospital mortality and/or need for MV measured 0.79 (95% CI, 0.78-0.80). The median LOS was 4 days, and mean hospital costs equaled $5,357. These also varied linearly with increasing BAP-65 score.

Conclusions:  The BAP-65 system captures severity of illness and represents a simple tool to categorize patients with AECOPD as to their risk for adverse outcomes. BAP-65 also correlates with measures of resource use. BAP-65 may represent a useful adjunct in the initial assessment of AECOPDs.

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