PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in increased morbidity and mortality, and constitute a tremendous socioeconomic burden. Predicting in-hospital mortality across a spectrum of severity, and formulating a scoring system derived from predictors of mortality may aid prognostication.
METHODS: 151 consecutive patients admitted with a diagnosis of AECOPD to a tertiary care center were followed to discharge or death in hospital stay. Secondary variables studied were duration of hospital stay, and need for and duration of mechanical ventilation.
RESULTS: Mean (SD) age of patients was 60.5 (11.4) years. 65.6% were mechanically ventilated, and 25.2% died in hospital. Independent predictors of mortality at admission were serum creatinine (Odds ratio [OR] 2.11, 95%Confidence Intervals [CI] 1.0 to 4.48; p= 0.05), and serum sodium (OR 0.94, 95%CI 0.89 to 0.99; p=0.034). An equation derived [Score= 8.087 + (0.75×Creatinine)- (0.059×Sodium)] to predict mortality, had an area under ROC curve of 70%, with a cut off of 0.716 having sensitivity, specificity, positive and negative predictive values for predicting death of 63%, 63%, 36% and 84%, respectively. Factors influencing in-hospital death were serum creatinine, serum sodium and duration of mechanical ventilation (p <0.05). Glasgow coma scale (OR 0.66, 95%CI 0.46 to 0.96, p=0.028), Simplified Acute Physiology Score (OR 1.12, 95%CI 1.03 to 1.22, p=0.009), PO2 (OR 1.02, 95%CI 1.002 to 1.03, p=0.024), and serum bicarbonate (OR 1.08, 95%CI 1.002 to 1.16, p=0.044) at admission independently predicted need for invasive ventilation. Duration of mechanical ventilation was affected by interval to intubation, need for ICU admission, duration of ICU stay, positive tracheal aspirate culture, hematocrit and cardiac arrest (p <0.01), and duration of hospital stay by need for and duration of mechanical ventilation (p<0.001).
CONCLUSION: Serum creatinine and sodium at admission are independent predictors of mortality for patients admitted with AECOPD. The equation derived from these two variables is a simple and useful method for predicting outcome.
CLINICAL IMPLICATIONS: Determining in-hospital prognosis of AECOPD will help in prognostication.
DISCLOSURE: Surya Prakash Bhatt, None.