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Obstructive Lung Diseases |

Validation of a Clinical Prediction Scale for Need for Mechanical Ventilation and Inpatient Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Diseases

Subhash Chandra*, MBBS; Krishna Keri, MBBS; Ujjaval Jariwala, MBBS; Rameet Thapa, MBBS; Nyan Latt, MD; Venkataraman Palabindala, MBBS; Surendra Marur, MD
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Greater Baltimore Medical Center, Baltimore, MD


Chest. 2012;142(4_MeetingAbstracts):677A. doi:10.1378/chest.1389486
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Abstract

SESSION TYPE: COPD: Severity and Risk Predictors

PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE: Till date no clinical prediction scale is widely accepted to be used in predicting need for ventilation and inpatient mortality in patient admitted to hospital for acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). In this study, we are validating the BAP-65 (elevated blood urea nitrogen, altered mental status, pulse more 109 beats/min, age over 65 years) score which was developed to predict above mentioned outcomes during hospitalization.

METHODS: : We have included all the patients age over 40-year admitted to adult medical service, both intensive care unit and medical floor over period of 6 years, October 2005 to September 2011 with the diagnosis of AECOPD. Patients sent to hospice care were excluded. Measured end-points were all cause inpatient mortality and need for mechanical ventilation. The AECOPD cases were identified using International Classification of Diseases, 9th revision - clinical modification for discharge diagnosis. Data-points on clinical and demographic characteristics and outcomes were pooled by medical informatics service. Prognostic performance of BAP-65 score was estimated using area under the receiver operating curve (ROC). Statistical analysis was performed using JMP version 9 (SAS Inc.).

RESULTS: Over 6 years, a total of 1,984 patients were discharged from medical service with AECOPD As first or second diagnosis in list of discharge diagnosis and 103 of them were transferred to hospice care and 1,138 were included in the analysis. Of those, 3.0% expired in the hospital and 6.4% required mechanical ventilation and 8.2% had a combination outcome (inpatient death and/or mechanical ventilation). Increase in BAP65 score was associated with significant increase in mortality, 1.4% in patients scoring 1 compared to 12.2% in patients scoring 3 or more on BAP score, z=-5.76, p<0.001 on Cochran-Armitage test. On plotting ROC, BAP65 score has AUC of 0.69 (95% CI; 0.62-0.77) for predicting mortality and 0.62 (95% CI; 0.57 to 0.67) for need of mechanical ventilation and 0.65 (95%CI; 0.60-0.70) for combined outcome.

CONCLUSIONS: Our study reports accuracy of BAP65 score in predicting inpatient mortality in patients admitted for AECOPD but predictive accuracy was not as good as it was reported earlier for need for mechanical ventilation.

CLINICAL IMPLICATIONS: Considering simplicity of calculation, BAP65 score could potentially be incorporated in clinical practice for risk stratification and appropriate allocation of resources.

DISCLOSURE: The following authors have nothing to disclose: Subhash Chandra, Krishna Keri, Ujjaval Jariwala, Rameet Thapa, Nyan Latt, Venkataraman Palabindala, Surendra Marur

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Greater Baltimore Medical Center, Baltimore, MD

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