Obstructive Lung Diseases |

Validation of the European Respiratory Society Guidelines for Pseudomonas aeruginosa Risk Factors in Patients With COPD Exacerbations FREE TO VIEW

Pedro Marcos, MD; Pilar Sanjuan, MD; Marina Blanco-Aparicio, MD; Jorge Ricoy, MD; Isabel Otero, MD; Hector Verea, MD; Marcos Restrepo, MD
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CHU A Coruña, A Coruña, Spain

Chest. 2014;145(3_MeetingAbstracts):380A. doi:10.1378/chest.1836136
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Limited data are available regarding the validation of the European respiratory society (ERS) guidelines recommendations in patients with acute exacerbations of COPD (AECOPD).The ERS use an A3 recommendation to consider Pseudomonas aeruginosa (PA) in the presence of at least two PA risk factors. Our aim was to validate the ERS PA risk factors recommendation among patients hospitalized with an AECOPD.

METHODS: This is a retrospective cohort study at hospital la Coruna, Spain over a 1-year period (2009). Inclusion criteria were: age >40 years old; former or active smokers (>10 ppk/years); prior spirometry (FEV1/FVC<70); admission diagnosis of AECOPD. Exclusion criteria: pneumonia by radiology as the cause of AECOPD. A dichotomized classification of ERS PA risk factors includes at least two of the following: 1) recent hospitalization, 2) frequent (>4 courses per year) or recent administration of antibiotics (last 3 months), 3) severe COPD disease (FEV <30%), and 4) oral steroid use (>10 mg of prednisolone daily in the last 2 weeks). Primary outcome was PA AECOPD.

RESULTS: We identify 143 subjects hospitalized with an AECOPD and 6 with documented PA. The presence of at least 1 PA risk factor occured in 38% of the patients, >2 or more in 6% and >3 or more in 0%, respectively. One or more PA risk factors identify PA with a sensitivity (Sn) of 67%, specificity (Sp) of 69%, positive predictive value (PPV) of 7%, and negative predictive value (NPV) of 98%, and area under curve (AUC) 0.64 ±0.12 . Two or more PA risks factors had a Sn 17%, Sp 95%, PPV 12%, NPV 96%, AUC 0,471± 0.12 ; and 3 or more PA risk factors a Sn 0%, Sp 96%, PPV 4%, NPV 99%, AUC 0,491 ± 0.13.

CONCLUSIONS: The ERS AECOPD PA risk factors recommendation when 2 or more had a high specificity and NPV with a low sensibility despite the low frequency rate of PA in the population.

CLINICAL IMPLICATIONS: The lack of sensitivity of the risk factor definition limits the value of the tool as a screening for patients with AECOPD. Improvement of clinical prediction rules focusing on risk factors to determine the presence of PA are essential before recommending an accurate clinical stratification.

DISCLOSURE: The following authors have nothing to disclose: Pedro Marcos, Pilar Sanjuan, Marina Blanco-Aparicio, Jorge Ricoy, Isabel Otero, Hector Verea, Marcos Restrepo

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