Obstructive Lung Diseases: Novel Predictors of COPD Outcomes |

General Prognostic Scores in Predicting Outcomes in Hospitalized Patients With Acute Exacerbation of COPD FREE TO VIEW

Nermeen Abdel Aleem, MD; Raafat Elsokkary, MD; Maha Ghanem, MD; Mohamed Metwally, MD
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Faculty of Medicine, Assiut University, Assiut, Egypt

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):913A. doi:10.1016/j.chest.2016.08.1013
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SESSION TITLE: Novel Predictors of COPD Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 01:30 PM - 03:00 PM

PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often require hospitalization, may necessitate mechanical ventilation (MV) and can be fatal. Prognostic tools are needed to assess AECOPD. The aim of the study is to evaluate and compare the performance of the general scoring systems which commonly used in the general ICUs in an attempt to accurately predict outcomes in a specific group of patients (AECOPD) in a 2 year prospective observational study. This study is registered on ClinicalTrials.gov, number NCT02259439.

METHODS: Between December 2012 and December 2014, we prospectively recruited 250 patients admitted to Chest Department, Assiut University Hospital with an AECOPD. The primary end point was in-hospital mortality. Need for intubation and MV served as a secondary end point. Acute physiology and chronic health evaluation (APACHE II), The Sequential Organ Failure Assessment (SOFA) Score, The Glasgow Coma Scale (GCS), Early Warning Score (EWS), Charlson Comorbidity Index (CCI) and age-adjusted Charlson comorbidity index (ACCI) were calculated at initial presentation. Performance is assessed by area under the receiver operating characteristic curve (AUC) for discrimination and Hosmer-Lemeshow-goodness of fit-test for calibration.

RESULTS: A total 250 patients were enrolled. The mean age ± SD was 64.59± 8.45 years. The total in-hospital mortality was 17.2% and the need for MV was 54.4%. The risk of clinical deterioration (need of MV and/or mortality) increased exponentially with increasing scores. All recorded scores were significantly higher in non-survivors compared with survivors. The discriminatory power of these scores was variable; AUC of APACHE-II, SOFA, EWS, GCS, CCI and ACCI Index were 0.79, 0.81, 0.76, 0.69, 0.68 and 0.73, respectively and all these models had good calibration in mortality prediction. Meanwhile, in predicting the need of intubation and MV in AECOPD, the discrimination power by AUC of 0.79, 0.80, 0.73, 0.81 and 0.61, 0.62, respectively. Calibration was acceptable for all scores except for SOFA, which had poor calibration.

CONCLUSIONS: Our results suggest that SOFA score performed well in predicting mortality in AECOPD. While GCS was found to be more useful in predicting the need of MV in patients with AECOPD. However, APACHE-II can be used as a tool to predict both mortality and intubation in a specific group of patients but with low discriminatory power.

CLINICAL IMPLICATIONS: GCS & SOFA score are simple, rapid, easy and accurate methods for risk stratification of patients with AECOPD admitted to hospital.

DISCLOSURE: The following authors have nothing to disclose: Nermeen Abdel Aleem, Raafat Elsokkary, Maha Ghanem, Mohamed Metwally

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