Clinical question: Do certain patient characteristics predict increased risk for mechanical ventilation or death among patients with acute exacerbations of chronic obstructive pulmonary disease (COPD)?
Background: Hospitalizations for acute COPD exacerbations are costly and impair quality of life. A validated tool has not been developed to help physicians risk-stratify and predict outcomes for patients presenting with acute exacerbations of COPD.
Study design: Retrospective cohort.
Setting: 191 U.S. hospitals, of which 41% were academic hospitals and 76% were urban hospitals.
Synopsis: Researchers used the Cardinal Health Clinical Outcomes Research Database to analyze the hospital admissions of 88,074 patients aged 40 years and older with acute exacerbations of COPD. The research team identified risk factors that predicted in-hospital mortality (primary endpoint) and the need for mechanical ventilation (secondary endpoint).
The main risk factors were a BUN level higher than 25 mg/dL, altered mental status, and pulse >109/minute. Patients <65 were found to be at lowest risk. Patients age <65 without any of the three main risk factors had a mortality rate of 0.3%, while patients with all three main risk factors had a mortality rate of 13.8%.
Similarly, patients with two or three primary risk characteristics were more likely to undergo mechanical ventilation. Researchers proposed a risk score known as BAP-65 (BUN, altered mental status, pulse, and age), and patients were placed into risk classes 1 through 5 based on their risk factors.
Bottom line: The BAP-65 score might be useful to predict the risk of death or need for mechanical ventilation in COPD patients with acute exacerbation.
Citation: Tabak YP, Sun X, Johannes RS, Gupta V, Shorr AF. Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: development and validation of a simple risk score. Arch Intern Med. 2009;169(17):1595-1602.
Reviewed for TH eWire by Anneliese M. Schleyer, MD, MHA, Mark C. Zaros, MD, Angelena Labella, MD, Heather L. Davidson, MD, Reena K. Julka, MD, Anna S. Loge, MD, and Paul R. Sutton, MD, PhD, University of Washington Medicine Hospital and Consultative Medicine Program, Seattle
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