Dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score and BAP-65 score, tools for prediction of mortality in acute exacerbations of chronic obstructive pulmonary disease: A comparative pilot study
Citation Information :
Sangwan V. Dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score and BAP-65 score, tools for prediction of mortality in acute exacerbations of chronic obstructive pulmonary disease: A comparative pilot study. Indian J Crit Care Med 2017; 21 (10):671-677.
Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) being common and often fatal, prognostic tools in AECOPD are lacking.
Materials and Methods: A prospective, observational study was carried out in fifty patients of AECOPD admitted in A and E department. Dyspnea, Eosinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) score and elevated blood urea nitrogen, altered mental status, pulse >109, age >65 (BAP-65) score were calculated. Dyspnea was scored using extended Medical Research Council Dyspnoea score. Data were collected and analyzed using SPSS 17.0 software.
Results: Forty-one patients were discharged and 9 (18%) died during treatment. Patients who were discharged and patients who died during hospital stay were compared. There was no significant difference in terms of sociodemographic variables, presence of comorbidities, and other markers of disease severity. A significant difference was found in blood counts, blood urea, serum creatinine, acidotic respiratory failure, and atrial fibrillation. A higher value of DECAF score and BAP-65 score was found more commonly in patients who died. Sensitivity for prediction of mortality for DECAF score and BAP-65 score was 100% and specificity was 34.1% and 63.4%, respectively. Sensitivity for prediction of need for invasive ventilation for DECAF score and BAP-65 score was 80% and 100%, respectively, and specificity was 80% and 60%, respectively.
Conclusion: Both DECAF and BAP-65 scores were found to be good predictors of mortality and need for ventilation in this pilot study.
World Health Organization. Available from: http://www.who.int/rsXespiratory/copd/burden/en/index.html.
Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global burden of disease study. Lancet 1997;349:1436-42.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-55.
BTS guidelines for the management of chronic obstructive pulmonary disease. The COPD Guidelines Group of the Standards of Care Committee of the BTS. Thorax 1997;52 Suppl 5:S1-28.
Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-46.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005-12.
Kostopoulou O, Wildman M. Sources of variability in uncertain medical decisions in the ICU: A process tracing study. Qual Saf Health Care 2004;13:272-80.
Wildman MJ, O'Dea J, Kostopoulou O, Tindall M, Walia S, Khan Z, et al. Variation in intubation decisions for patients with chronic obstructive pulmonary disease in one critical care network. QJM 2003;96:583-91.
Martínez-García MA, de la Rosa Carrillo D, Soler-Cataluña JJ, Donat-Sanz Y, Serra PC, Lerma MA, et al. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013;187:823-31.
Moreno A, Montón C, Belmonte Y, Gallego M, Pomares X, Real J, et al. Causes of death and risk factors for mortality in patients with severe chronic obstructive pulmonary disease. Arch Bronconeumol 2009;45:181-6.
Tantucci C, Donati P, Nicosia F, Bertella E, Redolfi S, De Vecchi M, et al. Inspiratory capacity predicts mortality in patients with chronic obstructive pulmonary disease. Respir Med 2008;102:613-9.
Casanova C, Cote C, de Torres JP, Aguirre-Jaime A, Marin JM, Pinto-Plata V, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;171:591-7.
Slenter RH, Sprooten RT, Kotz D, Wesseling G, Wouters EF, Rohde GG, et al. Predictors of 1-year mortality at hospital admission for acute exacerbations of chronic obstructive pulmonary disease. Respiration 2013;85:15-26.
Steer J, Norman EM, Afolabi OA, Gibson GJ, Bourke SC. Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD. Thorax 2012;67:117-21.
Soler-Cataluña JJ, Martínez-García MA, Sánchez LS, Tordera MP, Sánchez PR. Severe exacerbations and BODE index: Two independent risk factors for death in male COPD patients. Respir Med 2009;103:692-9.
Barnes PJ, Chowdhury B, Kharitonov SA, Magnussen H, Page CP, Postma D, et al. Pulmonary biomarkers in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006;174:6-14.
Shorr AF, Sun X, Johannes RS, Yaitanes A, Tabak YP. Validation of a novel risk score for severity of illness in acute exacerbations of COPD. Chest 2011;140:1177-83.
Shorr AF, Sun X, Johannes RS, Derby KG, Tabak YP. Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: Comparing the CURB-65 and BAP-65 scores. J Crit Care 2012;27:564-70.
Steer J, Gibson J, Bourke SC. The DECAF score: Predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012;67:970-6.