Application Of Different Prognostic Scores For Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective To compare the performance of BAP-65(BUN,altered mental status,pulse,and age)score,Modify early warning sore(MEWS),National early warning score(NEWS)and Chronic respiratory early warning score(CREWS)in acute exacerbations of chronic obstructive pulmonary disease(AECOPD)patients of normal ward.Methods1.This study was conducted using a convenient sampling method.According to the inclusion and exclusion criteria,a total of 249 patients with AECOPD in normal ward were selected.BAP-65,MEWS,NEWS and CREWS score were performed at patient admission.We prospectively collected the interrelated data and track outcomes of patients in hospital by special people.2.To compare the scores of BAP-65,MEWS,NEWS and CREWS in the groups of different prognosis of AECOPD patients.3.To build the ROC curve to analyze and compare the performance of BAP-65,MEWS,NEWS and CREWS in different prognosis of AECOPD patients.Results1.In this study,a total of 249 patients with AECOPD were selected,among them,there were 210 males and 39 females.The range of age was from 48 to 95 years old,and the average age was(72.24±9.374)years old.There were 10cases(4.0%)died in the hospital,28 cases(11.2%)stayed in ICU,64 cases(25.7%)needed for ventilation,11cases(4.4%)needed for invasive mechanical ventilation.2.The scores of BAP-65,MEWS,NEWS and CREWS between death group and survival group,ICU admission group and normal ward group,mechanical ventilation group and non-mechanical ventilation group,invasive mechanical ventilation group and non-invasive mechanical ventilation group were statistically significant(P<0.05),respectively.3.Base on the predicted result of in-hospital death,The AUROCs of BAP-65,MEWS,NEWS and CREWS were 0.760(95%CI 0.702~0.812),0.846(95%CI 0.751~0.860),0.959(95%CI 0.926~0.980)0.924,0.924(95%CI 0.884~0.958),respectively.Base on the predicted result of ICU admission,The AUROCs of BAP-65,MEWS,NEWS and CREWS were0.711(95%CI 0.622~0.750),0.753(95%CI 0.695~0.806),0.831(95%CI 0.771~0.877),0.830(95%CI 0.778~0.875),respectively.Base on the predicted result of mechanical ventilation,The AUROCs of BAP-65,MEWS,NEWS and CREWS were 0.593(95%CI 0.530~0.655),0.669(95%CI 0.604~0.734),0.778(95%CI 0.731~0.844),0.765(95%CI0.707~0.816),respectively.Base on the predicted result of invasive mechanical ventilation,The AUROCs of BAP-65,MEWS,NEWS and CREWS were 0.770(95%CI 0.598~0.728),0.797(95%CI 0.737~0.849),0.888(95%CI 0.903~0.970),0.910(95%CI 0.867~0.942),respectively.4.There was no statistically significant difference among the AUROCs of ICU admission of BAP-65,MEWS,NEWS and CREWS scores(P>0.05).But in the prediction of in-hospital death,the AUROC of NEWS was better than BAP-65(P<0.05).And in the prediction of mechanical ventilation or invasive mechanical ventilation,The AUROCs of NEWS or CREWS were better than the BAP-65 or MEWS(P<0.05).Conclusion Although the BAP-65 score is a specific prognostic tool for AECOPDs,it’s contains a laboratory indicator,thus,there are some limitations in the continuous monitoring of disease in normal wards.At same time,the BAP-65 score and MEWS are geneially used to predict the efficacy of general wards,so they did not apply to patients of AECOPD in general wards.In addition,the NEWS and CREWS not only superior the BAP-65 score and the MEWS,but are simple and practical.It can be seen,NEWS and CREWS is more suitable for general ward AECOPDs with disease assessment.