Application Of Four Prognosis Prediction Scores For Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective To investigate the status of prognosis in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).To predict the hospital mortality,ICU admissions and the need for mechanical ventilation in patients with AECOPD by CURB-65 score,CRB-65 score,BAP-65 score,DECAF score,evaluate and comparison the prediction efficiency of these scores.Methods The total of 208 inpatients with the first diagnosis of AECOPD in the First Affiliated Hospital of Guangxi Medical University From January 2013 to January2014 were recruited.We compared the death group and survival group,the ICU group and general ward group,mechanical ventilation group(MV group)and non mechanical ventilation group(non MV group)based on the CURB-65 score,CRB-65 score,BAP-65 score and DECAF score respectively.We compared the prediction accuracy of CURB-65 score,CRB-65 score,BAP-65 score and DECAF score on the hospital mortality,ICU admissions and the need for mechanical ventilation using the area under the receiver operating characteristic curves(AUROC).Results1.In this study,the longest length of hospital stay were 89 days,the median length of hospital stay were 15 days.Hospitalization costs range from 8613.1 yuan to 210822.31 yuan,the median costs were 20144.26 yuan;9 patients died in the hospital(4.3%);ICU admissions were 33 patients(15.9%);need for mechanical ventilation were 46 patients(22.1%),which including the 22 patients received noninvasive mechanical ventilation(10.6%)and 24 patients received Invasive mechanical ventilation(11.5%)?2.There were no statistical difference in CURB-65 score,CRB-65 score,BAP-65 score and DECAF score between the death group and survival group,the ICU group and general ward group,MV group and non MV group(P<0.01).In the death group,ICU group,MV group,CURB-65 score,CRB-65 score,BAP-65 score and DECAF score were higher than the survival group,general ward group,non MV group.3.The AUROC of CURB-65 score predicted hospital mortality,ICU admissions and the need for mechanical ventilation were 0.922(95%CI,0.877 to 0.955),0.759(95%Cl,0.695 to 0.815),0.804(95%Cl,0.743 to 0.855),respectively;The AUROC of CRB-65 score predicted hospital mortality,ICU admissions and the need for mechanical ventilation were 0.899(95%CI,0.849 to 0.936),0.734(95%CI,0.668 to 0.792),0.802(95%CI,0.741 to 0.853),respectively;The AUROC of BAP-65 score predicted hospital mortality,ICU admissions and the need for mechanical ventilation were 0.935(95%CI,0.892 to 0.964),0.757(95%CI,0.693 to 0.813),0.837(95%CI,0.780 to 0.885),respectively;The AUROC of DECAF score predicted hospital mortality,ICU admissions and the need for mechanical ventilation were 0.946(95%CI,0.906 to 0.972),0.811(95%CI,0.751 to 0.862),0.953(95%CI,0.915 to 0.915),respectively.4.The AUROC between CURB-65 score,CRB-65 score,BAP-65 score,and DECAF score for hospital mortality,ICU admissions were not statistical difference(P>0.05);there were also no significant difference of the AUROC between CURB-65 score,CRB-65 score,and BAP-65 score for need for mechanical ventilation(P>0.05),but the AUROC of D ECAF score for mechanical ventilation was higher than the CURB-65 sco re,CRB-65 score,BAP-65 score(P<0.05).Conclusion1.The patients of this research showed the prolonged length of hospital stay,expensive hospitalization costs,and the high rates of need for mechanical ventilation and ICU admissions,which embodies the characteristics of the large economic burden and severe disease of the patients with AECOPD.2.The AUROC of CURB-65 score,CRB-65 score,BAP-65 score,DECAF score for hospital mortality,ICU admissions,and need for mechanical ventilation were greater than 0.7,means the better of prediction performance of these scores.3.The prediction efficiency of CURB-65 score,CRB-65 score,BAP-65 score,DECAF score for hospital mortality,ICU admissions have no difference,but prediction efficiency of DECAF score for mechanical ventilation is higher than the CURB-65 score,CRB-65 score,BAP-65 score.4.BAP-65 score,DECAF score are both specific prognostic scores for AECOPD,due to the DECAF score including the arterial blood gas examination,imaging examination,and ECG,the data acquisition were not easy,and its costs were expensive,so the BAP-65 score may be more convenient and practical to predict the prognosis of patients with AECOPD,It is worthy to further promotion in the clinical.