| Background: Chronic Obstructive Pulmonary Disease(COPD),due to the large number of patients,high fatality rate and heavy social and economic burden,has become a major public health problem that seriously affects health.The acute exacerbation of Chronic obstructive pulmonary disease leads to decreased lung function,and significantly accelerates the process of Chronic obstructive pulmonary disease,which is an independent risk factor for death.Therefore,the Global Prevention and Control Initiative for Chronic Obstructive Pulmonary Disease(GOLD)emphasizes the prevention and avoidance of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Currently,the diagnosis of acute exacerbation is based on symptoms or events.However,the patient has heterogeneity in the symptoms,severity,frequency and complications,leading to the diagnosis of a large variability of the patient,resulting in an acute and aggravated missed diagnosis or misdiagnosis.However,there is no unified quantitative diagnostic criteria for the acute exacerbation of chronic obstructive pulmonary disease.Foreign scholars have developed the Exacerbations of chronic obstructive pulmonary disease tool-patients report outcome(EXACT-PRO)to differentiate stable and acute exacerbation state,including those rated by the the clinicians as mild,moderate and severe.The DECAF score was proposed by foreign experts to assess the hospitalization mortality in patients with AECOPD.Reliability of EXACT-PRO and DECAF is clinically proven.However,there are relatively few studies on EXACT-PRO and DECAF scores in China,especially in predicting the prognosis of patients with chronic obstructive pulmonary disease.The purpose of this study is to establish a clinical,simple,effective quantitative diagnostic tool by comparing patients between stable COPD group and AECOPD group on EXACT-PRO,m MRC(modified Medical Research Council dyspnoea scale)and CAT(COPD Assessment Test).According to the prognosis,the patients with COPD were divided into two groups: death and survival group,mechanical ventilation and non-mechanical ventilation group,invasive mechanical ventilation and non-invasive mechanical ventilation group.Comparing the differences of EXACT-PRO,m MRC,CAT and DECAF scores is to analyze the advantages and disadvantages on predicting the effectiveness of prognosis in hospital.Objective: To diagnose AECOPD and predict GOLD classification by using EXACT-PRO score;To predict the prognosis efficiency in the hospital by applying EXACT-PRO,m MRC,CAT and DECAF scores,and calculated their AUROC,95%CI,optimal cut-off point,sensitivity and specificity.Methods1.According to the inclusion and exclusion criteria,a total of 239 patients with AECOPD in the respiratory ward were selected,including mild 41 cases,moderate 103 cases,and severe 95 cases.The EXACT-PRO,m MRC,CAT and DECAF scores were performed at patient admission,respectively.We prospectively collected the interrelated data and track the prognosis of patients.EXACT-PRO,m MRC,CAT and DECAF scores are performed again before discharge.2.To compare the EXACT-PRO scores in different GOLD grades;To compare EXACT-PRO,m MRC and CAT scores between stable COPD group and AECOPD group;To compare the EXACT-PRO,m MRC,CAT scores between mild,moderate and severe group.3.To compare The EXACT-PRO,CAT,DECAF and m MRC scores,Areas under the curve(AUROC)of the prognosis prediction.4.To compare the EXACT-PRO,DECAF scores in patients with AECOPD between death and survival group,mechanical ventilation group and non-mechanical ventilation group,invasive mechanical ventilation and non-invasive ventilation group,respectively.5.To build the ROC curve to analyze the cut-off point of EXACT-PRO and DECAF scores in different prognosis of AECOPD patients.Results1.In this study,a total of 239 patients with AECOPD were selected and there were 196 males and 43 females.The range of age was from 43 to 91 years old(73.06±8.636 years).There were 6 cases(2.9%)died in the hospital,50 cases(24.4%)needed for ventilation,and 6 cases(2.9%)needed for invasive mechanical ventilation.2.It was statistically significant that EXACT PRO score with AECOPD group was higher than the stable COPD group(41.99±8.207 vs 26.21±5.859,P<0.01),while CAT and m MRC scores were statistically significant(23.73±5.925 vs 17.60±5.410,P<0.05;2.88±0.982 vs 2.05±0.800,P<0.05).The EXACT-PRO score of severe group was statistically higher than it in mild to moderate groups(48.01±6.444 vs.40.81±5.556,P<0.01;48.01±6.444 vs.30.88±3.572,P<0.01).3.Base on the results,The AUROC of EXACT-PRO score was 0.844(95%CI0.715-0.973)for death,0.824(95%CI0.759-0.889)for mechanical ventilation,0.832(95%CI0.693-0.970)for invasive mechanical ventilation,respectively.The AUROC of DECAF score for death,mechanical ventilation and invasive mechanical ventilation were 0.814(95%CI0.682-0.945),0.688(95%CI0.0.604-0.772),0.651(95%CI0.400-0.902),respectively.The overall predictive efficacy of EXACT-PRO and DECAF scores was better than that of CAT and m MRC score.4.For predicting hospital mortality,EXACT-PRO and DECAF scores had moderate predictive efficacy(AUROC=0.844,AUROC=0.824,respectively).For mechanical ventilation and mechanical ventilation prediction efficiency,EXACT-PRO score is better than DECAF score(AUROC0.824 vs 0.688;AUROC0.832 vs 0.651,respectively).5.The optimal cut-off points of EXACT-PRO score predicting death,mechanical ventilation and invasive mechanical ventilation were 51,44 and 46,respectively.Conclusion1.EXACT-PRO score can be used to assess lung function,the worse the lung function,the higher the EXACT-PRO score.2.EXACT-PRO score can differentiate stable and acute exacerbation state,including those rated by the the clinicians as mild,moderate and severe.3.In the prognosis prediction of patients with AECOPD,the EXACT-PRO score had moderate predictive efficacy for mechanical ventilation,hospital death,and invasive mechanical ventilation.The overall predictive efficacy of EXACT-PRO score was superior to those of CAT,DECAF,m MRC. |
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