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Mortality and Need for Mechanical Ventilation in Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Archives of Internal Medicine, 09/29/09

Tabak YP et al. – A simple risk class based on clinical variables easily obtained at presentation predicts mortality and need for mechanical ventilation. It may facilitate the triage and care of patients with Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs).

Methods

The authors analyzed 88 074 subjects admitted with an AECOPD between 2004 and 2006.
The authors used recursive partition to create risk classifications for in–hospital mortality.
Need for mechanical ventilation served as a secondary end point.
The authors internally validated the model via 1000 bootstrapping on half of patients and externally validated it on the remaining patients.
The authors assessed predictive ability using the area under the receiver operating curve (AUROC).

Results

The in–hospital mortality rate was 2%.
Three variables had high discrimination of outcomes: serum urea nitrogen level greater than 25 mg/dL (to convert to millimoles per liter, multiply by 0.357); acute mental status change, and pulse greater than 109/min.
For those without any of the 3 factors, age 65 years or younger further differentiated the lowest–risk group.
In those with all 3 factors, the mortality rates were 13.1% (131 in 1000) and 14.6% (146 in 1000) in the derivation and validation cohorts, respectively, compared with 0.3% (3 in 1000) in both cohorts among patients without any of the 3 factors and age 65 years or younger.
The AUROC for mortality in the 2 cohorts were 0.72 and 0.71, respectively.
For mechanical ventilation, the AUROCs were 0.77 for both cohorts.

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