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P136 Multidimensional prognostic index for exacerbations of COPD
  1. PM Short1,
  2. PA Williamson2,
  3. A Singanayagam3,
  4. A Akram4,
  5. S Schembri1,
  6. JD Chalmers1
  1. 1Ninewells Hospital, Dundee, UK
  2. 2Perth Royal Infirmary, Perth, UK
  3. 3Imperial College London, London, UK
  4. 4Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

Introduction and Objectives Prognostic assessment of COPD exacerbations is currently limited by models that only take into account short term prognostic factors. We developed a multidimensional tool for COPD exacerbations, predicting both short and long term outcome.

Methods A prospective multicentre, UK observational cohort of patients hospitalised with exacerbations of COPD 2009–2011. Cox-proportional hazards regression used to identify independent predictors of 30-day and 1 year mortality. Two independent risk scores based on exacerbation severity (acute score) and severity of COPD and co-morbidities (chronic score) were developed. The two scores were then used to generate a 4 class decision grid based on the GOLD 2011 criteria for stable COPD.

Results 1343 patients were included. 749 patients were readmitted or died during 1 year follow-up.

Predictors of 30-day mortality (acute score) were new onset confusion HR 2.23 (95%CI 1.34–3.71)- 1 point, Urea >7mmol/L 2.64 (95%CI 1.51–4.61)- 1 point, acidosis 4.22 (95%CI 2.68–6.65)- 2 points, glucose >8mmol/L 1.56 95%CI (1.00–2.46)- 1 point and albumin <35g/L 2.23 (95%CI 1.42–3.5)- 1 point and heart rate >110bpm 2.37 (95%CI 1.50–3.73)- 1 point. The AUC for 30 day mortality for the acute score was 0.84 (95%CI 0.80–0.88).

The strongest predictors of 1 year mortality were age >80 years HR 1.25 (95%CI 1.00–1.64)–1 point, neoplastic disease 1.91 (95%CI 1.37–2.65)–1 point, MRC dyspnoea grade 4 or 5 (3.82 95%CI 2.61–5.58)- 2 points, FEV1 <30% predicted 2.61 (95%CI 1.99–3.43)–1 point, long term oxygen therapy 1.60 95%CI 1.11–2.29)–1 point and a history of myocardial infarction or heart failure 2.76 95%CI 1.70–4.47)–1 point. The AUC for 1 year mortality of the chronic score was 0.76 (95%CI 0.73–0.80).

The resulting 4 stage model identifies different outcomes within each subgroup (See Figure 1). Furthermore the 4 stage model predicted 30-day mortality AUC 0.76 (95%CI 0.72–0.79), 1 year mortality 0.72 (95%CI 0.70–0.74) and readmissions 0.74 (95%CI 0.72–0.76) better than GOLD 2011 criteria.

Conclusion A multidimensional prognostic index can predict both short and long term outcomes after COPD exacerbations, and divides patients into clinically useful subgroups based on exacerbation severity and chronic health status.

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