Validation of a Novel Risk Score for Severity of Illness in Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
Chest. 2011 Apr 28;
Authors: Shorr AF, Sun X, Johannes RS, Yaitanes A, Tabak YP
ABSTRACT BACKGROUND: Clinicians lack a validated tool for risk stratification in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to validate the BAP-65 (elevated Blood urea nitrogen, Altered mental status, Pulse >109 bpm, age > 65 years) score for this purpose. METHODS: We analyzed 34,699 admissions to 177 US hospitals (2007) with either a principal diagnosis of AECOPD or acute respiratory failure with a secondary diagnosis of AECOPD. Hospital mortality and need for mechanical ventilation (MV) served as co-primary endpoints. Length of stay (LOS) and costs represented secondary endpoints. We assessed the accuracy of the BAP-65 via the area under the receiver operating characteristic (AUROC) curve. RESULTS: Nearly 4% of subjects expired while hospitalized and approximately 9% required MV. Mortality increased with increasing BAP-65 class, ranging from <1% in persons Class I (score of 0) to >25% in those meeting all BAP-65 criteria (Cochran-Armitage trend test z=-38.48, p<0.001). The need for MV also increased with escalating score (2% in the lowest risk cohort vs. 55% in the highest risk group, Cochran-Armitage trend test z=-58.89, p<0.001). The AUROC for the BAP-65 for hospital mortality and/or need for MV measured 0.79 (95% CI: 0.78-0.80). The median LOS was 4 days while mean hospital costs equaled $5,357. These also varied linearly with increasing BAP-65 score. CONCLUSIONS: The BAP-65 system captures severity of illness and represents a simple tool to categorize AECOPD patients as to their risk for adverse outcomes. BAP-65 also correlates with measures of resource use. BAP-65 may represent a useful adjunct in the initial assessment of AECOPDs.
PMID: 21527510 [PubMed - as supplied by publisher]