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Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease.

Liu D, Peng SH, Zhang J, Bai SH, Liu HX, Qu JM - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: The re-exacerbation rate in 90 days was 48.9% (86 out of 176).The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001).Further studies are required to verify these findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Background: The objective of the study is to develop a scoring system for predicting a 90-day re-exacerbation in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods: A total of 176 consecutive hospitalized patients with AECOPD were included. The sociodemographic characteristics, status before acute exacerbation (AE), presentations of and treatment for the current AE, and the re-exacerbation in 90 days after discharge from hospital were collected.

Results: The re-exacerbation rate in 90 days was 48.9% (86 out of 176). It was associated with the degree of lung function impairment (Global initiative for chronic Obstructive Lung Disease [GOLD] grades), frequency of AE in the previous year, and parameters of the current AE, including pleural effusion, use of accessory respiratory muscles, inhaled long-acting β-2-agonists, inhaled corticosteroids, controlled oxygen therapy, noninvasive mechanical ventilation, and length of hospital stay, but was not associated with body mass index, modified Medical Research Council scale, or chronic obstructive pulmonary disease assessment test. A subgroup of ten variables was selected and developed into the re-exacerbation index scoring system (age grades, GOLD grades, AE times in the previous year, pleural effusion, use of accessory respiratory muscles, noninvasive mechanical ventilation, controlled oxygen therapy, inhaled long-acting β-2-agonists and inhaled corticosteroids, and length of hospital stay). The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001).

Conclusion: A comprehensive assessment integrating parameters of stable chronic obstructive pulmonary disease, clinical presentations at exacerbation, and treatment showed a strong predictive capacity for short-term outcome in patients with AECOPD. Further studies are required to verify these findings.

No MeSH data available.


Related in: MedlinePlus

ROC curves for the re-AE INDEX, CODEX, GOLD grades, mMRC, CAT, and FEV1%.Notes: Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. CODEX, CAT, mMRC, GOLD stages, or FEV1% could not predict the outcome of re-exacerbation in 90 days after discharge efficiently.Abbreviations: ROC, receiver operating characteristic; Re-AE INDEX, re-exacerbation index; CODEX, comorbidity, obstruction, dyspnea, and previous severe exacerbations; GOLD, Global initiative for chronic Obstructive Lung Disease in stable COPD; mMRC, modified Medical Research Council scale in stable COPD; CAT, COPD assessment test in stable COPD; FEV1%, forced expiratory volume in 1 second percent of predicted in stable COPD.
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f2-copd-10-1265: ROC curves for the re-AE INDEX, CODEX, GOLD grades, mMRC, CAT, and FEV1%.Notes: Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. CODEX, CAT, mMRC, GOLD stages, or FEV1% could not predict the outcome of re-exacerbation in 90 days after discharge efficiently.Abbreviations: ROC, receiver operating characteristic; Re-AE INDEX, re-exacerbation index; CODEX, comorbidity, obstruction, dyspnea, and previous severe exacerbations; GOLD, Global initiative for chronic Obstructive Lung Disease in stable COPD; mMRC, modified Medical Research Council scale in stable COPD; CAT, COPD assessment test in stable COPD; FEV1%, forced expiratory volume in 1 second percent of predicted in stable COPD.

Mentions: The prediction efficacy is depicted using the C-statistic and sensitivity and specificity. Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. The INDEX showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001, Table 5, Figure 2). In our cohort, CODEX did not show statistical significance (P=0.107). CAT, mMRC, GOLD stages, or FEV1% could not efficiently predict the outcome of re-exacerbation in 90 days after discharge (P>0.05, Table 5, Figure 2).


Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease.

Liu D, Peng SH, Zhang J, Bai SH, Liu HX, Qu JM - Int J Chron Obstruct Pulmon Dis (2015)

ROC curves for the re-AE INDEX, CODEX, GOLD grades, mMRC, CAT, and FEV1%.Notes: Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. CODEX, CAT, mMRC, GOLD stages, or FEV1% could not predict the outcome of re-exacerbation in 90 days after discharge efficiently.Abbreviations: ROC, receiver operating characteristic; Re-AE INDEX, re-exacerbation index; CODEX, comorbidity, obstruction, dyspnea, and previous severe exacerbations; GOLD, Global initiative for chronic Obstructive Lung Disease in stable COPD; mMRC, modified Medical Research Council scale in stable COPD; CAT, COPD assessment test in stable COPD; FEV1%, forced expiratory volume in 1 second percent of predicted in stable COPD.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494178&req=5

f2-copd-10-1265: ROC curves for the re-AE INDEX, CODEX, GOLD grades, mMRC, CAT, and FEV1%.Notes: Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. CODEX, CAT, mMRC, GOLD stages, or FEV1% could not predict the outcome of re-exacerbation in 90 days after discharge efficiently.Abbreviations: ROC, receiver operating characteristic; Re-AE INDEX, re-exacerbation index; CODEX, comorbidity, obstruction, dyspnea, and previous severe exacerbations; GOLD, Global initiative for chronic Obstructive Lung Disease in stable COPD; mMRC, modified Medical Research Council scale in stable COPD; CAT, COPD assessment test in stable COPD; FEV1%, forced expiratory volume in 1 second percent of predicted in stable COPD.
Mentions: The prediction efficacy is depicted using the C-statistic and sensitivity and specificity. Risk of re-exacerbation strongly increased with increasing score of re-AE INDEX in the cohort. The INDEX showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001, Table 5, Figure 2). In our cohort, CODEX did not show statistical significance (P=0.107). CAT, mMRC, GOLD stages, or FEV1% could not efficiently predict the outcome of re-exacerbation in 90 days after discharge (P>0.05, Table 5, Figure 2).

Bottom Line: The re-exacerbation rate in 90 days was 48.9% (86 out of 176).The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001).Further studies are required to verify these findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Background: The objective of the study is to develop a scoring system for predicting a 90-day re-exacerbation in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods: A total of 176 consecutive hospitalized patients with AECOPD were included. The sociodemographic characteristics, status before acute exacerbation (AE), presentations of and treatment for the current AE, and the re-exacerbation in 90 days after discharge from hospital were collected.

Results: The re-exacerbation rate in 90 days was 48.9% (86 out of 176). It was associated with the degree of lung function impairment (Global initiative for chronic Obstructive Lung Disease [GOLD] grades), frequency of AE in the previous year, and parameters of the current AE, including pleural effusion, use of accessory respiratory muscles, inhaled long-acting β-2-agonists, inhaled corticosteroids, controlled oxygen therapy, noninvasive mechanical ventilation, and length of hospital stay, but was not associated with body mass index, modified Medical Research Council scale, or chronic obstructive pulmonary disease assessment test. A subgroup of ten variables was selected and developed into the re-exacerbation index scoring system (age grades, GOLD grades, AE times in the previous year, pleural effusion, use of accessory respiratory muscles, noninvasive mechanical ventilation, controlled oxygen therapy, inhaled long-acting β-2-agonists and inhaled corticosteroids, and length of hospital stay). The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001).

Conclusion: A comprehensive assessment integrating parameters of stable chronic obstructive pulmonary disease, clinical presentations at exacerbation, and treatment showed a strong predictive capacity for short-term outcome in patients with AECOPD. Further studies are required to verify these findings.

No MeSH data available.


Related in: MedlinePlus