Predictors of outcomes in COPD exacerbation cases presenting to the emergency department
Predictors of outcomes in COPD exacerbation cases presenting to the emergency department
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DOI：
10.1183/09031936.00129507
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发表时间：
2008-10-01
影响因子：
24.3
通讯作者：
Perrotin, D.
中科院分区：
文献类型：
--
作者：
Roche, N.;Zureik, M.;Perrotin, D.
这项前瞻性多中心研究的目的是建立一个简单的规则来预测急诊科就诊的慢性阻塞性肺疾病(COPD)急性加重患者的不良结局。所有在3个月期间到103家医院急诊科就诊的COPD急性加重患者，除了那些立即需要重症监护病房入院和/或呼吸机支持的患者外，都被纳入其中。收集的数据包括患者特征、住院结果(死亡率和住院时间)和出院方式(无人支持或需要医院后协助)。住院死亡率为7.4%(794人中有59人)。影响预后的独立因素为年龄、临床严重程度体征的个数(青紫、神经功能受损、肢体水肿、星形畸形、辅助吸气肌或呼气肌的使用)和稳定期呼吸困难分级。女性也预测了对医院后支持的需求。为了构建和验证基于这些项目的死亡率预测分数，患者被随机分配到一个派生组和一个验证队列。预测得分显示出良好的区分性，在派生队列和验证队列中的c-统计量分别为0.79和0.83。因此，简单的纯临床因素可以可靠地预测最初无生命危险的慢性阻塞性肺疾病急性加重患者的死亡风险和医院后支持需求。它们的使用需要进行前瞻性的验证。
The aim of the present prospective multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease (COPD) exacerbations in a real-life setting.All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included, except those who immediately required intensive care unit admission and/or ventilatory support. The data collected included patient characteristics, in-hospital outcomes (mortality and length of stay) and mode of discharge (unsupported or need for post-hospital assistance).The in-hospital mortality rate was 7.4% (59 out of 794). Independent prognostic factors were age, number of clinical signs of severity (among cyanosis, impaired neurological status, lower limb oedema, asterixis and use of accessory inspiratory or expiratory muscles) and dyspnoea grade in the stable state. The need for post-hospital support was also predicted by female sex. In order to construct and validate a prediction score for mortality based on these items, patients were randomly allocated to a derivation and a validation cohort. The prediction score showed good discrimination, with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort.Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease. Their use needs to be prospectively validated.