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Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Severity Scoring and its Correlation with the Length of Hospitalization and the Final Outcome

University of Athens, Sotiria, Athens, Greece

PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a significant cause of hospitalization and in-hospital mortality. Our aim was to assess AECOPD severity on admission by applying a scoring system and to investigate its possible correlations with the length of hospitalization (LOH) and the final outcome (FO).

METHODS: We applied a 10-domain scoring system (SS) actually comprising the routine evaluation of a newly admitted COPD patient. SS-domains included demographics (gender, age, body mass index), COPD history (smoking habit, influenza vaccination, symptom duration, need for domiciliary oxygen, hospitalizations per year), comorbidity, cor pulmonale, clinical examination, peak flow rate, blood gases, sputum purulence, chest X-ray, blood tests. FO was coded as 1=improvement and discharge from the ward, 2=need for noninvasive mechanical ventilation (NIMV) in the ward, 3=transfer to the ICU, intubation and mechanical intubation, and 4=death.

RESULTS: SS was applied to 145 COPD patients (117 males; aged 71±9 years) on admission to the ward. Mean LOH was 13±7 days and their FO was 1=113 patients, 2=15 patients, 3=7 patients and 4=10 patients (mortality 7%). Total SS correlated with both LOH (Pearson’s corr.coeff., r=0.67, p<0.001) and FO (ANOVA, p<0.001). Sputum purulence (r=0.53, p<0.001), clinical signs of severe dyspnea (r=0.44, p<0.001), long-term oxygen treatment (r=0.30, p=0.004) and the radiographic appearance of consolidation (r=0.28, p=0.008) were the most significant predictors of LOH. Hypercapnia (PCO2>60 mmHg, r=0.54, p<0.001), pH<7.32 (r=0.52, p<0.001), central nervous system (CNS) clinical signs (r=0.51, p<0.001) and cardiovascular comorbidity (r=0.29, p-0.003) were bad prognostic indexes with respect to the FO.

CONCLUSION: The proposed scoring system is easily applicable and correlates with parameters of AECOPD severity, such as the LOH and the FO.

CLINICAL IMPLICATIONS: A practical and reliable scoring system of the AECOPD severity is a useful tool aiding medical decisions such as the need for hospitalization and early institution of therapeutic modalities (i.e. NIMV). It may also serve to avoid unjustified admissions and to minimize unecessary healthcare utilization.

DISCLOSURE: E.N. Kosmas, None.