Prognostic scores for acute exacerbation of chronic obstructive pulmonary disease: which one performs best in the emergency department?

Background
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the main reason of hospital admission. Early diagnosis and prognostication of patients are important to guide clinicians in optimal decisions regarding the type and site of care. Different scores used to assess the severity of exacerbation and predict the outcome. This study aimed to assess the value of four scores [dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation (DECAF), BUN, altered mental status, pulse, age>65 (BAP-65), confusion, urea, blood pressure, age >65 (CURB-65) and quick sequential (sepsis-related) organ failure assessment (qSOFA)] in predicting intensive care unit admission and in-hospital death in patients with AECOPD.


Patients and methods
This prospective cohort study was conducted on 150 patients presented to the emergency department of Assiut University Hospital with AECOPD. Clinical, laboratory, radiographic, and electrocardiographic data were collected to calculate the prognostic scores.


Results

The current study enrolled 150 patients. Sixty-nine patients out of them needed ICU and 81 were admitted to the medical ward. There was a statistically significant difference between survivors and nonsurvivors regarding having diabetes mellitus (
P
value 0.023), cerebrovascular diseases (
P
<0.001), dyspnea grade (
P
value 0.006), conscious level (
P
<0.001), respiratory rate (
P
value 0.005), oxygen saturation (
P
value 0.004) and blood urea nitrogen (
P
value 0.044). DECAF score was the most sensitive score in predicting mortality (100% sensitivity) with an area under the curve of 0.874 followed by qSOFA and CURB-65 with sensitivity 85% for both scores. BAP-65 had the highest sensitivity (92.8%) in predicting ICU admission with an area under the curve of 0.857 followed by DECAF and CURB-65 score with sensitivity 91.3 and 87%, respectively. Multivariate regression study revealed a statistically significant correlation between mortality and dyspnea grade V, unconsciousness, low systolic blood pressure, high respiratory rate, low serum albumin level, and high DECAF and CURB-65 scores.



Conclusion
DECAF score was the most reliable indicator of in-hospital death followed by CURB-65 and qSOFA scores in AECOPD patients presented in the emergency department. BAP-65 performed best in predicting ICU admission in patients with AECOPD, followed by DECAF and CURB-65 scores.