Background The exacerbation of chronic obstructive pulmonary disease (AECOPD) is a chronic, frequent, and life-threatening lung disease. In 2014, a frailty index (FI) based on deficits in commonly used laboratory tests (FI-Lab) was suggested to identify older adults at increased risk of death. Objective We aim to study the prognostic value of the FI-Lab in older Chinese patients who were admitted because of AECOPD. Methods We screened 1932 older patients hospitalized with AECOPD from September 2016 to June 2019 at Zhenjiang First People’s Hospital, China. A multivariate logistic regression analysis was used to identify prognostic factors for in-hospital mortality. Results A total of 77 survivors and 77 non-survivors were finally included in the study. Both the mean DECAF (including dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score and the mean FI-Lab value of non-survivors were statistically higher than those of survivors (4.45 ± 0.80 versus 3.03 ± 0.90, P =0.000; 0.51 ± 0.13 versus 0.29 ± 0.10, P =0.000, respectively). Logistic regression analysis suggested that DECAF Rank and FI-Lab Rank were strongly related factors of death in AECOPD patients. The areas under the receiver-operating characteristic (ROC) curves were 0.906 for FI-Lab and 0.870 for DECAF ( P =0.2991). Conclusion FI-Lab is a simple, efficient, and objective tool to stratify the risk of in-hospital mortality of AECOPD.
Introduction: The exacerbation of chronic obstructive pulmonary disease(AECOPD)is a common and fetal disease but with no ideal predictor of in-hospital mortality. Frailty prevails in older adults with AECOPD and can cause increased vulnerability to many adverse health outcomes including death. However, we know little about how frailty affects in-hospital mortality in older AECOPD patients. Objective: To explore the predictive validity of FI-Lab—an objective tool for assessing frailty including 21 routine blood tests plus systolic and diastolic blood pressure (a score between 0 and 1, a higher score indicates greater frailty)—for in-hospital mortality in patients with AECOPD. Methods: We reviewed the hospitalization records of older AECOPD inpatients from September 2016 to June 2019 at Zhenjiang First People's Hospital. We compared survivors to non-survivors. We used propensity score matching (PSM) to balance priori differences between survivors and non-survivors. Logistic regression analysis was used to select the associated predictors of in-hospital mortality. Receiver-operating characteristic (ROC) curves were calculated to estimate the area under the ROC curve (AUCs) for FI-Lab and DECAF(a commonly used predictor of AECOPD including dyspnea, eosinophilia, pulmonary consolidation, acidemia, and atrial fibrillation; a score between 1and 6; a higher score indicates poorer condition)in relation to mortality. Data were analyzed using IBM SPSS for Windows, Version 23.0. Results: A total of 154 patients—77 survivors and 77 non-survivors—were included in the study finally. The mean age of these patients was 79.73 ± 8.38 years. Both of the mean DECAF score, the mean FI-Lab value of non-survivors were statistically higher than those of survivors(4.45 ± 0.80 versus 3.03 ± 0.90,P = 0.000; 0.51 ± 0.13 versus 0.29 ± 0.10,P = 0.000,respectively). Logistic regression analysis suggested that high DECAF grade and high FI-Lab grade were strong related factors of death in AECOPD patients (OR:5.620, 95%CI 2.811–11.236, P = 0.000; OR:8.705, 95%CI 3.646–20.782, P = 0.000, respectively). The DECAF scores of most non-survivors were ≥ 4༈n = 71,92.21%༉. FI-Lab value predicted in-hospital mortality at a cut-off value of 0.4388 with 70.1% sensitivity, 96.1% specificity, 0.675 Youden index. DECAF score predicted in-hospital mortality at a cut-off value of 3.5 with 92.2% sensitivity, 72.7% specificity, 0.649 Youden index. The areas under the ROC curves were 0.906 for FI-Lab and 0.870 for DECAF with no statistically significant༈P = 0.2991). Conclusions: FI-Lab has a slightly stronger screening ability than DECAF. FI-Lab is a simple, effective and objective indicator and can be quick to help clinicians to assess in-hospital mortality of AECOPD patients.
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