Application of the Rome severity classification of COPD exacerbations in a real-world cohort of hospitalised patients

Abstract

BackgroundRecently, the Rome classification was proposed in which objective and readily measurable variables were integrated to mark exacerbations of COPD (ECOPD) severity. The aim of this study is to investigate the distribution of a real-world patient population with hospitalized ECOPD according to the current classification across the newly proposed severity classification. We assume that a significant proportion of hospitalized patients will have a mild or moderate event.MethodsThe Rome classification was applied to a cohort of 364 COPD patients hospitalized at the Department of Respiratory Medicine of Maastricht University Medical Center (MUMC) with a severe ECOPD. Differences in in-hospital, 30- and 90-days mortality were compared between mild, moderate and severe ECOPD according to the new classification. Moreover, data was stratified by the different severity classes and compared regarding general disease characteristics and clinical parameters.ResultsAccording to the Rome proposal, 52 (14.3%) patients had a mild ECOPD, 204 (56.0%) moderate and 108 (29.7%) patients a severe ECOPD. In-hospital mortality in mild, moderate and severe events was 3.8%, 6.9% and 13.9%, respectively. Most clinical parameters indicated a significantly worse condition in patients classified in the severe group, compared to those in mild or moderate groups.ConclusionMost of the events, traditionally all classified as severe because of the hospitalization, were classified as moderate, while almost 15% were mild. The results of this study provide insight in the heterogeneity of hospitalized ECOPD and show that the newly proposed Rome criteria can differentiate between events with different short-term mortality rates.

Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events

“…Firstly, due to our study design, it remains uncertain to what extent patients with a severe AECOPD had impairments in physical status before hospitalization. Secondly, after finalization of our study, the ROME proposal suggested an alternative classification of exacerbation severity 54 . However, we have not evaluated the specific parameters utilized in the ROME classification, leaving us uncertain about the prevalence of mild or moderate exacerbations among our patients.…”

Validation of the Rome Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter Cohort Study

“… 11 Carmen et al applied the Rome classification to a cohort of 364 hospitalized patients with AECOPD in the Netherlands and found that the Rome classification can differentiate between exacerbation events with different short-term mortality rates. 12 The study conducted by Lee et al in Korea found excellent performance of the Rome classification for predicting ICU admission and the need for noninvasive mechanical ventilation (NIV) or IMV and acceptable performance for predicting in-hospital mortality by comparing the Rome classification with the DECAF score and GesEPOC 2021 criteria. 13 Our findings concerning the association between the Rome severity classification and the need for ICU admission and MV were highly consistent with Lee’s findings.…”

“…Similar results were also found by the two studies mentioned earlier and conducted in the Netherlands and Korea, respectively. 12 , 13 This revealed that a cutoff value of 10 mg/L may lack specificity to distinguish a moderate event from a severe one, and the mechanism linking CRP to the exacerbations of COPD may be complex and requires further researches. Probably due to the two flaws mentioned above, the Rome classification is valid in discriminating between mild and more severe AECOPD but fails to distinguish between moderate and severe AECOPD.…”

Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter?

“…Secondly, we analysed the influence of comorbid CHF on BaR scoring, experienced by patients at study inclusion ( Figure 1 ) and during ECOPDs ( Figures 2 and 3 ). The only published study we know of that applies the Rome proposal on ECOPDs is the one by Reumkens et al 28 Since this study applies the Rome proposal on ECOPDs without any data on BaR, we thought it would be of particular interest to include an analysis of BaR in the present study. In these analyses, we observed no significant difference regarding BaR at study inclusion between COPD patients without CHF and those with comorbid CHF ( Figure 1 ).…”