Establishment of risk prediction model and risk score for in‐hospital mortality in patients with AECOPD

Yu, Xing; Zhu, Gui-Ping; Cai, Teng-Fei; Zheng, Jianyi

doi:10.1111/crj.13246

Cited by 12 publications

(20 citation statements)

References 26 publications

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“…Previous studies have demonstrated the role of age as a determinant of prognosis [ 4 , 15 , 16 ]. Issues related to increasing age, such as frailty, sarcopenia and co-morbidity, might affect prognosis [ 17 ]. Besides, elder patients usually present with atypical symptoms, such as muscle weakness, vertigo, confusion and leg edema during severe exacerbations [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypoalbuminemia could also reflect poor clinical status and persistent inflammation. Several studies have suggested that hypoalbuminemia is associated with increased mortality among AECOPD patients [ 17 , 30 , 31 ]. Lymphocyte count, another biomarker of immune status and inflammation, could predict risk of mortality in AECOPD patients.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

Peng

Gong²,

Wu³

et al. 2022

BMC Pulm Med

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Background Acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) contributes significantly to mortality among patients with COPD in Intensive care unit (ICU). This study aimed to develop a nomogram to predict 30-day mortality among AECOPD patients in ICU. Methods In this retrospective cohort study, we extracted AECOPD patients from Medical Information Mart for Intensive Care III (MIMIC-III) database. Multivariate logistic regression based on Akaike information criterion (AIC) was used to establish the nomogram. Internal validation was performed by a bootstrap resampling approach with 1000 replications. The discrimination and calibration of the nomogram were evaluated by Harrell’s concordance index (C-index) and Hosmer–Lemeshow (HL) goodness-of-fit test. Decision curve analysis (DCA) was performed to evaluate its clinical application. Results A total of 494 patients were finally included in the study with a mean age of 70.8 years old. 417 (84.4%) patients were in the survivor group and 77 (15.6%) patients were in the non-survivor group. Multivariate logistic regression analysis based on AIC included age, pO2, neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), invasive mechanical ventilation and vasopressor use to construct the nomogram. The adjusted C-index was 0.745 (0.712, 0.778) with good calibration (HL test, P = 0.147). The Kaplan–Meier survival curves revealed a significantly lower survival probability in the high-risk group than that in the low-risk group (P < 0.001). DCA showed that nomogram was clinically useful. Conclusion The nomogram developed in this study could help clinicians to stratify AECOPD patients and provide appropriate care in clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

Peng

Gong²,

Wu³

et al. 2022

BMC Pulm Med

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“…Moreover, BUN level was measured only at admission, as studies have reported that there is a strong association between the extent of BUN level rise during the first 24 h and mortality. 16 The intervention during the time patients were hospitalized was also not considered, which was associated with patient outcomes. Finally, the results of this study cannot represent all patients with AECOPD because it only targeted patients who presented in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…AECOPD is a common presentation in the ED that is associated with a mortality rate of 1.8%-8%. [14][15][16][17] A number of studies have explored the risk factors associated with mortality in patients with AECOPD so far, and it is known that albumin, respiratory rate, blood gas analysis (PCO 2 , hemoglobin, lactic acid, etc. ), inflammation-related indicators, etc.…”

Section: Discussionmentioning

confidence: 99%

The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease

Chen

Zheng

et al. 2021

Chron Respir Dis

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Background and purpose High blood urea nitrogen (BUN) is associated with an elevated risk of mortality in various diseases, such as heart failure and pneumonia. Heart failure and pneumonia are common comorbidities of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, data on the relationship of BUN levels with mortality in patients with AECOPD are sparse. The purpose of this study was to evaluate the correlation between BUN level and in-hospital mortality in a cohort of patients with AECOPD who presented at the emergency department (ED). Methods A total of 842 patients with AECOPD were enrolled in the retrospective observational study from January 2018 to September 2020. The outcome was all-cause in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and logistic regression models were performed to evaluate the association of BUN levels with in-hospital mortality in patients with AECOPD. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics, and logistic regression models were also performed in the propensity score matching cohort. Results During hospitalization, 26 patients (3.09%) died from all causes, 142 patients (16.86%) needed invasive ventilation, and 190 patients (22.57%) were admitted to the ICU. The mean level of blood urea nitrogen was 7.5 ± 4.5 mmol/L. Patients in the hospital non-survivor group had higher BUN levels (13.48 ± 9.62 mmol/L vs. 7.35 ± 4.14 mmol/L, p < 0.001) than those in the survivor group. The area under the curve (AUC) was 0.76 (95% CI 0.73–0.79, p < 0.001), and the optimal BUN level cutoff was 7.63 mmol/L for hospital mortality. As a continuous variable, BUN level was associated with hospital mortality after adjusting respiratory rate, level of consciousness, pH, PCO2, lactic acid, albumin, glucose, CRP, hemoglobin, platelet distribution width, D-dimer, and pro-B-type natriuretic peptide (OR 1.10, 95% CI 1.03–1.17, p=0.005). The OR of hospital mortality was significantly higher in the BUN level ≥7.63 mmol/L group than in the BUN level <7.63 mmol/L group in adjusted model (OR 3.29, 95% CI 1.05–10.29, p=0.041). Similar results were found after multiple imputation and in the propensity score matching cohort. Conclusions Increased BUN level at ED admission is associated with hospital mortality in patients with AECOPD who present at the ED. The level of 7.63 mmol/L can be used as a cutoff value for critical stratification.

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“…Based on previous studies,many blood biomarkers have been reported to predict the prognosis and indicate the severity of AECOPD,such as C-reactive protein and procalcitonin [12,13].Compared with survivors,previous studies had found that nonsurvivors had higher blood urea nitrogen levels and poorer nutritional status than survivors [14][15][16].Therefore,We hypothesized that AECOPD patients with higher BUN/ALB levels exist an inverse relationship with the poorer outcomes of COPD exacerbation.However,to our knowledge,there is no study that has explored the association between the BUN/ALB ratio and inhospital mortality and the short-term prognosis in AECOPD patients.Accordingly,the objective of our study was to ascertain the prognostic role of BUN/ALB ratio for in-hospital and 90-day all-cause mortality in AECOPD.…”

Section: Introductionmentioning

confidence: 99%

Blood Urea Nitrogen to Serum Albumin Ratio: A Good Predictor of in-Hospital and 90-Day All-Cause Mortality in AECOPD Patients

Zeng

Gong

et al. 2022

Preprint

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Background: Compared with survivors,previous studies of AECOPD have found that those died in hospital had higher blood urea nitrogen levels and poorer nutritional status.Nevertheless,the association between blood urea nitrogen to serum albumin ratio (BUN/ALB ratio) and in-hospital and short-term prognosis in AECOPD patients remains unclear.The aim of this study was to explore the usefulness of BUN/ALB ratio in AECOPD as an objective predictor for in-hospital and 90-day all-cause mortality.Methods: BUN/ALB ratio levels were measured in AECOPD patients on admission.By drawing the ROC curve of the patients,we obtained the cut-point of the BUN/ALB ratio level for in-hospital death.Multivariate logistic regression was used for analyses of the factors of in-hospital mortality and multivariate Cox regression was used to analyse the factors of 90-day all-cause mortality.Results: A total of 362 patients were recruited and 319 patients were finally analyzed,23 patients died during hospitalization and the fatality rate was 7.2%. Furthermore,14 patients died during 90-day follow-up.Compared with those in-hospital survivors,patients who died in hospital were older(80.78±6.58vs.75.09±9.73 years old, P =0.001),had a higher percentage of congestive heart failure(69.6% vs.27.4%, P<0.001),had higher BUN/ALB ratio levels(0.329(0.250,0.399)vs.0.145(0.111,0.210), P<0.001),had higher neutrophil counts(10.27(7.21，14.04)vs.6.58(4.58，9.04), P<0.001),higher blood urea nitrogen levels(10.86(7.10,12.25) vs.5.35(4.14,7.40), P<0.001),a lower albumin level(32.58±3.72vs.36.26±4.53, P<0.001) and had a lower lymphocyte count(0.85(0.58,1.21) vs.1.22(0.86,1.72), P=0.001).The ROC curve showed that the area under the curve (AUC) of BUN/ALB ratio for in-hospital death was 0.87, (95%CI: 0.81-0.93, P< 0.001), the best cut-point value to discriminate survivors from nonsurvivors in hospital was 0.249, the sensitivity was 78.3%, the specificity was 86.5%, and the youden’s index was 0.648.Having an BUN/ALB ratio ≥0.249 was an independent risk factor for both in-hospital and 90-day all-cause mortality after adjustment for relative risk(RR)(RR=15.08,95% CI:3.80-59.78, P< 0.001 for the multivariate logistic regression analysis) and hazard ratio (HR)(HR=5.34,95% CI:1.62-17.57, P=0.006 for the multivariate cox regression analysis).Conclusion: An elevated BUN/ALB ratio level was a strong and independent predictor of in-hospital and 90-day all-cause mortality in AECOPD patients.

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Establishment of risk prediction model and risk score for in‐hospital mortality in patients with AECOPD

Cited by 12 publications

References 26 publications

Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

Development and validation of a prognostic nomogram among patients with acute exacerbation of chronic obstructive pulmonary disease in intensive care unit

The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease

Blood Urea Nitrogen to Serum Albumin Ratio: A Good Predictor of in-Hospital and 90-Day All-Cause Mortality in AECOPD Patients

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