Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

Abstract

BACKGROUND: Hospital admissions for COPD exacerbations account for 70% of total costs of COPD treatment, and the duration of hospital stay is directly related to this cost. The aim of this study was to investigate possible associations of demographic, clinical, laboratory, and functional parameters with stay of subjects admitted for COPD exacerbations and to provide a score for the prediction of the need for prolonged hospitalization. METHODS: We included 164 consecutive subjects admitted to 2 respiratory medicine departments of 2 tertiary hospitals for a COPD exacerbation, and we evaluated laboratory, clinical, and functional parameters possibly related to the duration of hospital stay. RESULTS: Seven parameters evaluated on subject admission (Antonisen type of exacerbation, number of Exacerbations in the previous year, Charlson index of comorbidities, Oxygenation, Partial pressure of P aCO 2 in arterial blood gases, Dyspnea according to the Borg dyspnea scale, and history of chronic respiratory Failure) were able to predict stay and were included in a simple score named AECOPD-F. The area under the curve of the score for the prediction of prolonged hospital stay is 0.960, and a cutoff point > 3 predicts prolonged stay with a sensitivity of 84.5% and a specificity of 92.5% (95% CI 0.917-0.984). The AECOPD-F score was validated in a second group of 88 subjects admitted to the hospital for a COPD exacerbation. In the validation group, subjects with a score > 3 required prolonged stay compared with those with a score < 3 (8.0 [6.0 -10.0] vs 6.5 [4.0 -9.0] d, respectively, P ‫؍‬ .007). CONCLUSION: The AECOPD-F score could accurately predict stay in hospitalized COPD subjects. The implementation of this score in clinical practice could be useful in the discharge planning of such subjects.

Clinical variables predicting the risk of a hospital stay for longer than 7 days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study

“…As outlined, we used the threshold of 7 days in line with the time when complications typically develop in an AECOPD [12]. Overall, the baseline characteristics of our AECOPD cohort were comparable to those of other studies [6, 7, 20], but we also considered variables not previously reported in this field. These included the symptom duration before admission and the use of antibiotics and the received therapy in both the short- and the long-term before hospitalisation.…”

Utilization due to chronic obstructive pulmonary disease and its predictors: a study using the U.S. National Emergency Department Sample (NEDS)

“…As noted above, our study findings of the association of various socio-demographic, comorbidity and hospital characteristics with COPD-hospitalization add to the current knowledge. Factors such as long term oxygen therapy, low health status, poor health related quality of life and inadequate physical activity [ 22 ] and body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index [ 46 ] are associated with COPD hospitalization, and can predict hospital length of stay in and mortality in patients with COPD [ 47 – 50 ]. Our study identified additional risk factors for COPD hospitalization.…”

Impact of Hyponatremia on COPD Exacerbation Prognosis

“…Patients with hypernatremia, defined as serum sodium levels above 145 [21], were excluded from the analysis to avoid confounding factors between high serum sodium and poor progress. Patients with prolonged stay were identified as those with a stay equal to or greater than the median stay of the study population (in our case, 7 days) [22]. Causes of death were classified into 4 groups according to origin: (1) respiratory; (2) cardiovascular (IHD, CHF, and pulmonary embolism); (3) cancer; (4) other causes (septic shock, bronchial aspiration, unknown origin, .…”