Tabak et al reported a risk-adjustment model for mortality in patients hospitalized for an acute exacerbation of COPD. This can help to identify a patient who may require more aggressive management. The authors are from CareFusion (San Diego), Harvard Medical School, Brigham and Women's Hospital, Washington Hospital Center, Baystate Medical Center and Tufts University.
Patient selection: hospitalized with an acute exacerbation for COPD
Outcome: in-hospital mortality
Parameters:
(1) age in years
(2) serum BUN in mg/dL
(3) arterial pH
(4) serum albumin in g/dL
(5) white blood cell count per microliter
(6) arterial pCO2 in mm Hg
(7) serum troponin I in ng/mL
(8) serum CK in U/L
(9) arterial PO2 in mm Hg
(10) serum sodium in mmol/L
(11) hemoglobin in g/dL
(12) INR
(13) percent bands
(14) platelet count per microliter
(15) heart rate in beats per minute
(16) oral temperature in °F
(17) respiratory rate in breaths per minute
(18) systolic blood pressure in mm Hg
(19) mental status
(20) congestive heart failure
(21) disease of the pulmonary circulation
(22) weight loss
(23) cancer
|
Parameter |
Finding |
Points |
|
age in years |
< 55 years |
0 |
|
|
55 to 64 years |
4 |
|
|
65 to 74 years |
7 |
|
|
75 to 84 years |
10 |
|
|
>= 85 years |
11 |
|
serum BUN |
<= 25 mg/dL |
0 |
|
|
26 to 30 mg/dL |
3 |
|
|
31 to 40 mg/dL |
4 |
|
|
> 40 mg/dL |
7 |
|
arterial pH |
> 7.30 |
0 |
|
|
<= 7.30 |
4 |
|
serum albumin |
> 3 g/dL |
0 |
|
|
2.5 to 3.0 g/dL |
2 |
|
|
< 2.5 g/dL |
5 |
|
WBC count |
< 10,900 per µL |
0 |
|
|
10,900 to 14,100 |
1 |
|
|
14,200 to 19,800 |
2 |
|
|
> 19,800 per µL |
4 |
|
arterial pCO2 |
<= 30 mm Hg |
3 |
|
|
31 to 85 mm Hg |
0 |
|
|
> 85 mm Hg |
3 |
|
serum troponin I |
<= 0.7 ng/mL |
0 |
|
|
> 0.7 ng/mL |
3 |
|
serum CK |
<= 35 U/L |
2 |
|
|
36 to 500 U/L |
0 |
|
|
> 500 U/L |
2 |
|
pO2 |
<= 50 mm Hg |
2 |
|
|
51 to 140 mm Hg |
0 |
|
|
> 140 mm Hg |
2 |
|
serum sodium |
<= 135 mmol/L |
1 |
|
|
136 to 145 mmol/L |
0 |
|
|
> 145 mmol/L |
1 |
|
hemoglobin |
<= 11 g/dL |
2 |
|
|
11.1 to 18 g/dL |
0 |
|
|
> 18 g/dL |
2 |
|
INR |
<= 1.2 |
0 |
|
|
> 1.2 |
1 |
|
percent bands |
<= 32% |
0 |
|
|
> 32% |
3 |
|
platelet count |
> 115,000 per µL |
0 |
|
|
<= 115,000 per µL |
3 |
|
heart rate |
<= 49 beats per minute |
7 |
|
|
50 to 99 bpm |
0 |
|
|
100 to 119 bpm |
3 |
|
|
120 to 129 bpm |
4 |
|
|
> 129 beats per minute |
7 |
|
oral temperature |
> 95°F |
0 |
|
|
<= 95°F |
3 |
|
respiratory rate |
< 30 bpm |
0 |
|
|
30 to 39 bpm |
2 |
|
|
>= 40 bpm |
3 |
|
systolic blood pressure |
> 99 mm Hg |
0 |
|
|
<= 99 mm Hg |
3 |
|
mental status |
normal |
0 |
|
|
altered mild to moderate |
4 |
|
|
altered severe |
9 |
|
CHF |
absent |
0 |
|
|
present |
3 |
|
pulmonary circulation disorder |
absent |
0 |
|
|
present |
6 |
|
weight loss |
absent |
0 |
|
|
present |
6 |
|
malignancy |
none |
0 |
|
|
hematologic |
4 |
|
|
solid nonmetastatic |
4 |
|
|
solid metastatic |
8 |
where:
• The cutoff for serum troponin may need to be adjusted for the method used.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 99 (maximum in study populations 69)
• The higher the scores the greater the mortality.
|
Score |
Mortality |
|
0 to 13 |
< 1% |
|
14 or 15 |
1% |
|
16 or 17 |
1.8% |
|
18 or 19 |
2.1% |
|
20 or 21 |
3.1% |
|
22 to 24 |
5% |
|
25 to 28 |
7% |
|
29 to 32 |
12% |
|
33 to 41 |
18% |
|
>= 42 |
35% |
estimated from Figure 2
Performance:
• The area under the ROC curve is 0.83.
Specialty: Pulmonology
