Predicting early mortality in acute exacerbation of chronic obstructive pulmonary disease using the CURB65 score

被引:58
作者
Chang, Catherina L. [1 ]
Sullivan, Glenda D. [2 ]
Karalus, Noel C. [2 ]
Mills, Graham D.
Mclachlan, John D. [2 ]
Hancox, Robert J. [2 ]
机构
[1] Waikato Hosp, Dept Resp Med, Resp Res Unit, Hamilton 3240, New Zealand
[2] Waikato Hosp, Dept Med, Hamilton 3240, New Zealand
关键词
acute exacerbation; chronic obstructive pulmonary disease; mortality; risk score; COMMUNITY-ACQUIRED PNEUMONIA; RISK-FACTORS; SEVERITY; COPD; HOSPITALIZATION; MANAGEMENT; ADMISSION; OUTCOMES; ADULTS; AUDIT;
D O I
10.1111/j.1440-1843.2010.01866.x
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background and Objective: Hospitalization for exacerbation of COPD is associated with a high risk of mortality. A risk-prediction model using information easily obtained on admission could help to identify high-risk individuals. The CURB65 score was developed to predict mortality risk in community acquired pneumonia. A retrospective study found that this score was also associated with mortality in COPD exacerbations. We conducted a prospective study to assess the utility of the CURB65 score in acute COPD exacerbations. Methods: Consecutive patients with physician diagnosed COPD exacerbations admitted to a public hospital during a 1-year period were studied prospectively. The CURB65 scores were calculated from information obtained at initial hospital presentation. CURB65 = one point each for Confusion, Urea > 7 mmol/L, Respiratory rate >= 30/min, low Blood pressure, age >= 65 years. Results: 30-day mortality data were available for 249 of 252 patients. CURB65 scores on admission significantly predicted risk of death during the hospital admission and at 30 days. The 30-day mortality by score groups were: low risk (scores 0-1) 2.0% (2/98), moderate risk (score 2) 6.7% (6/90) and high risk (scores 3-5) 21.3% (13/61). CURB65 scores were not predictive of 1-year mortality. Conclusions: A simple 6-point score based on confusion, blood urea, respiratory rate, blood pressure and age can be used to stratify patients with COPD exacerbation into different management groups. The CURB65 score was as effective in predicting early mortality in our cohort of acute COPD exacerbations as it was in previous cohorts with community acquired pneumonia. Our findings suggest that CURB65 scores can help clinicians to assess patients with exacerbation of COPD.
引用
收藏
页码:146 / 151
页数:6
相关论文
共 27 条
[1]   Mortality after hospitalization for COPD [J].
Almagro, P ;
Calbo, E ;
de Echagüen, AO ;
Barreiro, B ;
Quintana, S ;
Heredia, JL ;
Garau, J .
CHEST, 2002, 121 (05) :1441-1448
[2]   New evidence of risk factors for community-acquired pneumonia:: a population-based study [J].
Almirall, J. ;
Bolibar, I. ;
Serra-Prat, M. ;
Roig, J. ;
Hospital, I. ;
Carandell, E. ;
Agusti, M. ;
Ayuso, P. ;
Estela, A. ;
Torres, A. .
EUROPEAN RESPIRATORY JOURNAL, 2008, 31 (06) :1274-1284
[3]   Risk factors for community-acquired pneumonia in adults:: a population-based case-control study [J].
Almirall, J ;
Bolíbar, I ;
Balanzó, X ;
González, CA .
EUROPEAN RESPIRATORY JOURNAL, 1999, 13 (02) :349-355
[4]   Patients admitted to hospital with suspected pneumonia and normal chest radiographs: Epidemiology, microbiology, and outcomes [J].
Basi, SK ;
Marrie, TJ ;
Huang, JQ ;
Majumdar, SR .
AMERICAN JOURNAL OF MEDICINE, 2004, 117 (05) :305-311
[5]  
*BRIT THOR SOC, 2004, THORAX, V59, P27
[6]   Exacerbations of chronic obstructive pulmonary disease [J].
Celli, B. R. ;
Barnes, P. J. .
EUROPEAN RESPIRATORY JOURNAL, 2007, 29 (06) :1224-1238
[7]   The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease [J].
Celli, BR ;
Cote, CG ;
Marin, JM ;
Casanova, C ;
de Oca, MM ;
Mendez, RA ;
Pinto Plata, V ;
Cabral, HJ .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (10) :1005-1012
[8]   Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome [J].
Chang, C. L. ;
Sullivan, G. D. ;
Karalus, N. C. ;
Hancox, R. J. ;
McLachlan, J. D. ;
Mills, G. D. .
INTERNAL MEDICINE JOURNAL, 2007, 37 (04) :236-241
[9]   SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia [J].
Charles, Patrick G. P. ;
Wolfe, Rory ;
Whitby, Michael ;
Fine, Michael J. ;
Fuller, Andrew J. ;
Stirling, Robert ;
Wright, Alistair A. ;
Ramirez, Julio A. ;
Christiansen, Keryn J. ;
Waterer, Grant W. ;
Pierce, Robert J. ;
Armstrong, John G. ;
Korman, Tony M. ;
Holmes, Peter ;
Obrosky, D. Scott ;
Peyrani, Paula ;
Johnson, Barbara ;
Hooy, Michelle ;
Grayson, M. Lindsay .
CLINICAL INFECTIOUS DISEASES, 2008, 47 (03) :375-384
[10]   Outcomes following acute exacerbation of severe chronic obstructive lung disease [J].
Connors, AF ;
Dawson, NV ;
Thomas, C ;
Harrell, FE ;
Desbiens, N ;
Fulkerson, WJ ;
Kussin, P ;
Bellamy, P ;
Goldman, L ;
Knaus, WA .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1996, 154 (04) :959-967