Prediction Model of In-Hospital Death for Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients Admitted to Intensive Care Unit: The PD-ICU Score.

IF 3.5 3区医学 Q2 RESPIRATORY SYSTEM

Respiration Pub Date : 2024-09-11 DOI:10.1159/000541367

Xiaoqian Li, Qun Yi, Yuanming Luo, Hailong Wei, Huiqing Ge, Huiguo Liu, Jianchu Zhang, Xianhua Li, Xiufang Xie, Pinhua Pan, Hui Zhou, Liang Liu, Chen Zhou, Jiarui Zhang, Lige Peng, Jiaqi Pu, Jianlin Yuan, Xueqing Chen, Yongjiang Tang, Haixia Zhou

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引用次数: 0

Abstract

Introduction: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care unit (ICU) are exposed to poor clinical outcomes, and no specific prognostic models are available among this population. We aimed to develop and validate a risk score for prognosis prediction for these patients.

Methods: This was a multicenter observation study. AECOPD patients admitted to ICU were included for model derivation from a prospective, multicenter cohort study. Logistic regression analysis was applied to identify independent predictors for in-hospital death and establish the prognostic risk score. The risk score was further validated and compared with DECAF, BAP-65, CURB-65, and APACHE II score in another multicenter cohort.

Results: Five variables were identified as independent predictors for in-hospital death in APCOPD patients admitted to ICU, and a corresponding risk score (PD-ICU score) was established, which was composed of procalcitonin >0.5 μg/L, diastolic blood pressure <60 mm Hg, need for invasive mechanical ventilation, disturbance of consciousness, and blood urea nitrogen >7.2 mmol/L. Patients were classified into three risk categories according to the PD-ICU score. The in-hospital mortality of low-risk, intermediate-risk, and high-risk patients was 0.3%, 7.3%, and 27.9%, respectively. PD-ICU score displayed excellent discrimination ability with an area under the receiver-operating characteristic curve (AUC) of 0.815 in the derivation cohort and 0.754 in the validation cohort which outperformed other prognostic models.

Conclusion: We derived and validated a simple and clinician-friendly prediction model (PD-ICU score) for in-hospital mortality among AECOPD patients admitted to ICU. With good performance and clinical practicability, this model may facilitate early risk stratification and optimal decision-making among these patients.

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入住重症监护室的 AECOPD 患者院内死亡预测模型：PD-ICU 评分。

简介入住重症监护室（ICU）的慢性阻塞性肺疾病急性加重期（AECOPD）患者的临床预后较差，目前尚无针对此类患者的特定预后模型。我们旨在为这些患者开发并验证一种预后预测风险评分：这是一项多中心观察研究。一项前瞻性多中心队列研究纳入了入住重症监护室的 AECOPD 患者，用于推导模型。应用逻辑回归分析确定院内死亡的独立预测因素，并建立预后风险评分。在另一项多中心队列研究中，该风险评分与 DECAF、BAP-65、CURB-65 和 APACHE Ⅱ 评分进行了进一步验证和比较：结果：在入住重症监护室的 APCOPD 患者中，有五个变量被确定为院内死亡的独立预测因子，并建立了相应的风险评分（PD-ICU 评分），其中包括降钙素原>0.5ug/L、舒张压<60mmHg、需要有创机械通气、意识障碍和血尿素氮>7.2mmol/L。根据 PD-ICU 评分，患者被分为三个风险类别。低危、中危和高危患者的院内死亡率分别为 0.3%、7.3% 和 27.9%。PD-ICU 评分显示出卓越的判别能力，在推导队列中的接收者操作特征曲线下面积（AUC）为 0.815，在验证队列中的接收者操作特征曲线下面积（AUC）为 0.754，优于其他预后模型：我们推导并验证了一个简单且便于临床医生使用的预测模型（PD-ICU 评分），用于预测入住 ICU 的 AECOPD 患者的院内死亡率。该模型具有良好的性能和临床实用性，有助于对这些患者进行早期风险分层和优化决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiration 医学-呼吸系统

CiteScore

7.30

自引率

5.40%

发文量

审稿时长

4-8 weeks

期刊介绍： ''Respiration'' brings together the results of both clinical and experimental investigations on all aspects of the respiratory system in health and disease. Clinical improvements in the diagnosis and treatment of chest and lung diseases are covered, as are the latest findings in physiology, biochemistry, pathology, immunology and pharmacology. The journal includes classic features such as editorials that accompany original articles in clinical and basic science research, reviews and letters to the editor. Further sections are: Technical Notes, The Eye Catcher, What’s Your Diagnosis?, The Opinion Corner, New Drugs in Respiratory Medicine, New Insights from Clinical Practice and Guidelines. ''Respiration'' is the official journal of the Swiss Society for Pneumology (SGP) and also home to the European Association for Bronchology and Interventional Pulmonology (EABIP), which occupies a dedicated section on Interventional Pulmonology in the journal. This modern mix of different features and a stringent peer-review process by a dedicated editorial board make ''Respiration'' a complete guide to progress in thoracic medicine.