Application of three kinds of scoring system for prognostic evaluation of patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Objective To compare the prognostic efficacy of CRB-65 (Confusion, Uremia, Respiratory, BP, Age 65 Years) , BAP-65 (BUN, Altered Mental Status, Pulse, and Age 65 years) and DECAF (Extended MRC Dyspnea Score, Eosinopenia, Consolidation, Acidaemia, and Atrial Fibrillation) scoring systems in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . Methods Clinical data, CRB-65, BAP-65 and DECAF scoring rubrics of 181 AECOPD patients hospitalized in the Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively collected. According to the outcomes, the patients were divided into stable disease group (patients discharged, n=121) and critically ill group (patients transferred to ICU or died, n=60) . The clinical data and scores were compared between the two groups. The sensitivity, specificity and accuracy of CRB-65, BAP-65 and DECAF scoring systems in predicting the prognosis of the patients was calculated with the death and admission into ICU as the observation endpoints. The receiver operating characteristic curves (ROC) of the three scoring systems were drawn, and the area under the curve (AUC) was calculated to identify the best cut-off point in predicting the prognosis. Results The acute exacerbation frequency, CRB-65 score, DECAF score, and BAP-65 score in the past year in the critically ill group were higher than those in the stable disease group (t=-4.899, -31.748, -34.611, 7.227; P<0.001) . The best cutoff points of CRB-65 score, BAP-65 score and DECAF score for predicting the patients' outcome were ≥3, ≥Ⅲ, ≥3 (sensitivity=70.00%, 81.67%, 90.00%; specificity=61.16%, 77.69%, 83.47%; accuracy=64.09%, 79.00%, 85.63%) . The AUC of DECAF score, BAP-65 score and CRB-65 score for predicting the prognosis of AECOPD patients was 0.811 (95%CI: 0.845-0.948) , 0.774 (95%CI: 0.707-0.869) , and 0.669 (95%CI: 0.595-0.779) , and the AUC of DECAF score for predicting the prognosis of AECOPD patients was higher than those of BAP-65 score and CRB-65 score (Z=3.891, 4.799; P=0.026, 0.005) . Conclusions CRB-65, BAP-65 and DECAF scores are of certain clinical value in predicting the prognosis of AECOPD patients. Among them, DECAF has the highest predictive efficacy, while CRB-65 is faster and more convenient. Key words: Pulmonary disease, chronic obstructive; Acute exacerbation; Clinical score; Prognostic efficacy; Prognosis