Predictors of outcomes in COPD exacerbations presenting to the emergency department

¹ Respiratory and intensive care medicine, Hôtel-Dieu, Paris Descartes University.
² INSERM U700, Paris 7 University, Paris.
³ Intensive care medicine, Bretonneau Hospital, Tours University

^* To whom correspondence should be addressed. E-mail: nicolas.roche{at}htd.aphp.fr.

	Abstract

This prospective multi-centre study aimed at developing a simple rule to predict poor outcome in patients presenting to emergency departments (EDs) with initially non life-threatening COPD exacerbations (AECOPD) in a "real life" setting.

All AECOPD visiting EDs of 103 hospitals during a 3-month period were included, except those who immediately required ICU admission and/or ventilatory support. Collected data included patients characteristics, in-hospital outcomes (mortality, length of stay) and mode of discharge (unsupported or need for post-hospital assistance). In-hospital mortality rate was 7.4% (n=59/794). Independent prognostic factors were age, number of clinical signs of severity (among cyanosis, impaired neurological status, lower limb oedema, asterixis, use of accessory inspiratory or expiratory muscles) and dyspnoea grade at stable state. Need for post-hospital support was also predicted by female gender. To build and validate a prediction score of mortality based on these items, patients were randomly allocated to a derivation and a validation cohort. The prediction score showed good discrimination, with c statistics of 0.79 in the derivation cohort and 0.83 in the validation cohort.

Thus, simple purely clinical factors can reliably predict the risk of death and need for post-hospital support in initially non life-threatening AECOPD. Their use needs to be prospectively validated.

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