Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models
Por:
García-Rivero JL, Esquinas C, Barrecheguren M, Bonnin-Vilaplana M, García-Sidro P, Herrejón A, Martinez-Rivera C, Malo de Molina R, Marcos PJ, Mayoralas S, Naval E, Ros JA, Valle M and Miravitlles M
Publicada:
1 ene 2017
Ahead of Print:
16 dic 2016
Resumen:
The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD). We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1 < 45%, Charlson >= 3, hemoglobin (Hb)< 13 g/L, PCO2 >= 46 mmHg, fibrinogen >= 554 g/L, C-reactive protein (CRP) >= 45 mg/L, leukocyte count < 9810 x 10(9)/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT >= 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95% CI 1.09-6.36), CRP >= 45 mg/L (OR = 2.91, 95% CI: 1.11-7.49) and LTOT (3.07, 95% CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT >= 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.
Filiaciones:
García-Rivero JL:
a Hospital Comarcal de Laredo , Laredo , Spain
Esquinas C:
b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
Barrecheguren M:
b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
Bonnin-Vilaplana M:
c Fundació Salut Empordà , Figueres , Spain
:
d Hospital Universitario de La Plana , Vila-real , Spain
:
e Hospital Dr. Pesset , Valencia , Spain
Martinez-Rivera C:
f Hospital Germans Trias i Pujol , Barcelona , Spain
Malo de Molina R:
g Hospital Puerta del Hierro , Majadahonda , Spain
Marcos PJ:
h Complejo Hospitalario Universitario A Coruña , A Coruña , Spain
Mayoralas S:
i Hospital Ramón y Cajal , Madrid , Spain
:
j Hospital de La Ribera , Alzira , Spain
Ros JA:
k Hospital Virgen de Arrixaca , Murcia , Spain
Valle M:
g Hospital Puerta del Hierro , Majadahonda , Spain
Miravitlles M:
b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
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