Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care.

Zhihong Feng,Ping Liu,Zhiming Luo,Sipeng Chen,Bing Wei,Xiuhong Nie,Han Xiao,Tao Wang,Ning Xia

doi:10.1155/2017/3063510

Abstract

We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age (P < 0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II (P = 1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

Highlights

Identification of patients at high risk for severe disease or death enables clinicians to promptly initiate aggressive treatment and thereby save lives
Acute Physiology and Chronic Health Evaluation (APACHE) II is designed for intensive care unit (ICU) patients and is mostly used for prognostic evaluation of such patients, it is increasingly being used for emergency department patients and has been proven to yield excellent results for clinical prediction of sepsis in these patients [1,2,3,4]
A systematic and scientific approach for patient examination is essential in order to ensure timely and appropriate treatment for critically ill patients with atypical clinical manifestations

Summary

Introduction

Identification of patients at high risk for severe disease or death enables clinicians to promptly initiate aggressive treatment and thereby save lives. APACHE II is designed for intensive care unit (ICU) patients and is mostly used for prognostic evaluation of such patients, it is increasingly being used for emergency department patients and has been proven to yield excellent results for clinical prediction of sepsis in these patients [1,2,3,4]. Dynamic trends of the APACHE II score reflect disease evolution, enable timely clinical interventions, and guide amendments in healthcare plans This system is very complex and has not been proven to correctly reflect the severity of Canadian Respiratory Journal disease in different affected organs in the case of multiorgan disease. Recent reports show that the SAPS II system can be used to evaluate the condition of critically ill patients and predict mortality

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