Evaluation of PEARL score in assessingprognosis among patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Context Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a very common disease, and 20% of the patients with COPD keep getting admitted with exacerbation and 33% patients are readmitted within 90 days. Early identification of these patients allows improved prognosis and reduced deaths. So PEARL score is used as a prognostic tool to identify poor prognostic patients. Aims To assess the reliability of PEARL score as compared with ADO and BODEX indices for prognosis and prediction of 90-day readmission or death after hospitalization for AECOPD. Settings and design A hospital-based prospective observational study was conducted at the Department of Respiratory Medicine in a tertiary care center of Rajasthan. Patients and methods This prospective observational study was conducted in 100 patients with AECOPD, and PEARL score calculated in all patients. Statistical analysis Data collected were entered into an excel spreadsheet, and quantitative data were expressed as number and percentage. Results Our study showed that the mean age of male was 64.02±8.487 years (range, 42–81 years) and female was 58.88±9.401 years (range, 43–81 years). The comparison of the means was statistically significant (P=0.0312). Of 100 patients, 51 patients were not admitted, 29 patients were readmitted, and 20 patients died. The mean value of ADO index was 5.294±1.221, 6.480±0.8710, and 7.150±0.9881; the mean value of BODEX index was 6.294±1.238, 7.759±0.9876, and 8.300±0.6569; and the mean value of PEARL score was 1.569±0.7281, 4.034±1.592, and 5.850±1.461 in not admitted, readmitted, and dead patients, respectively. The area under the curve cure was 0.6250 in PEARL score as compared with 0.5000 in ADO and 0.500 in BODEX index. Conclusion PEARL score was found to be superior to ADO and BODEX indices for prognosis of patients with AECOPD. Hence, PEARL score can be used as a tool to guide readmission-avoidance strategies without invasive parameters.