Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Yu ¹ , ZHANG Jiarui ¹ , LUO Yuanming ² , WEI Hailong ³ , GE Huiqing ⁴ , LIU Huiguo ⁵ , ZHANG Jianchu ⁶ , PAN Pinhua ⁷ , LI Xianhua ⁸ , ZHOU Hui ⁹ , XIE Xiufang ⁸ , CHENG Li'na ¹⁰ , YI Mengqiu ¹⁰ , ZHOU Chen ¹¹ , Adila ·Aili ¹ , PENG Lige ¹ , PU Jiaqi ¹ , LIU Liang ⁹ , ZHANG Xiaohong ¹² , FENG Haipan ¹² ,  ZHOU Haixia ¹ ,  YI Qun ¹³

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong 510120, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Leshan People's Hospital of Sichuan Province, Leshan, Sichuan 614000, P. R. China;
4. Department of Respiratory and Critical Care Medicine, Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P. R. China;
5. Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
6. Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
7. Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410000, P. R. China;
8. Department of Respiratory and Critical Care Medicine, Neijiang First People's Hospital, Neijiang, Sichuan 641000, P. R. China;
9. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan 610081, P. R. China;
10. Department of Emergency, Jiujiang First People's Hospital, Jiujiang, Jiangxi 332000, P. R. China;
11. West China Medical College of Sichuan University, Chengdu, Sichuan 610041, P. R. China;
12. Department of Respiratory and Critical Care Medicine, Chengdu Sixth People's Hospital, Chengdu, Sichuan 610051, P. R. China;
13. Sichuan Cancer Hospital, Chengdu, Sichuan 610042, P. R. China;

Corresponding author：

ZHOU Haixia, Email: zhouhaixia925@163.com; YI Qun, Email: yiqun925@126.com

Keywords：

Acute exacerbation of chronic obstructive pulmonary; community-acquired pneumonia; BAP-65 score; DECAF score; CURB-65 score; pneumonia severity index

DOI：

10.7507/1671-6205.202301013

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Objective To compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). Methods This study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. Results A total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. Conclusions AECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.

Citation： LIU Yu, ZHANG Jiarui, LUO Yuanming, WEI Hailong, GE Huiqing, LIU Huiguo, ZHANG Jianchu, PAN Pinhua, LI Xianhua, ZHOU Hui, XIE Xiufang, CHENG Li'na, YI Mengqiu, ZHOU Chen, Adila ·Aili, PENG Lige, PU Jiaqi, LIU Liang, ZHANG Xiaohong, FENG Haipan, ZHOU Haixia, YI Qun. Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(3): 159-167. doi: 10.7507/1671-6205.202301013 Copy

1.	Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2.	Myint PK, Lowe D, Stone RA, et al. U. K. National COPD Resources and Outcomes Project 2008: patients with chronic obstructive pulmonary disease exacerbations who present with radiological pneumonia have worse outcome compared to those with non-pneumonic chronic obstructive pulmonary disease exacerbations. Respiration, 2011, 82(4): 320-327.
3.	Shin B, Kim SH, Yong SJ, et al. Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chron Respir Dis, 2019, 16: 1479972318809480.
4.	Restrepo MI, Mortensen EM, Pugh JA, et al. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J, 2006, 28(2): 346-351.
5.	陈亮, 韩秀迪, 邢西迁, 等. 合并慢性阻塞性肺疾病的社区获得性肺炎住院患者临床特征和预后因素分析. 中国呼吸与危重监护杂志, 2019, 18(5): 409-417.
6.	Lu ZW, Cheng YS, Tu XW, et al. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units. Int J Chron Obstruct Pulmon Dis, 2016, 11(1): 1867-1872.
7.	Andreassen SL, Liaaen ED, Stenfors N, et al. Impact of pneumonia on hospitalizations due to acute exacerbations of COPD. Clin Respir J, 2014, 8(1): 93-99.
8.	Niu YY, Xing YL, Li JF, et al. Effect of community-acquired pneumonia on acute exacerbation of chronic obstructive pulmonary disease. COPD, 2021, 18(4): 417-424.
9.	Gayaf M, Karadeniz G, Güldaval F, et al. Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR. Expert Rev Respir Med, 2021, 15(6): 845-851.
10.	焦桂微, 刘晓民, 任强, 等. 慢性阻塞性肺疾病合并社区获得性肺炎与慢性阻塞性肺疾病急性加重期患者的临床对比分析. 哈尔滨医科大学学报, 2021, 55(6): 593-597.
11.	Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. A systematic review and meta-analysis. Ann Am Thorac Soc, 2013, 10(2): 81-89.
12.	Holter JC, Ueland T, Jenum PA, et al. Risk factors for long-term mortality after hospitalization for community-acquired pneumonia: a 5-year prospective follow-up study. PLoS One, 2016, 11(2): e0148741.
13.	Ma HM, Tang WH, Woo J. Predictors of in-hospital mortality of older patients admitted for community-acquired pneumonia. Age Ageing, 2011, 40(6): 736-741.
14.	Sibila O, Mortensen EM, Anzueto A, et al. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia. Eur Respir J, 2014, 43(1): 36-42.
15.	Mao YX, Qian YY, Sun XY, et al. Eosinopenia predicting long-term mortality in hospitalized acute exacerbation of COPD patients with community-acquired pneumonia - a retrospective analysis. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3551-3559.
16.	Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet, 2016, 388(10056): 2142-2152.
17.	Böhm M, Ferreira JP, Mahfoud F, et al. Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial. Eur Heart J, 2020, 41(17): 1673-1683.
18.	Protogerou AD, Safar ME, Iaria P, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension, 2007, 50(1): 172-180.
19.	Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev, 2008, 88(3): 1009-1086.
20.	Hu GP, Zhou YM, Wu YK, et al. The pneumonia severity index as a predictor of in-hospital mortality in acute exacerbation of chronic obstructive pulmonary disease. PloS One, 2015, 10(7): e0133160.
21.	Huang QR, He CY, Xiong HY, et al. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open, 2020, 10(10): e037923.
22.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
23.	Tabak YP, Sun XW, Johannes RS, et al. Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: development and validation of a simple risk score. Arch Intern Med, 2009, 169(17): 1595-1602.
24.	Shiroshita A, Kimura Y, Shiba H, et al. Predicting in-hospital death in pneumonic COPD exacerbation via BAP-65, CURB-65 and machine learning. ERJ Open Res, 2022, 8(1): 00452-2021.
25.	Germini F, Veronese G, Marcucci M, et al. Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med, 2019, 61: 62-68.
26.	Shorr AF, Sun XW, Johannes RS, et al. Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: comparing the CURB-65 and BAP-65 scores. J Crit Care, 2012, 27(6): 564-570.

1. Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2. Myint PK, Lowe D, Stone RA, et al. U. K. National COPD Resources and Outcomes Project 2008: patients with chronic obstructive pulmonary disease exacerbations who present with radiological pneumonia have worse outcome compared to those with non-pneumonic chronic obstructive pulmonary disease exacerbations. Respiration, 2011, 82(4): 320-327.
3. Shin B, Kim SH, Yong SJ, et al. Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chron Respir Dis, 2019, 16: 1479972318809480.
4. Restrepo MI, Mortensen EM, Pugh JA, et al. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J, 2006, 28(2): 346-351.
5. 陈亮, 韩秀迪, 邢西迁, 等. 合并慢性阻塞性肺疾病的社区获得性肺炎住院患者临床特征和预后因素分析. 中国呼吸与危重监护杂志, 2019, 18(5): 409-417.
6. Lu ZW, Cheng YS, Tu XW, et al. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units. Int J Chron Obstruct Pulmon Dis, 2016, 11(1): 1867-1872.
7. Andreassen SL, Liaaen ED, Stenfors N, et al. Impact of pneumonia on hospitalizations due to acute exacerbations of COPD. Clin Respir J, 2014, 8(1): 93-99.
8. Niu YY, Xing YL, Li JF, et al. Effect of community-acquired pneumonia on acute exacerbation of chronic obstructive pulmonary disease. COPD, 2021, 18(4): 417-424.
9. Gayaf M, Karadeniz G, Güldaval F, et al. Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR. Expert Rev Respir Med, 2021, 15(6): 845-851.
10. 焦桂微, 刘晓民, 任强, 等. 慢性阻塞性肺疾病合并社区获得性肺炎与慢性阻塞性肺疾病急性加重期患者的临床对比分析. 哈尔滨医科大学学报, 2021, 55(6): 593-597.
11. Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. A systematic review and meta-analysis. Ann Am Thorac Soc, 2013, 10(2): 81-89.
12. Holter JC, Ueland T, Jenum PA, et al. Risk factors for long-term mortality after hospitalization for community-acquired pneumonia: a 5-year prospective follow-up study. PLoS One, 2016, 11(2): e0148741.
13. Ma HM, Tang WH, Woo J. Predictors of in-hospital mortality of older patients admitted for community-acquired pneumonia. Age Ageing, 2011, 40(6): 736-741.
14. Sibila O, Mortensen EM, Anzueto A, et al. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia. Eur Respir J, 2014, 43(1): 36-42.
15. Mao YX, Qian YY, Sun XY, et al. Eosinopenia predicting long-term mortality in hospitalized acute exacerbation of COPD patients with community-acquired pneumonia - a retrospective analysis. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3551-3559.
16. Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet, 2016, 388(10056): 2142-2152.
17. Böhm M, Ferreira JP, Mahfoud F, et al. Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial. Eur Heart J, 2020, 41(17): 1673-1683.
18. Protogerou AD, Safar ME, Iaria P, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension, 2007, 50(1): 172-180.
19. Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev, 2008, 88(3): 1009-1086.
20. Hu GP, Zhou YM, Wu YK, et al. The pneumonia severity index as a predictor of in-hospital mortality in acute exacerbation of chronic obstructive pulmonary disease. PloS One, 2015, 10(7): e0133160.
21. Huang QR, He CY, Xiong HY, et al. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open, 2020, 10(10): e037923.
22. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
23. Tabak YP, Sun XW, Johannes RS, et al. Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: development and validation of a simple risk score. Arch Intern Med, 2009, 169(17): 1595-1602.
24. Shiroshita A, Kimura Y, Shiba H, et al. Predicting in-hospital death in pneumonic COPD exacerbation via BAP-65, CURB-65 and machine learning. ERJ Open Res, 2022, 8(1): 00452-2021.
25. Germini F, Veronese G, Marcucci M, et al. Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med, 2019, 61: 62-68.
26. Shorr AF, Sun XW, Johannes RS, et al. Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: comparing the CURB-65 and BAP-65 scores. J Crit Care, 2012, 27(6): 564-570.

Chinese Journal of Respiratory and Critical Care Medicine

Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

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