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Usefulness of different prognostic scores for AECOPD: APACHE II, BAP65, 2008, and CAPS scores

Egyptian Journal of Bronchology volume 13, pages 498–504 (2019)Cite this article

Abstract

Purpose

The purpose of this study was to compare four different scores [Acute Physiology and Chronic Health Evaluation (APACHE II); elevated blood urea nitrogen, altered mental status, pulse >109/min, age >65 years (BAP65); chronic obstructive pulmonary disease (COPD) and Asthma Physiology Score (CAPS); and 2008 score) to test their predictive properties for the need of mechanical ventilation (MV) and short-term mortality in patients with acute exacerbation COPD (AECOPD).

Patients and methods

This study enrolled 100 consecutive patients with acute exacerbation COPD, over a 6-month duration, admitted to the Emergency Department in Alexandria Main University Hospitals. The four scores were calculated for each patient, and clinical data and outcome (need for MV and mortality during hospitalization or within a week after discharge) were recorded.

Results

Their mean age was 61.1±10.7 years, and 88% were males. Duration of hospital stay was less than or equal to 20 days in 67%. Mortality rate was 4%. Overall, 40% required MV. Blood urea nitrogen, pulse, CO2, pH, altered consciousness, and white blood cell were significant predictors of mortality in univariate but not multivariate analysis. Previous MV, cyanosis, and paradoxical abdominal movement were significant predictors of need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality prediction [area under the curve (AUC), 0.982; P=0.001] or need for MV (AUC, 0.959; P<0.001), followed by BAP65 score for mortality prediction (AUC, 0.967; P=0.002) and 2008 score for predicting the need for MV (AUC, 0.851; P<0.001).

Conclusion

All studied scores correlated significantly with mortality, but only APACHE II and 2008 score correlated significantly with the need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality or need for MV prediction. Previous need for MV was the most important predictor for the need for MV. The routine use of these practical scores in triage of patients may direct early interventions to reduce mortality rate.

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Author information

Authors and Affiliations

  1. Department of Chest Diseases, Alexandria Main University Hospital, Alexandria, Egypt

    Rania A. Sweed (MD) & Mostafa Abd El Mageed Shaheen

  2. Department of Emergency Medicine, Alexandria Main University Hospital, Alexandria, Egypt

    Esraa A. El Gendy

Authors
  1. Rania A. Sweed
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  2. Mostafa Abd El Mageed Shaheen
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Correspondence to Rania A. Sweed.

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Sweed, R.A., Shaheen, M.A.E.M. & El Gendy, E.A. Usefulness of different prognostic scores for AECOPD: APACHE II, BAP65, 2008, and CAPS scores. Egypt J Bronchol 13, 498–504 (2019). https://doi.org/10.4103/ejb.ejb_20_19

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  • DOI: https://doi.org/10.4103/ejb.ejb_20_19

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