Risk factors of poor outcomes after admission for a COPD exacerbations. Multivariate logistic predictive models
European Respiratory JournalÂ 2015Â 46:Â PA403;Â DOI:Â 10.1183/13993003.congress-2015.PA403
Banckground:Â The aim of the study was to identify an age-adjusted multivariate model to predict failure after admission for a COPD exacerbation.
Methods:Â Multicenter, observational and prospective study. COPD admitted patients were followed during 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-off for a new exacerbation were indentified using receiver operating characteristic (ROC) curves, Finally, a stepwise logistic regression model were performed.
Results:Â A total of 106 patients were included. Mean age 71.1 (9.8), mean FEV1(%): 45.2%. Mean CAT at admission 24.8 (7.1). At 3 months 39 (36.8%) patients presented failure: death (2.8%), readmission (20.8%) or new ambulatory exacerbation (13.2%). Variables included in logistic model were: previous hospital admission, FEV1<45%, Charlsonâ‰¥3, hemoglobin (Hb) <13 mg/dL, PCO2â‰¥46 mmHg, Fibrinogenâ‰¥554 mg/dL, CRPâ‰¥45g/L, leukocytes<9810 x109/L, presence of sputum purulence and CAT at admissionâ‰¥31. Final model showed that Hg<13 mg/dL(OR=2,86, CI95% 1,09-7,49) and CRPâ‰¥45g/L (OR=2,80, CI95%=1,05-7,46) increased the probability for failure up to 62%. After adding the presence of CAT â‰¥31 at admission, the probability increased to 84% (AUC=0.785(p=0.001))
Conclusions:Â Up to 38.8% of patients have a poor outcomes at 3 months after admission. Low Hb and high CRP are risk factors for failure. High CAT score at admission increase the predictive value of the model.