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Risk factors of poor outcomes after admission for a COPD exacerbations. Multivariate logistic predictive models

Juan Luis Garcia-Rivero, Cristina Esquinas, Miriam Barrecheguren, Patricia Garcia-Sidro, Elsa Naval, Carlos Martinez, Rosa Malo de Molina, P.J. Marcos, J.M. Diez, Alberto Herrejón, J.A. Ros, Sagrario Mayoralas, Manuel Valle, Marc Miravitlles

European Respiratory Journal 2015 46: PA403; DOI: 10.1183/13993003.congress-2015.PA403


Banckground: The aim of the study was to identify an age-adjusted multivariate model to predict failure after admission for a COPD exacerbation.

Methods: 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: 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%, Charlson≥3, hemoglobin (Hb) <13 mg/dL, PCO2≥46 mmHg, Fibrinogen≥554 mg/dL, CRP≥45g/L, leukocytes<9810 x109/L, presence of sputum purulence and CAT at admission≥31. Final model showed that Hg<13 mg/dL(OR=2,86, CI95% 1,09-7,49) and CRP≥45g/L (OR=2,80, CI95%=1,05-7,46) increased the probability for failure up to 62%. After adding the presence of CAT ≥31 at admission, the probability increased to 84% (AUC=0.785(p=0.001))

Conclusions: 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.

sumber : https://erj.ersjournals.com/content/46/suppl_59/PA403


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