A clinical in-hospital prognostic score for acute exacerbations of COPD
Identifieur interne : 000359 ( Main/Exploration ); précédent : 000358; suivant : 000360A clinical in-hospital prognostic score for acute exacerbations of COPD
Auteurs : Nicolas Roche [France] ; Jean-Michel Chavaillon [France] ; Cyril Maurer [France] ; Mahmoud Zureik [France] ; Jacques Piquet [France]Source :
- Respiratory Research [ 1465-9921 ] ; 2014.
Abstract
The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD (AECOPD). We previously developed a score (‘2008 score’, based on age, dyspnea grade at steady state and number of clinical signs of severity) predicting in-hospital mortality in patients with AECOPD visiting emergency departments (EDs). External validity of this score remained to be assessed.
To test the predictive properties of the ‘2008 score’ in a population of patients hospitalized in medical respiratory wards for AECOPD, and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance.
Data from a cohort study in 1824 patients hospitalized in a medical ward for an AECOPD were analyzed. Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed. A new score was developed using multivariate logistic regression modeling in a randomly selected derivation population sample followed by testing in the remaining population (validation sample). Robustness of results was assessed by case-by-case validation.
The 2008 score was characterized by a c-statistic at 0.77, a sensitivity of 69% and a specificity of 76% for prediction of in-hospital mortality. The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78, a sensitivity of 77% and specificity of 66%.
A score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AECOPD. Adding cardiac comorbidities to the original score increased its sensitivity while decreasing its specificity.
The online version of this article (doi:10.1186/s12931-014-0099-9) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12931-014-0099-9
PubMed: 25158759
PubMed Central: 4244057
Affiliations:
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wicri:level="3"><nlm:aff id="Aff2">Respiratory medicine and intensive care department, Antibes General Hospital, 06606 Antibes-Juan les Pins, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory medicine and intensive care department, Antibes General Hospital, 06606 Antibes-Juan les Pins</wicri:regionArea><placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region><settlement type="city">Antibes-Juan les Pins</settlement></placeName></affiliation></author><author><name sortKey="Maurer, Cyril" sort="Maurer, Cyril" uniqKey="Maurer C" first="Cyril" last="Maurer">Cyril Maurer</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil</wicri:regionArea><placeName><region type="region" 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department, Le Raincy-Montfermeil hospital, 93370 Montfermeil</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Montfermeil</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25158759</idno><idno type="pmc">4244057</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244057</idno><idno type="RBID">PMC:4244057</idno><idno type="doi">10.1186/s12931-014-0099-9</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000043</idno><idno type="wicri:Area/Pmc/Curation">000041</idno><idno type="wicri:Area/Pmc/Checkpoint">000057</idno><idno type="wicri:Area/Ncbi/Merge">000428</idno><idno type="wicri:Area/Ncbi/Curation">000428</idno><idno type="wicri:Area/Ncbi/Checkpoint">000428</idno><idno type="wicri:doubleKey">1465-9921:2014:Roche N:a:clinical:in</idno><idno type="wicri:Area/Main/Merge">000357</idno><idno type="wicri:Area/Main/Curation">000359</idno><idno type="wicri:Area/Main/Exploration">000359</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A clinical in-hospital prognostic score for acute exacerbations of COPD</title><author><name sortKey="Roche, Nicolas" sort="Roche, Nicolas" uniqKey="Roche N" first="Nicolas" last="Roche">Nicolas Roche</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Respiratory and Intensive Care Medicine department, Cochin Hospital Group, APHP, University Paris Descartes (EA2511), 75005 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory and Intensive Care Medicine department, Cochin Hospital Group, APHP, University Paris Descartes (EA2511), 75005 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Chavaillon, Jean Michel" sort="Chavaillon, Jean Michel" uniqKey="Chavaillon J" first="Jean-Michel" last="Chavaillon">Jean-Michel Chavaillon</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Respiratory medicine and intensive care department, Antibes General Hospital, 06606 Antibes-Juan les Pins, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory medicine and intensive care department, Antibes General Hospital, 06606 Antibes-Juan les Pins</wicri:regionArea><placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region><settlement type="city">Antibes-Juan les Pins</settlement></placeName></affiliation></author><author><name sortKey="Maurer, Cyril" sort="Maurer, Cyril" uniqKey="Maurer C" first="Cyril" last="Maurer">Cyril Maurer</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Montfermeil</settlement></placeName></affiliation></author><author><name sortKey="Zureik, Mahmoud" sort="Zureik, Mahmoud" uniqKey="Zureik M" first="Mahmoud" last="Zureik">Mahmoud Zureik</name><affiliation wicri:level="3"><nlm:aff id="Aff4">INSERM Unit 700, Xavier Bichat University, 75018 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM Unit 700, Xavier Bichat University, 75018 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Piquet, Jacques" sort="Piquet, Jacques" uniqKey="Piquet J" first="Jacques" last="Piquet">Jacques Piquet</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Respiratory medicine department, Le Raincy-Montfermeil hospital, 93370 Montfermeil</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Montfermeil</settlement></placeName></affiliation></author></analytic><series><title level="j">Respiratory Research</title><idno type="ISSN">1465-9921</idno><idno type="eISSN">1465-993X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD (AECOPD). We previously developed a score (‘2008 score’, based on age, dyspnea grade at steady state and number of clinical signs of severity) predicting in-hospital mortality in patients with AECOPD visiting emergency departments (EDs). External validity of this score remained to be assessed.</p></sec><sec><title>Objectives</title><p>To test the predictive properties of the ‘2008 score’ in a population of patients hospitalized in medical respiratory wards for AECOPD, and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance.</p></sec><sec><title>Methods</title><p>Data from a cohort study in 1824 patients hospitalized in a medical ward for an AECOPD were analyzed. Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed. A new score was developed using multivariate logistic regression modeling in a randomly selected derivation population sample followed by testing in the remaining population (validation sample). Robustness of results was assessed by case-by-case validation.</p></sec><sec><title>Results</title><p>The 2008 score was characterized by a c-statistic at 0.77, a sensitivity of 69% and a specificity of 76% for prediction of in-hospital mortality. The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78, a sensitivity of 77% and specificity of 66%.</p></sec><sec><title>Conclusions</title><p>A score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AECOPD. Adding cardiac comorbidities to the original score increased its sensitivity while decreasing its specificity.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12931-014-0099-9) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wedzicha, Ja" uniqKey="Wedzicha J">JA Wedzicha</name></author><author><name sortKey="Seemungal, Tar" uniqKey="Seemungal T">TAR Seemungal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jeppesen, E" uniqKey="Jeppesen E">E Jeppesen</name></author><author><name sortKey="Brurberg, Kg" uniqKey="Brurberg K">KG Brurberg</name></author><author><name sortKey="Vist, Ge" uniqKey="Vist G">GE Vist</name></author><author><name sortKey="Wedzicha, Ja" uniqKey="Wedzicha J">JA Wedzicha</name></author><author><name sortKey="Wright, Jj" uniqKey="Wright 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sortKey="Carter, R" uniqKey="Carter R">R Carter</name></author><author><name sortKey="Dunn, Fg" uniqKey="Dunn F">FG Dunn</name></author><author><name sortKey="Mcmurray, Jjv" uniqKey="Mcmurray J">JJV McMurray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zureik, M" uniqKey="Zureik M">M Zureik</name></author><author><name sortKey="Benetos, A" uniqKey="Benetos A">A Benetos</name></author><author><name sortKey="Neukirch, C" uniqKey="Neukirch C">C Neukirch</name></author><author><name sortKey="Courbon, D" uniqKey="Courbon D">D Courbon</name></author><author><name sortKey="Bean, K" uniqKey="Bean K">K Bean</name></author><author><name sortKey="Thomas, F" uniqKey="Thomas F">F Thomas</name></author><author><name sortKey="Ducimetiere, P" uniqKey="Ducimetiere P">P Ducimetiere</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sin, Dd" uniqKey="Sin D">DD Sin</name></author><author><name sortKey="Wu, L" uniqKey="Wu L">L Wu</name></author><author><name sortKey="Man, Sf" uniqKey="Man S">SF Man</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcallister, Da" uniqKey="Mcallister D">DA McAllister</name></author><author><name sortKey="Maclay, Jd" uniqKey="Maclay J">JD Maclay</name></author><author><name sortKey="Mills, Nl" uniqKey="Mills N">NL Mills</name></author><author><name sortKey="Leitch, A" uniqKey="Leitch A">A Leitch</name></author><author><name sortKey="Reid, P" uniqKey="Reid P">P Reid</name></author><author><name sortKey="Carruthers, R" uniqKey="Carruthers R">R Carruthers</name></author><author><name sortKey="O Onnor, J" uniqKey="O Onnor J">J O’Connor</name></author><author><name sortKey="Mcalpine, L" uniqKey="Mcalpine L">L McAlpine</name></author><author><name sortKey="Chalmers, G" uniqKey="Chalmers G">G Chalmers</name></author><author><name sortKey="Newby, De" uniqKey="Newby D">DE Newby</name></author><author><name sortKey="Clark, E" uniqKey="Clark E">E Clark</name></author><author><name sortKey="Macfarlane, Pw" uniqKey="Macfarlane P">PW Macfarlane</name></author><author><name sortKey="Macnee, W" uniqKey="Macnee W">W Macnee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Donaldson, Gc" uniqKey="Donaldson G">GC Donaldson</name></author><author><name sortKey="Hurst, Jr" uniqKey="Hurst J">JR Hurst</name></author><author><name sortKey="Smith, Cj" uniqKey="Smith C">CJ Smith</name></author><author><name sortKey="Hubbard, Rb" uniqKey="Hubbard R">RB Hubbard</name></author><author><name sortKey="Wedzicha, Ja" uniqKey="Wedzicha J">JA Wedzicha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rizkallah, J" uniqKey="Rizkallah J">J Rizkallah</name></author><author><name sortKey="Man, Sfp" uniqKey="Man S">SFP Man</name></author><author><name sortKey="Sin, Dd" uniqKey="Sin D">DD Sin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shorr, Af" uniqKey="Shorr A">AF Shorr</name></author><author><name sortKey="Sun, X" uniqKey="Sun X">X Sun</name></author><author><name sortKey="Johannes, Rs" uniqKey="Johannes R">RS Johannes</name></author><author><name sortKey="Yaitanes, A" uniqKey="Yaitanes A">A Yaitanes</name></author><author><name sortKey="Tabak, Yp" uniqKey="Tabak Y">YP Tabak</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>France</li></country><region><li>Provence-Alpes-Côte d'Azur</li><li>Île-de-France</li></region><settlement><li>Antibes-Juan les Pins</li><li>Montfermeil</li><li>Paris</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Roche, Nicolas" sort="Roche, Nicolas" uniqKey="Roche N" first="Nicolas" last="Roche">Nicolas Roche</name></region><name sortKey="Chavaillon, Jean Michel" sort="Chavaillon, Jean Michel" uniqKey="Chavaillon J" first="Jean-Michel" last="Chavaillon">Jean-Michel Chavaillon</name><name sortKey="Maurer, Cyril" sort="Maurer, Cyril" uniqKey="Maurer C" first="Cyril" last="Maurer">Cyril Maurer</name><name sortKey="Piquet, Jacques" sort="Piquet, Jacques" uniqKey="Piquet J" first="Jacques" last="Piquet">Jacques Piquet</name><name sortKey="Zureik, Mahmoud" sort="Zureik, Mahmoud" uniqKey="Zureik M" first="Mahmoud" last="Zureik">Mahmoud Zureik</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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