[Use of acute physiology and chronic health evaluation III in evaluating prognosis of chronic obstructive pulmonary disease in elderly patients on mechanical ventilation].
OBJECTIVE
To investigate the feasibility of estimating risk of prognosis and hospital mortality in elderly patients (> or =60 years old) with chronic obstructive pulmonary disease (COPD) under the treatment of mechanical ventilation by using acute physiology and chronic health evaluation III (APACHE III).


METHODS
Fifty elderly patients with COPD treated with mechanical ventilation were analyzed retrospectively. A risk estimation equation for hospital mortality was first developed by using APACHE III in evaluating 40 randomly-selected patients before mechanical ventilation. Changes in APACHE III on the 1 st, 3 rd and 7 th day for each patient after intubation were recorded and analyzed.


RESULTS
The risk estimate equation for hospital mortality was developed as p=Apa(gamma)/(D(gamma)(50)+Apa(gamma)), D(50)=73.4, gamma=8 with 80% prediction accuracy. A statistical significant cutoff was developed by dynamically recording acute physiology scores after intubation, and a decrease of 32.8% or more (compared with APACHE III before intubation) of APACHE III on the 3 rd day predicted survival of the patient.


CONCLUSIONS
APACHE III score and its dynamic change could be an ideal tool to predict risk for hospital mortality in elderly patients with COPD on mechanical ventilation.
Long
Wei
W
Beijing Friendship Hospital, Beijing 100050, China.
Xie
Miao-rong
MR
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment