Chronic obstructive pulmonary disease exacerbations in emergency departments: predictors of outcome.
OBJECTIVE
Exacerbations have a major short-term and long-term impact on patients with chronic obstructive pulmonary disease (COPD). Risk stratification of patients presenting to the emergency department for an exacerbation of COPD is of utmost importance to help in deciding patients' orientation and treatment and in improving outcomes.


RESULTS
Studies on predictors of outcomes of COPD exacerbations are markedly heterogeneous in terms of assessed variables, outcomes of interest and timeframe (short-term vs. long-term outcomes). Age, severity of underlying disease, clinical signs of immediate severity, and comorbidities are among the most frequently identified prognostic factors of in-hospital outcome. In the most severe patients, ICU scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) also have a prognostic value. Several biomarkers have also been studied, but their additional value for risk stratification is not clarified.


CONCLUSIONS
Scores predicting the risk of poor outcome could prove useful in the management of COPD exacerbations. Some have been suggested but remain to be further validated before their use can be generalized.
Roche
Nicolas
N
Respiratory and Intensive Care Medicine, Hôtel-Dieu, Paris Descartes University, Paris, France. nicolas.roche@htd.aphp.fr
Rabbat
Antoine
A
Zureik
Mahmoud
M
Huchon
Gérard
G
D015415:Biomarkers / Q000378:metabolism; D004636:Emergency Service, Hospital; D006801:Humans; D007902:Length of Stay; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D012121:Respiration, Artificial
D015415:Biomarkers