title: A clinical in-hospital prognostic score for acute exacerbations of COPD.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Respiratory and Intensive Care Medicine department, Cochin Hospital Group, APHP, University Paris Descartes (EA2511), Paris, 75005, France. nicolas.roche@cch.aphp.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Chavaillon
authors.forename: Cyril
authors.initials: C
authors.lastname: Maurer
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Zureik
authors.forename: Jacques
authors.initials: J
authors.lastname: Piquet
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality*; D012720:Severity of Illness Index