title: The CAT (COPD Assessment Test) questionnaire as a predictor of the evolution of severe COPD exacerbations.
abstract: BACKGROUND
  Since exacerbations of chronic obstructive pulmonary disease (COPD) cause both a great impact on the progression of the disease and generate high health expenditures, there is a need to develop tools to evaluate their prognosis.
  
  
  METHODS
  Multicenter, observational, prospective study that evaluated the prognostic utility of the COPD Assessment Test (CAT) in severe exacerbations of COPD. Anthropometric and clinical variables were analyzed: smoking, history of exacerbations during the previous year, drug treatment, degree of baseline dyspnea, comorbidities; laboratory variables at admission (complete blood count, arterial blood gas and biochemistry) and CAT scores in the first 24 h of admission, on the third day, at discharge and at 3 months.
  
  
  RESULTS
  We evaluated 106 patients (91 males) with a mean age of 71.1 (SD 9.8 years), mean FEV1 45.2% (14.7%) and average CAT score at admission of 24.7 points (7.1). At three months after discharge, treatment failure was observed in 39 (36.8%) patients: 14 (13.2%) presented an exacerbation without the need for hospital admission, 22 were readmitted (20.8%) and 3 (2.8%) died during follow-up. The three factors associated with increased risk of failure were a reduction less than 4 units in the CAT at discharge compared to admission, lower hemoglobin levels and treatment with domiciliary oxygen.
  
  
  CONCLUSIONS
  A change of ≤4 points in the CAT score at discharge compared to that obtained at admission due to a severe exacerbation of COPD, helps to predict therapeutic failure such as a new exacerbation, readmission or death in the subsequent three months.
authors.affiliation: University Hospital de La Plana, Vila-real, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: García-Sidro
authors.affiliation: Hospital of La Ribera, Alzira, Spain.
authors.forename: Elsa
authors.initials: E
authors.lastname: Naval
authors.affiliation: Germans Trias i Pujol Hospital, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez Rivera
authors.affiliation: Fundació Salut Empordà, Figueres, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Bonnin-Vilaplana
authors.affiliation: Regional Hospital of Laredo, Santander, Spain.
authors.forename: Juan Luís
authors.initials: JL
authors.lastname: Garcia-Rivero
authors.affiliation: Hospital Dr. Peset, Valencia, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Herrejón
authors.affiliation: Puerta del Hierro Hospital, Majadahonda, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Malo de Molina
authors.affiliation: Pneumology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidad de A Coruña (UDC), A Coruña, Spain.
authors.forename: Pedro Jorge
authors.initials: PJ
authors.lastname: Marcos
authors.affiliation: Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Mayoralas-Alises
authors.affiliation: Hospital Virgen de Arrixaca, Murcia, Spain.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Ros
authors.affiliation: Puerta del Hierro Hospital, Majadahonda, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Valle
authors.affiliation: Pneumology Department, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Esquinas
authors.affiliation: Pneumology Department, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Barrecheguren
authors.affiliation: Pneumology Department, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Electronic address: mmiravitlles@vhebron.net.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D012372:ROC Curve; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014797:Vital Capacity / Q000502:physiology
keywords: CAT; COPD; Exacerbations