title: Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models.
abstract: The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD).  We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1< 45%, Charlson ≥ 3, hemoglobin (Hb)<13 g/L, PCO2 ≥ 46 mmHg, fibrinogen ≥ 554 g/L, C-reactive protein (CRP)≥45 mg/L, leukocyte count < 9810 × 109/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT ≥ 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95%CI 1.09-6.36), CRP ≥ 45 mg/L (OR = 2.91, 95%CI: 1.11-7.49) and LTOT (3.07, 95%CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT ≥ 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.
authors.affiliation: a Hospital Comarcal de Laredo , Laredo , Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: García-Rivero
authors.affiliation: b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Esquinas
authors.affiliation: b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Barrecheguren
authors.affiliation: c Fundació Salut Empordà , Figueres , Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Bonnin-Vilaplana
authors.affiliation: d Hospital Universitario de La Plana , Vila-real , Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: García-Sidro
authors.affiliation: e Hospital Dr. Pesset , Valencia , Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Herrejón
authors.affiliation: f Hospital Germans Trias i Pujol , Barcelona , Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez-Rivera
authors.affiliation: g Hospital Puerta del Hierro , Majadahonda , Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Malo de Molina
authors.affiliation: h Complejo Hospitalario Universitario A Coruña , A Coruña , Spain.
authors.forename: Pedro Jorge
authors.initials: PJ
authors.lastname: Marcos
authors.affiliation: i Hospital Ramón y Cajal , Madrid , Spain.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Mayoralas
authors.affiliation: j Hospital de La Ribera , Alzira , Spain.
authors.forename: Elsa
authors.initials: E
authors.lastname: Naval
authors.affiliation: k Hospital Virgen de Arrixaca , Murcia , Spain.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Ros
authors.affiliation: g Hospital Puerta del Hierro , Majadahonda , Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Valle
authors.affiliation: b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D018450:Disease Progression; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010102:Oxygen Inhalation Therapy; D010343:Patient Admission / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D012372:ROC Curve; D012307:Risk Factors; D063189:Symptom Assessment; D000067251:Symptom Flare Up; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein
keywords: CAT; COPD; exacerbations