Highlights
- •Patients with COPDE are at risk of adverse short-term clinical outcome.
- •The BAP-65 score has been proposed for the prediction of mortality and use of IMV.
- •We validated the prognostic performance of the score in the ED setting.
- •The BAP-65 tool is not sufficiently accurate for risk prediction in ED patients with COPDE.
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPDE) frequently require
hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are
associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment
model (RAM) based on simple variables, that has been proposed for the prediction of
these adverse outcomes in patients with COPDE. If showed to be accurate, the BAP-65
RAM might be used to guide the patients management, in terms of destination and treatment.
We conducted a retrospective, multicentre, chart-review study, on patients attending
the ED for a COPDE during 2014. The aim of the study was the validation of the BAP-65
RAM for the prediction of in-hospital death or use of IMV (composite primary outcome).
We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We
enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation)
age was 76 (11) years, and 38% of patients were female. The composite outcome occurred
in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI
0.59–0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was
44% (95% CI 34%–55%), the specificity was 84% (95% CI 82%–85%), the positive predictive
value was 9% (95% CI 6%–12%), and the negative predictive value was 98% (95% CI 97%–98%).
Conclusions
In patients attending Italian EDs with a COPDE, we found that the BAP-65 score did
not have sufficient accuracy to stratify patients upon their risk of severe in-hospital
outcomes.
Keywords
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Article info
Publication history
Published online: October 31, 2018
Accepted:
October 24,
2018
Received in revised form:
October 7,
2018
Received:
August 4,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
