P211 Exacerbation frequency and maintenance treatment of COPD in UK clinical practice

Abstract

Background: Despite the often poor outcome of patients hospitalisedwith acute exacerbations of COPD (AECOPD), it is difficult accuratelyto identify those at high risk of mortality. To aid prognosticationin AECOPD, we have developed a simple, easily memorableand effective tool, based on clinical data available shortly afteradmission. Methods: Consecutive patients hospitalised with AECOPD wererecruited, with clinical and demographic data collected at admission.In-hospital mortality data were collected from hospital records.Variables were dichotomised and the strongest independent predictorsof mortality were identified by logistic regression analysis. Toolperformance was assessed using ROC curve analysis. Results: 920 patients were recruited: mean (SD) age was 73.1(10.0) years, with 53.9% female; most had severe airflow obstruction(FEV1 43.6 (17.2) % predicted) and were of normal weight (BMI 24.6(6.3) kg/m2). 32.5% of patients had coexistent consolidation and 199(21.6%) received assisted ventilation during their hospital stay. 96(10.4%) patients died in-hospital. In descending order of strength,the factors independently predicting mortality were: the extendedMRC Dyspnoea Scale (eMRCD)1; coexistent radiographic consolidation;eosinopenia (<0.053109/l); pH <7.3; atrial fibrillation;cough effectiveness; albumin <36 g/dl; age=80 years; cerebrovasculardisease; and BMI <18.5 kg/m2. The strongest five variableswere selected to form the DECAF (Dyspnoea, Eosinopenia,Consolidation, Acidaemia, atrial Fibrillation) score (Abstract P212 (Table presented) table 1). Each predictor was assigned a score of 1 (present) or 0(absent), except for eMRCD score which could be 0, 1 or 2, giving amaximum DECAF score of 6. The DECAF score showed goodperformance for the prediction of in-hospital mortality (area underROC curve=0.858, 95% CI 0.82 to 0.89), and was a strongerpredictor (p<0.0001) than either the APACHE (AUROC=0.727) orCAPS (AUROC=0.710) prognostic scores. In patients with coexistentconsolidation (n=299), DECAF was a stronger predictor ofmortality than CURB-65 (AUROC=0.77 vs 0.66, p=0.0064).Conclusion The DECAF score is a strong predictor of in-hospitalmortality and may improve the prognostication of patients hospitalisedwith AECOPD. External validation is required beforerecommending widespread application.