Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU) Academic Article uri icon

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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.

authors

  • Germini, Federico
  • Veronese, Giacomo
  • Marcucci, Maura
  • Coen, Daniele
  • Ardemagni, Deborah
  • Montano, Nicola
  • Fabbri, Andrea
  • Adinolfi, Luigi Elio
  • Alvisi, Antonella
  • Antonio, Pagano
  • Azin, Giulia
  • Balloni, Andrea
  • Bandiera, Geminiano
  • Barchetti, Marco
  • Barillari, Alfredo
  • Barozzi, Marco
  • Belloni, Giulia
  • Belotti, Eugenia
  • Binetti, Nicola
  • Bonora, Miriam
  • Bruni, Rosamaria
  • Cacco, Silvia
  • Camisa, Daniele
  • Carbone, Giorgio
  • Carpinteri, Giuseppe
  • Catino, Laura
  • Cazzaniga, Massimo
  • Cenni, Patrizia
  • Chelli, Vittorio
  • Cicero, Leonora
  • Cottone, Carlo Domenico
  • Cuccia, Filippa
  • D'Angelo, Luciano
  • Dalmonte, Francesca
  • Daviddi, Fabio
  • De Vita, Anna
  • Famà, Fausto
  • Fedele, Marta
  • Fonti, Caterina
  • Frigerio, Marta
  • Gallingani, Alan
  • Ghiglione, Valeria
  • Gioffrè-Florio, Maria
  • Giordano, Mauro
  • Giostra, Fabrizio
  • Galli, Maria Giulia
  • Greggi, Maria Elena
  • Groff, Paolo
  • Guizzardi, Stefano
  • Lagasio, Chiara
  • Lazzara, Giuseppe
  • Lubini, Eloisa
  • Magni, Laura
  • Mancarella, Sandro
  • Mangano, Giuseppe
  • Maragno, Margherita
  • Menabue, Monia
  • Meoni, Eleonora
  • Molinaro, Federica
  • Morelli, Alice
  • Moscariello, Francesco
  • Nevola, Riccardo
  • Noto, Paola
  • Paladino, Fiorella
  • Pancani, Roberta
  • Petrelli, Giuseppina
  • Petrino, Roberta
  • Sinno, Carmine
  • Tafa, Aferdita
  • Tartaglia, Sergio
  • Taurino, Chiara
  • Treleani, Martina
  • Villari, Liliana
  • Vitelli, Alessandra
  • Zaccagni, Cinzia
  • Zaccaro, Bruna
  • Zacchino, Massimo

publication date

  • March 2019