Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.
Respirology. 2011 Jan;16(1):146-51. doi: 10.1111/j.1440-1843.2010.01866.x.
Hospitalization for exacerbation of COPD is associated with a high risk of mortality. A risk-prediction model using information easily obtained on admission could help to identify high-risk individuals. The CURB65 score was developed to predict mortality risk in community acquired pneumonia. A retrospective study found that this score was also associated with mortality in COPD exacerbations. We conducted a prospective study to assess the utility of the CURB65 score in acute COPD exacerbations.
Consecutive patients with physician diagnosed COPD exacerbations admitted to a public hospital during a 1-year period were studied prospectively. The CURB65 scores were calculated from information obtained at initial hospital presentation. CURB65 = one point each for Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30/min, low Blood pressure, age ≥ 65 years.
30-day mortality data were available for 249 of 252 patients. CURB65 scores on admission significantly predicted risk of death during the hospital admission and at 30 days. The 30-day mortality by score groups were: low risk (scores 0-1) 2.0% (2/98), moderate risk (score 2) 6.7% (6/90) and high risk (scores 3-5) 21.3% (13/61). CURB65 scores were not predictive of 1-year mortality.
A simple 6-point score based on confusion, blood urea, respiratory rate, blood pressure and age can be used to stratify patients with COPD exacerbation into different management groups. The CURB65 score was as effective in predicting early mortality in our cohort of acute COPD exacerbations as it was in previous cohorts with community acquired pneumonia. Our findings suggest that CURB65 scores can help clinicians to assess patients with exacerbation of COPD.
COPD 恶化导致的住院与高死亡率相关。利用入院时易于获取的信息建立风险预测模型，有助于识别高危人群。CURB65 评分最初是为预测社区获得性肺炎患者的死亡风险而开发的。一项回顾性研究发现，该评分与 COPD 恶化患者的死亡率相关。我们进行了一项前瞻性研究，以评估 CURB65 评分在急性 COPD 恶化中的应用价值。
连续纳入我院在 1 年期间因医生诊断 COPD 恶化而入院的患者，前瞻性研究。入院时根据获得的信息计算 CURB65 评分。CURB65 评分：意识障碍 1 分、血尿素氮（Urea）>7mmol/L 1 分、呼吸频率（Respiratory rate）≥30/min 1 分、低血压 1 分、年龄≥65 岁 1 分。
252 例患者中，249 例患者的 30 天死亡率数据可用。入院时的 CURB65 评分显著预测了住院期间和 30 天的死亡风险。按评分分组的 30 天死亡率为：低危组（评分 0-1）2.0%（2/98）、中危组（评分 2）6.7%（6/90）和高危组（评分 3-5）21.3%（13/61）。CURB65 评分不能预测 1 年死亡率。
基于意识障碍、血尿素、呼吸频率、血压和年龄的简单 6 分评分可用于将 COPD 恶化患者分层为不同的管理组。在本队列中，CURB65 评分与既往社区获得性肺炎患者队列一样，能有效预测急性 COPD 恶化患者的早期死亡率。我们的研究结果表明，CURB65 评分有助于临床医生评估 COPD 恶化患者。
