Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Ther Adv Respir Dis. 2023 Jan-Dec;17:17534666231172917. doi: 10.1177/17534666231172917.
The Rome proposal provides an objective assessment tool for severity of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) but requires validation.
We aimed to evaluate the predictive performance of the Rome proposal in patients with AE-COPD.
This observational study assessed the patients who visited the emergency room (ER) or were hospitalized due to AE-COPD between January 2010 and December 2020.
We compared the performance of the Rome Proposal with that of the DECAF score or GesEPOC 2021 criteria in predicting intensive care unit (ICU) admission, need for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), and in-hospital mortality.
A total of 740 events of ER visit or hospitalization due to AE-COPD were reviewed and classified into mild (30.9%), moderate (58.6%), or severe (10.4%) group according to the Rome proposal. The severe group had a higher rate of ICU admission, required more NIV or IMV, and had a higher in-hospital mortality than the mild and moderate groups. The predictive performance of the Rome proposal was significantly better for ICU admission [area under the receiver operating characteristic curve (AU-ROC) = 0.850 0.736, = 0.004] and need for NIV or IMV (AU-ROC = 0.870 0.770, = 0.004) than that of the GesEPOC 2021 criteria but better than that of the DECAF score only in female patients. There was no significant difference in predicting the in-hospital mortality between the Rome proposal and DECAF score or GesEPOC 2021 criteria.
External validation of the Rome Proposal in Korean patients demonstrated excellent performance for ICU admission and need for NIV or IMV and an acceptable performance for in-hospital mortality.
罗马提案为慢性阻塞性肺疾病（COPD）急性加重（AE-COPD）的严重程度提供了一种客观评估工具，但需要验证。
我们旨在评估罗马提案在 AE-COPD 患者中的预测性能。
本观察性研究评估了 2010 年 1 月至 2020 年 12 月期间因 AE-COPD 就诊于急诊室（ER）或住院的患者。
我们比较了罗马提案与 DECAF 评分或 GesEPOC 2021 标准在预测 ICU 入院、需要无创通气（NIV）或有创机械通气（IMV）以及住院死亡率方面的表现。
共回顾了 740 例因 AE-COPD 就诊于 ER 或住院的事件，并根据罗马提案分为轻度（30.9%）、中度（58.6%）或重度（10.4%）组。与轻度和中度组相比，重度组 ICU 入院率更高，需要更多的 NIV 或 IMV，住院死亡率更高。罗马提案对 ICU 入院（AU-ROC=0.850 0.736，=0.004）和需要 NIV 或 IMV（AU-ROC=0.870 0.770，=0.004）的预测性能明显优于 GesEPOC 2021 标准，但仅在女性患者中优于 DECAF 评分。罗马提案与 DECAF 评分或 GesEPOC 2021 标准在预测住院死亡率方面无显著差异。
在韩国患者中对罗马提案进行的外部验证表明，其在 ICU 入院和需要 NIV 或 IMV 方面具有出色的表现，在住院死亡率方面表现可接受。
