. Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
. Centro de Investigação em Tecnologias e Serviços de Saúde - CINTESIS - Universidade do Porto, Porto, Portugal.
J Bras Pneumol. 2023 Oct 30;49(5):e20230032. doi: 10.36416/1806-3756/e20230032. eCollection 2023.
Acute exacerbations of COPD (AECOPD) are common causes of hospitalization. Various scoring systems have been proposed to classify the risk of clinical deterioration or mortality in hospitalized patients with AECOPD. We sought to investigate whether clinical deterioration and mortality scores at admission can predict adverse events occurring during hospitalization and after discharge of patients with AECOPD.
We performed a retrospective study of patients admitted with AECOPD. The National Early Warning Score 2 (NEWS2), the NEWS288-92%, the Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF) score, and the modified DECAF (mDECAF) score were calculated at admission. We assessed the sensitivity, specificity, and overall performance of the scores for the following outcomes: in-hospital mortality; need for invasive mechanical ventilation or noninvasive ventilation (NIV); long hospital stays; hospital readmissions; and future AECOPD.
We included 119 patients admitted with AECOPD. The median age was 75 years, and 87.9% were male. The NEWS288-92% was associated with an 8.9% reduction in the number of individuals classified as requiring close, continuous observation, without an increased risk of death in the group of individuals classified as being low-risk patients. The NEWS288-92% and NEWS2 scores were found to be adequate in predicting the need for acute NIV and longer hospital stays. The DECAF and mDECAF scores were found to be better at predicting in-hospital mortality than the NEWS2 and NEWS288-92%.
The NEWS288-92% safely reduces the need for clinical monitoring in patients with AECOPD when compared with the NEWS2. The NEWS2 and NEWS288-92% appear to be good predictors of the length of hospital stay and need for NIV, but they do not replace the DECAF and mDECAF scores as predictors of mortality.
COPD 急性加重（AECOPD）是住院的常见原因。已经提出了各种评分系统来对住院 AECOPD 患者的临床恶化或死亡率风险进行分类。我们旨在研究入院时的临床恶化和死亡评分是否可以预测 AECOPD 患者住院期间和出院后的不良事件。
我们对因 AECOPD 住院的患者进行了回顾性研究。入院时计算了国家早期预警评分 2 （NEWS2）、NEWS288-92%、呼吸困难、嗜酸性粒细胞减少、实变、酸中毒和心房颤动（DECAF）评分以及改良 DECAF（mDECAF）评分。我们评估了评分对于以下结局的敏感性、特异性和总体性能：院内死亡率；需要有创机械通气或无创通气（NIV）；住院时间长；医院再入院；以及未来的 AECOPD。
我们纳入了 119 例因 AECOPD 住院的患者。中位年龄为 75 岁，87.9%为男性。NEWS288-92%可使需要密切、连续观察的人数减少 8.9%，而被归类为低危患者的人群中死亡风险并未增加。NEWS288-92%和 NEWS2 评分可充分预测需要急性 NIV 和延长住院时间。DECAF 和 mDECAF 评分在预测院内死亡率方面优于 NEWS2 和 NEWS288-92%。
与 NEWS2 相比，NEWS288-92%可安全减少 AECOPD 患者的临床监测需求。NEWS2 和 NEWS288-92%似乎是住院时间和需要 NIV 的良好预测指标，但它们不能替代 DECAF 和 mDECAF 评分作为死亡率的预测指标。
