Castro-Portillo Enrique, Soriano Joan B, López-Izquierdo Raúl, Del Pozo Vegas Carlos, Martín-Conty José L, Sánchez Soberón Irene, Delgado Benito Juan F, Polonio-López Begoña, Sánchez-de-la-Torre Manuel, Castro Villamor Miguel Á, Sanz-García Ancor, Martín-Rodríguez Francisco
Primary Health Care Unit, Centro de Salud Delicias I, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain.
E. Castro-Portillo and J.B. Soriano contributed equally as first authors.
ERJ Open Res. 2025 Apr 22;11(2). doi: 10.1183/23120541.00744-2024. eCollection 2025 Mar.
COPD, a condition whose acute exacerbations (AECOPD) are commonly faced by the emergency medical services (EMSs), could modify the performance of early warning scores (EWSs). Our objectives were to assess the 2-day mortality predictive performance of five EWSs in patients with baseline COPD managed by an EMS with unselected acute diseases and to compare the EWS performance between those with AECOPD and those without.
This was a prospective observational study of adults (age >18 years) with a previous COPD diagnosis who were admitted to and transferred to the emergency department by the EMSs due to an unselected acute disease, whether AECOPD or other according to the emergency medical team. Demographics, vital signs for the five EWSs (National Early Warning Score 2 (NEWS2), quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), quick COVID-19 Severity Index (qCSI), CURB-65 score for pneumonia severity and BAP-65 score for AECOPD) calculations and outcomes (hospital and intensive care unit (ICU) admission and 2-day mortality) were collected.
A total of 1703 patients with COPD were selected: 524 with AECOPD and 1179 without. NEWS2 presented the highest predictive capacity for the global, AECOPD and non-AECOPD cohorts: area under the curve 0.880 (95% CI 0.84-0.91), 0.775 (95% CI 0.68-0.86) and 0.913 (95% CI 0.86-0.96), respectively.
NEWS2 was the best predictive model for COPD, presenting excellent performance for the global and non-AECOPD cohorts but a decreased performance for the AECOPD cohort. Therefore, NEWS2 may aid in EMS decision making through appropriate risk assessment, but its use in COPD patients with AECOPD should be handled with care due to decreased performance.
慢性阻塞性肺疾病（COPD）的急性加重（AECOPD）是紧急医疗服务（EMS）经常面临的情况，它可能会改变早期预警评分（EWS）的表现。我们的目标是评估五种EWS对由EMS管理的患有未选择急性疾病的基线COPD患者的2天死亡率预测性能，并比较有AECOPD和无AECOPD患者的EWS性能。
这是一项对既往诊断为COPD的成年人（年龄>18岁）的前瞻性观察性研究，这些患者因未选择的急性疾病（根据紧急医疗团队判断是否为AECOPD或其他疾病）由EMS送往急诊科并转入。收集了人口统计学信息、用于计算五种EWS（国家早期预警评分2（NEWS2）、快速序贯（脓毒症相关）器官功能衰竭评估（qSOFA）、快速COVID-19严重程度指数（qCSI）、肺炎严重程度的CURB-65评分和AECOPD的BAP-65评分）的生命体征以及结局（住院和重症监护病房（ICU）入住情况以及两天死亡率）。
共选择了1703例COPD患者：524例有AECOPD，1179例无AECOPD。NEWS2在总体、AECOPD和非AECOPD队列中表现出最高的预测能力：曲线下面积分别为0.880（95%CI 0.84 - 0.91）、0.775（95%CI 0.68 - 0.86）和0.913（95%CI 0.86 - 0.96）。
NEWS2是COPD的最佳预测模型，在总体和非AECOPD队列中表现出色，但在AECOPD队列中性能下降。因此，NEWS2可通过适当的风险评估帮助EMS进行决策，但由于性能下降，在患有AECOPD的COPD患者中使用时应谨慎。
