Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: Comparing the CURB-65 and BAP-65 scores

• Published in: Journal of critical care 2012-12, Vol.27 (6), p.564-570
• Main Authors: Shorr, Andrew F., MD, MPH, Sun, Xiaowu, PhD, Johannes, Richard S., MD, MS, Derby, Karen G, Tabak, Ying P., PhD
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Blood pressure; Chronic obstructive pulmonary disease; Coma; Comorbidity; Critical Care; Diagnosis related groups; Disease; DRGs; Exacerbation; Female; Health Insurance Portability & Accountability Act 1996-US; Hospitalization; Hospitals; Humans; Intensive Care Units; Male; Mechanical ventilation; Middle Aged; Mortality; Pneumonia; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Respiration, Artificial; Retrospective Studies; Risk Assessment; Risk score; Sensitivity and Specificity; Severity of Illness Index; Teaching hospitals; United States
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.02.015

Abstract Purpose Clinicians lack a validated tool for risk stratification for need for mechanical ventilation (MV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to compare 2 risk scores, BAP-65 and CURB-65, at predicting a need for MV in AECOPDs. Materials and Methods We analyzed 34 478 AECOPD admissions to 195 US hospitals (2007). We compared the rates of MV at admission and at any point during hospitalization based on the respective BAP-65 and CURB-65 scores. We compared the accuracy of the 2 scores via the area under the receiver operating characteristic curves. Results The overall MV rate at admission was 7.9%, and the rate of MV any time equaled 9.3%. Use of MV increased with escalating BAP-65 and CURB-65 scores. The area under the receiver operating characteristic curve for BAP-65 was higher than that for CURB-65 for both early MV, 0.81 (95% confidence interval [CI], 0.80-0.82) vs 0.76 (95% CI, 0.75-0.77), P < .0001, and MV any time, 0.78 (95% CI, 0.77-0.79) vs 0.74 (95% CI, 0.73-0.75), P < .0001. Conclusions BAP-65 identifies patients with AECOPD at high risk for need of MV more accurately than does CURB-65. BAP-65 may represent a useful tool for initial MV risk stratification in AECOPD.