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. 2015 Mar;7(3):329-36.
doi: 10.3978/j.issn.2072-1439.2014.11.27.

Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation

Kun Xiao  1 , Chao Guo  1 , Longxiang Su  1 , Peng Yan  1 , Xin Li  1 , Lixin Xie  1
Affiliations

Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation

Kun Xiao et al. J Thorac Dis. 2015 Mar.

Abstract

Background and objective: Chronic obstructive pulmonary disease (COPD) represents an increasing healthcare concern as a leading cause of morbidity and mortality worldwide. Our objective was to predict the outcome of COPD patients associated with multiple organ dysfunction syndrome (MODS) by scoring models.

Methods: A retrospective study was performed on severe COPD patients within 24 hours of the onset of MODS. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score II (SAPS II), and Sepsis-related Organ Failure Assessment (SOFA) scores were calculated for patients.

Results: A total of 153 elderly patients were recruited. Compared to 30-day survivors, the number of failing organs and all of the scoring models were significantly higher in 30-day non-survivors. The SOFA showed the highest sensitivity and area under the curve (AUC) for predicting the prognosis of patients with MODS induced by acute exacerbation of COPD. The results of logistic regression indicated that factors that were correlated with the prognosis of COPD included the exacerbation history, SOFA score, number of failing organs, and duration of ICU stay. The value of exacerbation frequency for predicting the outcome of COPD was excellent (AUC: 0.892), with a sensitivity of 0.851 and a specificity of 0.797.

Conclusions: The SOFA score, determined at the onset of MODS in elderly patients with COPD, was a reliable predictor of the prognosis. The exacerbation frequency, number of failing organs, and the SOFA score were risk factors of a poor prognosis, and the exacerbation frequency could also effectively predict the outcome of COPD.

Keywords: Acute exacerbation (AE); chronic obstructive pulmonary disease (COPD); multiple organ dysfunction syndrome (MODS); prognosis.

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Figures

Figure 1
Figure 1
Flow chart of patient enrolment in this study. COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
The ROC curves of the scoring systems for predicting the prognosis of enrolled patients (n=153). MODS, multiple organ dysfunction syndrome; SOFA, Sepsis-related Organ Failure Assessment; APACHE, the acute Physiology and Chronic Health Evaluation; SAPS, Simplified Acute Physiology Score II; ROC, receiver operating characteristic.
Figure 3
Figure 3
The ROC curves of the scoring systems for predicting the prognosis of enrolled patients requiring mechanical ventilation (n=89). ROC, receiver operating characteristic; SOFA, Sepsis-related Organ Failure Assessment.
Figure 4
Figure 4
The ROC curve of the SOFA score for predicting the outcome of enrolled patients based on exacerbation frequency. ROC, receiver operating characteristic; SOFA, Sepsis-related Organ Failure Assessment.
Figure 5
Figure 5
The difference in SOFA scores between different levels of exacerbation frequency in the preceding year before admission to the hospital in patients with COPD. SOFA, Sepsis-related Organ Failure Assessment; COPD, chronic obstructive pulmonary disease.
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