MORTALITY PREDICTORS IN PATIENTS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONRY DISEASES
Authors: Saini Dr. Rajendra Kumar , Singh Dr. Jai Prakash 
Published: September 2019

INTRODUCTION: COPD is a chronic disease which involves the airways, lung parenchyma, and pulmonary vasculature and also has considerable systemic manifestations. This disease is progressive and there is gene–environment interaction and hence can be prevented by avoiding exposure to the noxious particles. Commonest attributing risk factor is cigarette smoking in any form or air pollution.The in-hospital mortality rate for acute exacerbation of COPD may range from 2.5% - 25%; readmission rates from 25% to 55% for those who survived, and 25% -50% of these patients may die within one year. Most important single most crucial parameter to determine the risk of mortality in patients experiencing acute exacerbation of COPD is the forced expiratory volume in one second (FEV1). This DACF score can be useful in severely ill patients to predict mortality. This study was carried out to evaluate the DACF score as a clinical prediction of mortality for patients with acute exacerbation of COPD.

MATERIAL AND METHODS: All patients admitted for an acute exacerbation of COPD during study period were included in the study. All included patients were cases of COPD confirmed with pulmonary function test i.e. forced expiratory volume in one second/forced vital capacity <0.7 and irreversible airway obstruction and were treated with a combination of various bronchodilators. The study included patients aged 40 years or older and who were admitted in the hospital and had a primary clinical diagnosis of AECOPD. Sociodemographic data was recorded which includes age, gender, comorbidities, and number of previous AECOPD. Plain chest x-ray, spirometry, electrocardiogram was carried out. Relevant tests such as ABG analysis, complete blood count, kidney function test, liver function test, and serum electrolytes were done. DACF score was calculated.

RESULTS: A total of 124 patients were included in the study, out of which 104 (83.88%) survived and were placed in group 2 and 20 (16.12%) patients died during the hospital stay were placed in group 1. Hence, the overall in hospital mortality rate for AECOPD was 16.12%.FEV1 in non-survivors group was 38 ± 12.98 while in survivor group it was 45 ± 11.55. Long-term oxygen therapy was given to 11 (55%) in non-survival group while it was given to 20 (19.23%) in survivors group.DACF score was calculated, most common score was 3 (48, 39%). On DACF score 1 there were 2(10%) non survivors and 34 (33%) survivors.35% mortality was seen in score 4, while no survivor was found on same score, this was statistically significant (P<0.0001). on DACF score three, 25% patients died while 41% survived. Purulent sputum was observed in 90% of non survivors and 49% of survivors. Respiratory rate/min in Non-survivors (n=20) was 29.2±5.4 and in Survivors (n=104) was 25.4±3.8. Arterial blood gases analysis pH in Non-survivors (n=20) was 7.29±0.04 and in Survivors (n=104) was 7.45±0.08. paCO2 (mm Hg) in Non-survivors was 50.78±13.44 and in Survivors was 43.11±11.49. Body mass index (kg/m2) in Non-survivors was 21.65±7.4 and in Survivors was 26.97±8.9.63.

CONCLUSION: DACF score can predicts mortality and effectively stratifies COPD patients admitted with acute exacerbations into survivors and non-survivor’s category and clinical tests such as PaCO2, arterial pH, purulent sputum can be used to predict the mortality in AECOPD.