Predicting 1-Year Mortality Rate for Patients Admitted With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease to an Intensive Care Unit: An Opportunity for Palliative Care

• Published in: Mayo Clinic proceedings Vol. 89; no. 5; pp. 638 - 643
• Main Authors: Batzlaff, Cassandra M., MD, Karpman, Craig, MD, Afessa, Bekele, MD, Benzo, Roberto P., MD, MSc
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.05.2014; Elsevier, Inc; Elsevier Limited
• Subjects: Acute Disease; Age Distribution; Aged; APACHE; Care and treatment; Demographic aspects; Disease Progression; Female; Humans; Intensive Care Units - statistics & numerical data; Internal Medicine; Kaplan-Meier Estimate; Length of Stay; Logistic Models; Lung diseases, Obstructive; Male; Mortality; Multivariate Analysis; Organ Dysfunction Scores; Palliative Care - standards; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive - mortality; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Risk Assessment - methods; Tertiary Care Centers - statistics & numerical data; Time Factors; United States; United States; SOFA; APACHE III; ICU; intensive care unit; area under the operating curve; Acute Physiology and Chronic Health Evaluation III; Sequential Organ Failure Assessment; AUC; COPD; chronic obstructive pulmonary disease
• DOI: 10.1016/j.mayocp.2013.12.004
• ISSN: 0025-6196

Abstract The objective of this study was to develop a model to aid clinicians in better predicting 1-year mortality rate for patients with an acute exacerbation of chronic obstructive pulmonary disease admitted to the medical intensive care unit (ICU) with the goal of earlier initiation of palliative care and end-of-life communications in this patient population. This retrospective cohort study included patients from a medical ICU from April 1, 1995, to November 30, 2009. Data collected from the Acute Physiology and Chronic Health Evaluation III database included demographic characteristics; severity of illness scores; noninvasive and invasive mechanical ventilation time; ICU and hospital length of stay; and ICU, hospital, and 1-year mortality. Statistically significant univariate variables for 1-year mortality were entered into a multivariate model, and the independent variables were used to generate a scoring system to predict 1-year mortality rate. At 1-year follow-up, 295 of 591 patients died (50%). Age and hospital length of stay were identified as independent determinants of mortality at 1 year by using multivariate analysis, and the predictive model developed had an area under the operating curve of 0.68. Bootstrap analysis with 1000 iterations validated the model, age, and hospital length of stay, entered the model 100% of the time (area under the operating curve=0.687; 95% CI, 0.686-0.688). A simple model using age and hospital length of stay may be informative for providers willing to identify patients with chronic obstructive pulmonary disease with high 1-year mortality rate who may benefit from end-of-life communications and from palliative care.