Classification of COPD Exacerbation Predicts Prognosis

Adults with exacerbations of chronic obstructive pulmonary disease (ECOPD) whose condition was classified as severe using the Rome criteria had a higher risk of death at 1 year than those who were classified as having moderate or mild disease, as determined from data from more than 300 individuals.

Patients hospitalized with severe exacerbations of ECOPD are at increased risk for worse clinical outcomes and death, so early identification is important, write Ernesto Crisafulli, MD, of the University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Italy, and colleagues.

To help predict prognosis for patients with ECOPD, an expert opinion group updated the definition of ECOPD using a new severity classification known as the Rome definition, which grades ECOPD as mild, moderate, or severe on the basis of more objective and disease-related aspects. However, data on the clinical usefulness of the Rome criteria are limited, they say.

In a study published in the journal Chest, the researchers retrospectively categorized 347 adults hospitalized with ECOPD using the Rome severity classifications of mild, moderate, and severe.

Classifications were made using baseline, clinical and microbiologic factors, as well as gas analysis and laboratory variables. The researchers also reviewed data on the length of hospital stay and mortality (in-hospital and over a follow-up of 6 months to 3 years).

Approximately one third of the patients (39%) were classified as having mild disease, 31% as having moderate disease, and 30% as having severe illness. Overall, hospital stay was significantly longer for the patients with severe disease, although in-hospital mortality was similar across all three groups.

Patients classified as having severe disease also had a worse prognosis at all follow-up time points, and severe classification was significantly associated with worse cumulative survival at 1 year and 3 years (Gehan-Breslow-Wilson test, P = 0.032 and P = 0.004, respectively).

In a multivariate analysis, the risk of death at 1 year was significantly higher among patients classified as severe or moderate (hazard ratio [HR], 1.99 and 1.47, respectively), compared to those classified as mild.

Mortality risk also was higher among patients aged 80 years and older and among those requiring long-term oxygen therapy or with a history of ECOPD episodes, the researchers note. Body mass index in the range of 25–29 kg/m2 was associated with lower risk.

The study was limited by several factors, including the replacement of dyspnea perception in the Rome classification with other objective measures, the researchers note. Other limitations include the retrospective design, small sample size, use of data from a single center, and lack of data on causes of mortality. Women were underrepresented in the study, and so additional research involving women is needed, the researchers note.

The results suggest that the Rome classification allows for the effective identification of patients with ECOPD who have a worse prognosis. The Rome classification may help guide disease management through targeted interventions and personalized care programs for this population, the researchers conclude.

The study received no outside funding. The researchers have disclosed no relevant financial relationships.

Chest. Published online July 26, 2023. Abstract

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