Background

The morbidity and mortality among hospital inpatients with AECOPD and CVDs remains unacceptably high. We therefore aimed to derive and validate a simple clinical risk score to assess individuals? risk of poor prognosis in patients with AECOPD and CVDs.

Study Design and Methods

We evaluated inpatients with AECOPD and CVDs in a prospective, noninterventional, multicenter cohort study. We used a multivariable logistic regression analysis to identify the independent prognostic risk factors and created a risk score model according to patients? data from a derivation cohort. Discrimination was evaluated by area under the receiver-operating characteristic curve (AUC) and calibration was assessed by Hosmer?Lemeshow goodness-of-fit test. The model was validated and compared with the BAP-65, CURB-65, DECAF and NIVO models in a validation cohort.

Results

We derived a combined risk score, the A2CDPS score that included the following variables: age >75 years, altered mental status, consolidation, diastolic blood pressure ?60 mmHg, pulse >109 beats per minute and serum BUN >7 mmol/L. Discrimination (AUC 0.849, 95% CI, 0.806-0.891) and calibration (Hosmer-Lemeshow statistic, P= 0.94) were good in the derivation cohort, and similar in the validation cohort (AUC 0.819, 95% CI,0.765-0.873). The A2CDPS score also had significantly better predictivity for in-hospital mortality compared with the BAP-65, CURB-65, DECAF, and NIVO scores (all P<0.001).

Conclusions

The A2CDPS risk score model could help predict mortality in AECOPD and CVDs patients and guide further clinical research on risk-based treatment.