Development of a nomogram for predicting in-hospital mortality of patients with exacerbation of chronic obstructive pulmonary disease

Abstract

Background and objectives

Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of their disease, sometimes requiring hospital admission and being associated with increased mortality. Although previous studies have reported mortality from exacerbations of COPD, there is limited information about prediction of individual in-hospital mortality. We therefore aimed to use data from a nationwide inpatient database in Japan to generate a nomogram for predicting in-hospital mortality from patients’ characteristics on admission.

Methods

We retrospectively collected data on patients with COPD who had been admitted for exacerbations and been discharged between July 1, 2010 and March 31, 2013. We performed multivariable logistic regression analysis to examine factors associated with in-hospital mortality and thereafter used these factors to develop a nomogram for predicting in-hospital prognosis.

Results

The study comprised 3,064 eligible patients. In-hospital death occurred in 209 patients (6.8%). Higher mortality was associated with older age, being male, lower body mass index, disturbance of consciousness, severe dyspnea, history of mechanical ventilation, pneumonia, and having no asthma on admission. We developed a nomogram based on these variables to predict in-hospital mortality. The concordance index of the nomogram was 0.775. Internal validation was performed by a bootstrap method with 50 resamples, and calibration plots were found to be well fitted to predict in-hospital mortality.

Conclusion

We developed a nomogram for predicting in-hospital mortality of exacerbations of COPD. This nomogram could help clinicians to predict risk of in-hospital mortality in individual patients with COPD exacerbation.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2017

Publication date (Electronic): 29 May 2017

Volume: 12

Pages: 1605-1611

Affiliations

[1 ]Department of Respiratory Medicine, Graduate School of Medicine

[2 ]Department of Clinical Epidemiology and Health Economics, School of Public Health

[3 ]Department of Health Services Research, Graduate School of Medicine, University of Tokyo

[4 ]Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

Author notes

Correspondence: Yasuhiro Yamauchi, Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan, Tel [phone], Fax [phone], Email yamauchiy-int@ 123456h.u-tokyo.ac.jp

Article

Publisher ID: copd-12-1605

DOI: 10.2147/COPD.S129714

PMC ID: 5459957

Copyright statement: © 2017 Sakamoto et al. This work is published and licensed by Dove Medical Press Limited

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Categories

Subject: Original Research