The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission

ABSTRACT Background and Objective: The CRB65 score, a risk stratification method validated for use in community‐acquired pneumonia, has recently been shown to have utility in acute exacerbations of COPD (AECOPD). The objective of this study was to independently validate the CRB65 score as a predictor of mortality in patients who required hospital admission with AECOPD. Methods: The medical records of patients admitted to Wellington Hospital with AECOPD during a 12‐month period from June 2006 were reviewed. Logistic regression was used to determine the strength of the association between the CRB65 score and death at three measurement times: in‐hospital, 30 days and 12 months. Results: Complete data were available in 133/174 patient admissions. In‐hospital and 30‐day mortality increased progressively with increasing CRB65 score and was markedly higher in the CRB 3–4 group (3%, 5%, 29%, and 4%, 9%, 43% for CRB65 scores 0–1, 2, 3–4 for in‐hospital and 30‐day mortality, respectively). Differences in 1‐year mortality were less apparent (24%, 25%, 57% for CRB65 scores 0–1, 2, 3–4, respectively). The CRB65 score demonstrated a modest value for predicting in‐hospital and 30‐day mortality with a c statistic of 0.68 at both time points. Conclusions: The CRB65 score shows similar characteristics for predicting short‐term mortality in AECOPD as its use in community‐acquired pneumonia. We recommend its use in clinical practice, particularly in patients with a score ≥3, which is associated with a high risk of early mortality, and need for intensive hospital management. The CRB65 score shows similar characteristics for predicting short‐term mortality in acute exacerbations of COPD as its use in community‐acquired pneumonia.