***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease ( e COPD ) attending an emergency department ( ED ) . Such information could help stratify these patients and guide medical decision-making . The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit . Methods This was a prospect i ve cohort study of patients with e COPD attending the EDs of 16 participating hospitals . Recruitment started in June 2008 and ended in September 2010 . Information on possible predictor variables was recorded during the time the patient was evaluated in the ED , at the time a decision was made to admit the patient to the hospital or discharge home , and during follow-up . Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED , as well as at death within 1 month of the index ED visit .  Multivariate logistic regression models  were developed in a derivation sample and vali date d in a validation sample . The score was compared with other published prediction rules for patients with stable COPD . Results In total , 2,487 patients were included in the study . Predictors of death during hospital admission , or within 1 week of discharge to home from the ED were patient age , baseline dyspnea , previous need for long-term home oxygen therapy or non-invasive mechanical ventilation , altered mental status , and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival ( area under the curve ( AUC ) = 0.85 ) . Addition of arterial blood gas parameters ( oxygen and carbon dioxide partial pressures ( PO2 and PCO2 ) ) and pH ) did not improve the model . The same variables were predictors of death at 1 month ( AUC = 0.85 ) . Compared with other commonly used tools for predicting the severity of COPD in stable patients , our rule was significantly better . Conclusions Five clinical predictors easily available in the ED , and also in the primary care setting , can be used to create a simple and easily obtained score that allows clinicians to stratify patients with e COPD upon ED arrival and guide the medical decision-making process BACKGROUND AND OBJECTIVE Hospitalization for exacerbation of COPD is associated with a high risk of mortality . A risk-prediction model using information easily obtained on admission could help to identify high-risk individuals . The CURB65 score was developed to predict mortality risk in community acquired pneumonia . A retrospective study found that this score was also associated with mortality in COPD exacerbations . We conducted a prospect i ve study to assess the utility of the CURB65 score in acute COPD exacerbations . METHODS Consecutive patients with physician diagnosed COPD exacerbations admitted to a public hospital during a 1-year period were studied prospect ively . The CURB65 scores were calculated from information obtained at initial hospital presentation . CURB65 = one point each for Confusion , Urea > 7 mmol/L , Respiratory rate ≥ 30/min , low Blood pressure , age ≥ 65 years . RESULTS 30-day mortality data were available for 249 of 252 patients . CURB65 scores on admission significantly predicted risk of death during the hospital admission and at 30 days . The 30-day mortality by score groups were : low risk ( scores 0 - 1 ) 2.0 % ( 2/98 ) , moderate risk ( score 2 ) 6.7 % ( 6/90 ) and high risk ( scores 3 - 5 ) 21.3 % ( 13/61 ) . CURB65 scores were not predictive of 1-year mortality . CONCLUSIONS A simple 6-point score based on confusion , blood urea , respiratory rate , blood pressure and age can be used to stratify patients with COPD exacerbation into different management groups . The CURB65 score was as effective in predicting early mortality in our cohort of acute COPD exacerbations as it was in previous cohorts with community acquired pneumonia . Our findings suggest that CURB65 scores can help clinicians to assess patients with exacerbation of COPD The aim of the present prospect i ve multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease ( COPD ) exacerbations in a real-life setting . All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included , except those who immediately required intensive care unit admission and /or ventilatory support .  The data collected included patient characteristics , in-hospital outcomes ( mortality and length of stay ) and mode of discharge ( unsupported or need for post-hospital assistance ) . The in-hospital mortality rate was 7.4 % ( 59 out of 794 ) . Independent prognostic factors were age , number of clinical signs of severity ( among cyanosis , impaired neurological status , lower limb oedema , asterixis and use of accessory inspiratory or expiratory muscles ) and dyspnoea grade in the stable state . The need for post-hospital support was also predicted by female sex . In order to construct and vali date a prediction score for mortality based on these items , patients were r and omly allocated to a derivation and a validation cohort . The prediction score showed good discrimination , with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort . Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease . Their use needs to be prospect ively vali date SETTING Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations ( e COPD ) are various and inconsistent in the bibliography . OBJECTIVE To develop clinical prediction rules for short-term outcomes in e COPD patients attending an emergency department ( ED ) . DESIGN Prospect i ve cohort study of patients with an e COPD . Short-term outcomes were admission to an intensive care unit ( ICU ) , admission to an intermediate respiratory care unit ( IRCU ) and death in these groups . Multivariate logistic regression models were developed for each of the outcomes . RESULTS Predictors of ICU or IRCU admission were use of long-term home oxygen therapy ( LT-HOT ) or non-invasive mechanical ventilation ( NIMV ) , elevated PCO2 and decreased pH upon ED arrival ( area under the curve [ AUC ] 0.87 in the derivation sample ; 0.89 in the validation sample ) . Among those admitted to an ICU or IRCU , predictors of death were increased age , use at home of LT-HOT or NIMV , use of inspiratory accessory muscles upon ED arrival and altered Glasgow Coma Scale ( < 15 points ) ( AUC 0.78 ) . CONCLUSIONS Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among e COPD patients . Such a score can be a tool for clinical practice Background The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD ( AE COPD ) . We previously developed a score ( ‘ 2008 score ’ , based on age , dyspnea grade at steady state and number of clinical signs of severity ) predicting in-hospital mortality in patients with AE COPD visiting emergency departments ( EDs ) . External validity of this score remained to be assessed . Objectives To test the predictive properties of the ‘ 2008 score ’ in a population of patients hospitalized in medical respiratory wards for AE COPD , and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance . Methods Data from a cohort study in 1824 patients hospitalized in a medical ward for an AE COPD were analyzed . Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed . A new score was developed using multivariate logistic regression modeling in a r and omly selected derivation population sample followed by testing in the remaining population ( validation sample ) . Robustness of results was assessed by case-by-case validation . Results The 2008 score was characterized by a c-statistic at 0.77 , a sensitivity of 69 % and a specificity of 76 % for prediction of in-hospital mortality . The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78 , a sensitivity of 77 % and specificity of 66 % . Conclusions A score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AE COPD . Adding cardiac comorbidities to the original score increased its sensitivity while decreasing its specificity Background In patients with acute hypercapnic respiratory failure ( AHRF ) during exacerbations of COPD , mortality can be high despite noninvasive ventilation ( NIV ) . For some , AHRF is terminal and NIV is inappropriate . However there is no definitive method of identifying patients who are unlikely to survive . The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD . Methods COPD patients presenting with AHRF and who were treated with NIV  were studied prospect ively . The forced expiratory volume in 1 second ( FEV1 ) , World Health Organization performance status ( WHO-PS ) , clinical observations , a composite physiological score ( Early Warning Score ) , routine hematology and biochemistry , and arterial blood gases prior to commencing NIV , were recorded . Results In total , 65 patients were included for study , 29 males and 36 females , with a mean age of 71 ± 10.5 years . Inpatient mortality in the group was 33.8 % . Mortality at 30 days and 12 months after admission were 38.5 % and 58.5 % , respectively . On univariate analysis , the variables associated with inpatient death were : WHO-PS ≥ 3 , long-term oxygen therapy , anemia , diastolic blood pressure < 70 mmHg , Early Warning Score ≥ 3 , severe acidosis ( pH < 7.20 ) , and serum albumin < 35 g/L. On multivariate analysis , only anemia and WHO-PS ≥ 3 were significant . The presence of both predicted 68 % of inpatient deaths , with a specificity of 98 % . Conclusion WHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD . A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV The aim of this study was to develop and vali date a new method : a classification and regression tree ( CART ) based on easily accessible measures to predict mortality in patients with stable chronic obstructive pulmonary disease ( COPD ) . This was a prospect i ve study of two independent prospect i ve cohorts : a derivation cohort with 611 recruited patients and a validation cohort with 348 patients , all followed for 5 yrs .  CART analysis was used to predict 5-yr mortality risk using the following covariates from the derivation cohort : age , % predicted forced expiratory volume in 1 s ( FEV1 ) , dyspnoea , physical activity , general health and number of hospital admissions for COPD exacerbations in the previous 2 yrs . Age ( ≥75 or < 75 yrs ) provided the first branch of the COPD -CART . The highest mortality risk ( 0.74 ) was seen in patients > 75 yrs of age with higher levels of dyspnoea and FEV1 < 50 % pred . Patients with the lowest risk of 5-yr mortality ( 0.04 ) were < 55 yrs of age with FEV1 > 35 % pred and one or no recent hospitalisations for COPD exacerbations . A simple decision tree that uses variables commonly gathered by physicians can provide a quick assessment of the severity of the disease , as measured by the risk of 5-yr mortality BACKGROUND Mortality rate , the possible factors affecting mortality and intubation in patients with acute exacerbation of chronic obstructive pulmonary diseases ( COPD ) and hypercapnic respiratory failure ( RF ) are yet unclear . OBJECTIVE To identify the possible factors affecting mortality and intubation in COPD patients . DESIGN A prospect i ve study using data obtained over the first 24h of respiratory intensive care unit ( RICU ) admission . Consecutive admissions of 656 patients were monitored and 151 of them who had acute exacerbation of COPD and hypercapnic RF were enrolled . SETTING University hospital , Department of Chest Diseases , RICU . RESULTS Mean age was 65.1 years . The mean APACHE II score was 23.7 . Eighty-seven patients ( 57.6 % ) received mechanical ventilation ( MV ) via an endotracheal tube for more than 24 h. Twenty-two patients received non-invasive ventilation ( NIV ) . Fifty patients died ( 33.1 % ) in hospital during the study period . The mortality rate was 52.9 % in patients in need of MV . In the multivariate analysis , the need for intubation , inadequate metabolic compensation for respiratory acidosis , and low ( = bad ) Glasgow Coma Score ( GCS ) were determined as independent factors associated with mortality . The low GCS ( OR : 0.61 ; CI : 0.48 - 0.78 ) and high APACHE II score ( OR : 1.24 ; CI 
    Output:
    
This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients .