Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: Comparing the CURB-65 and BAP-65 scores

Purpose: Clinicians lack a validated tool for risk stratification for need for mechanical ventilation (MV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to compare 2 risk scores, BAP-65 and CURB-65, at predicting a need for MV in AECOPDs. Materials and Methods: We analyzed 34 478 AECOPD admissions to 195 US hospitals (2007). We compared the rates of MV at admission and at any point during hospitalization based on the respective BAP-65 and CURB-65 scores. We compared the accuracy of the 2 scores via the area under the receiver operating characteristic curves. Results: The overall MV rate at admission was 7.9%, and the rate of MV any time equaled 9.3%. Use of MV increased with escalating BAP-65 and CURB-65 scores. The area under the receiver operating characteristic curve for BAP-65 was higher than that for CURB-65 for both early MV, 0.81 (95% confidence interval [CI], 0.80-0.82) vs 0.76 (95% CI, 0.75-0.77), P < .0001, and MV any time, 0.78 (95% CI, 0.77-0.79) vs 0.74 (95% CI, 0.73-0.75), P < .0001. Conclusions: BAP-65 identifies patients with AECOPD at high risk for need of MV more accurately than does CURB-65. BAP-65 may represent a useful tool for initial MV risk stratification in AECOPD. (C) 2012 Elsevier Inc. All rights reserved.