, Volume 189, Issue 3, pp 225–232 | Cite as

Routine Laboratory Tests can Predict In-hospital Mortality in Acute Exacerbations of COPD

  • Alex C. Asiimwe
  • Fraser J. H. Brims
  • Neil P. Andrews
  • Dave R. Prytherch
  • Bernie R. Higgins
  • Sally A. Kilburn
  • Anoop J. Chauhan


Chronic obstructive pulmonary disease (COPD) has a rising global incidence and acute exacerbation of COPD (AECOPD) carries a high health-care economic burden. Classification and regression tree (CART) analysis is able to create decision trees to classify risk groups. We analysed routinely collected laboratory data to identify prognostic factors for inpatient mortality with AECOPD from our large district hospital. Data from 5,985 patients with 9,915 admissions for AECOPD over a 7-year period were examined. Randomly allocated training (n = 4,986) or validation (n = 4,929) data sets were developed and CART analysis was used to model the risk of all-cause death during admission. Inpatient mortality was 15.5%, mean age was 71.5 (±11.5) years, 56.2% were male, and mean length of stay was 9.2 (±12.2) days. Of 29 variables used, CART analysis identified three (serum albumin, urea, and arterial pCO2) to predict in-hospital mortality in five risk groups, with mortality ranging from 3.0 to 23.4%. C statistic indices were 0.734 and 0.701 on the training and validation sets, respectively, indicating good model performance. The highest-risk group (23.4% mortality) had serum urea >7.35 mmol/l, arterial pCO2 >6.45 kPa, and normal serum albumin (>36.5 g/l). It is possible to develop clinically useful risk prediction models for mortality using laboratory data from the first 24 h of admission in AECOPD.


COPD Exacerbations Mortality Risk Decision tree analysis 



We are grateful to the Departments of Clinical Coding, Cardiology, Haematology, and Biochemistry for providing the data and to Sumita Kerley for her assistance in data collection. This project was supported by a student bursary (for AA) from the University of Portsmouth.


All authors declare that there are no competing interests related to this manuscript.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alex C. Asiimwe
    • 1
  • Fraser J. H. Brims
    • 2
  • Neil P. Andrews
    • 3
  • Dave R. Prytherch
    • 4
  • Bernie R. Higgins
    • 1
  • Sally A. Kilburn
    • 1
  • Anoop J. Chauhan
    • 3
    • 5
  1. 1.School of Health Sciences and Social WorkUniversity of PortsmouthPortsmouthUK
  2. 2.Centre for Respiratory ResearchUniversity College LondonLondonUK
  3. 3.Portsmouth Hospitals NHS TrustPortsmouthUK
  4. 4.Centre for Healthcare Modelling and InformaticsUniversity of PortsmouthPortsmouthUK
  5. 5.Respiratory Centre, Queen Alexandra HospitalPortsmouthUK

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