الفهرس 
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Abstract
Chronic Obstructive Pulmonary disease is a common disease with a steadily increasing prevalence and mortality. It is expected to be the third leading cause of death worldwide by 2020. Identifying upon admission those at higher risk of mortality during their hospitalisation could be useful for triaging patients to the appropriate level of care, deciding aggressiveness of therapies and timing the safe discharge. Therefore, many scores should be used to predict the severity and mortality of exacerbations such as APACHE II, BAP-65, CAPS, DECAF and 2008 scores but till now, no standard validation.
The aim of this study was to compare four different scores (APACHE II, BAP65, CAPS and 2008 score) to test their predictive properties in a population of patients hospitalized with AECOPD for short-term mortality during hospital admission or within a week after discharge to home.
This study was conducted on one hundred consecutive adult patients with acute exacerbation of COPD admitted to the ED, Alexandria Main University Hospitals. Both sexes are involved. Patients with other morbidities such as liver failure, malignancies, end stage renal disease, tuberculosis, restrictive lung disease, pneumothorax and patients with pleural thickening were excluded.
On admission, all patients were subjected to full history taking, complete clinical examination, laboratory investigations (CBC, ABG, BUN, creatinine, serum albumin, sodium and potassium), radiological investigations, and applying the studied scores (APACHE II, BAP65, CAPS and 2008 score)
Eighty-eight of included patients (88%) were males and 12 patients (12%) were females with mean age of 61.10 ± 10.66. AF was present in 8% of patients. By the end of this study, 96% of patients survived and 4% of patients died. Also, 60% of patients didn’t need MV and 40% of patients needed MV. In the latter group, 25% of them were on invasive MV and 15% of them were on non-invasive MV.
Comparing survivors to non-survivors, there was significant difference regarding AF, heart rate, GCS, neurological impairment, cyanosis, and paradoxical abdominal movements (p value 0.031, ˂ 0.001, ˂ 0.001, ˂ 0.001, 0.002, and 0.017, respectively). Also, there was significant difference regarding PaCo2, WBCs, BUN and urea (p value 0.003, 0.023, 0.043 and 0.042, respectively).
Comparing survived patients who needed MV and who did not need MV, there was significant difference regarding previous need for MV, GCS, asterixis, neurological impairment, LL oedema, cyanosis and paradoxical abdominal movement (p value ˂ 0.001, 0.006, 0.027, 0.004, 0.001, ˂ 0.001 and ˂ 0.001, respectively). Furthermore, there was significant difference regarding all ABG components (p value ˂ 0.001), creatinine and albumin (p value 0.002 for both).
Regarding mortality, all scores had significant correlations with mortality. APACHE II had the highest area under the curve followed by BAP65. Regarding the need for MV, APACHE II had the highest area under the curve followed by 2008 score and both had significant correlations with the need for MV.