Validation of the Rome Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter Cohort Study

Abstract

Background

The Rome severity classification is an objective assessment tool for the severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on readily measurable variables but has not been widely validated. The aim of this study is to evaluate the validity of the Rome classification in distinguishing the severity of AECOPD based on short-term mortality and other adverse outcomes.

Methods

The Rome severity classification was applied to a large multicenter cohort of inpatients with AECOPD. Differences in clinical features, in-hospital and 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) and invasive mechanical ventilation (IMV) usage were compared among the mild, moderate and severe AECOPD according to the Rome proposal. Moreover, univariate logistic analysis and Kaplan Meier survival analysis were also performed to find the association between the Rome severity classification and those adverse outcomes.

Results

A total of 7712 patients hospitalized for AECOPD were included and classified into mild (41.88%), moderate (40.33%), or severe (17.79%) group according to the Rome proposal. The rate of ICU admission (6.4% vs 12.0% vs 14.9%, P <0.001), MV (11.7% vs 33.7% vs 45.3%, P <0.001) and IMV (1.4% vs 6.8% vs 8.9%, P <0.001) increased significantly with the increase of severity classification from mild to moderate to severe AECOPD. The 60-day mortality was higher in the moderate or severe group than in the mild group (3.5% vs 1.9%, 4.3% vs 1.9%, respectively, P <0.05) but showed no difference between the moderate and severe groups (2.6% vs 2.5%, P >0.05), results for in-hospital mortality showed the same trends. Similar findings were observed by univariate logistic analysis and survival analysis.

Conclusion

Rome severity classification demonstrated excellent performance in predicting ICU admission and the need for MV or IMV, but how it performs in differentiating short-term mortality still needs to be confirmed.

Keywords:

• AECOPD
• the Rome severity classification
• short-term mortality
• intensive care unit admission
• mechanical ventilation
• multicenter cohort

Abbreviations

AECOPD, Acute exacerbations of chronic obstructive pulmonary disease; COPD, Chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MAGNET AECOPD, MAnaGement aNd advErse ouTcomes in inpatients with acute exacerbation of COPD) Registry; FEV1/FVC, forced expiratory volume in 1-second/forced vital capacity ratio; HR, heart rate; bpm, beats per minute; RR, respiration rate; CRP, C-reactive protein; VAS, visual analog scale; PaCO2, arterial carbon dioxide tension; pH, hydrogen ion concentration; PO2, arterial oxygen tension; SaO2, Arterial Oxygen Saturation; ICU, intensive care unit; MV, mechanical ventilation; IMV, invasive mechanical ventilation; LOS, length of stay; SD, standard deviation; ANOVA, one-way analysis of variance; IQR, interquartile range; ORs, odds ratios; 95% Cis, 95% confidence intervals; SPSS, Statistic Package for Social Science; BMI, body mass index; Kg/m², kilogram per square meter; ILD, interstitial lung disease; LTOT, Long-term home oxygen therapy; RBC, red blood cell; WBC, White blood cell; NEUT, neutrophil percentage; EOSR, Percentage of eosinophils; SBP, Systolic blood pressure; DBP, diastolic blood pressure; NT-pro-BNP, N-terminal pro-brain natriuretic peptide; cTNT, Cardiac troponin T; NIV, noninvasive mechanical ventilation; GesEPOC, Spanish COPD Guidelines; BUN, serum urea nitrogen.

Data Sharing Statement

The data will be shared on reasonable request to the corresponding author.

Ethics Approval and Informed Consent

This study was approved by the Ethics Committee of the ten academic medical centers that participated. Written informed consent was obtained from all the participants. This study complies with the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (82370021), the Sichuan Science and Technology Program (2022YFS0262), the Suzhou Collaborative Medical Health Foundation (Y117) and National Key Research Program of China (2016YFC1304202).