Objective: To investigate the feasibility of estimating risk of prognosis and hospital mortality in elderly patients (> or =60 years old) with chronic obstructive pulmonary disease (COPD) under the treatment of mechanical ventilation by using acute physiology and chronic health evaluation III (APACHE III).
Methods: Fifty elderly patients with COPD treated with mechanical ventilation were analyzed retrospectively. A risk estimation equation for hospital mortality was first developed by using APACHE III in evaluating 40 randomly-selected patients before mechanical ventilation. Changes in APACHE III on the 1 st, 3 rd and 7 th day for each patient after intubation were recorded and analyzed.
Results: The risk estimate equation for hospital mortality was developed as p=Apa(gamma)/(D(gamma)(50)+Apa(gamma)), D(50)=73.4, gamma=8 with 80% prediction accuracy. A statistical significant cutoff was developed by dynamically recording acute physiology scores after intubation, and a decrease of 32.8% or more (compared with APACHE III before intubation) of APACHE III on the 3 rd day predicted survival of the patient.
Conclusion: APACHE III score and its dynamic change could be an ideal tool to predict risk for hospital mortality in elderly patients with COPD on mechanical ventilation.
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