Patients’ outcomes during chronic obstructive pulmonary disease exacerbations are associated with the severity score of the Lancet Commission

BACKGROUND: Chronic obstructive pulmonary disease (COPD) exacerbations significantly affect morbidity, mortality, and healthcare costs. The Lancet Commission proposed a severity classification for COPD exacerbations, but its validation has not been performed. This study aims to assess the relationship between exacerbation severity scores, as defined by the Lancet Commission, and patient outcomes, including morbidity and mortality. METHODS: A retrospective, single-center study analyzed 240 hospitalized patients with COPD exacerbations from January 2023 to January 2024. Patients were categorized into three severity groups based on the Lancet exacerbation severity scores. Clinical and laboratory parameters, duration of hospitalization, intensive care unit (ICU) admissions, ventilatory support, and 30-day mortality rates were compared. RESULTS: Our study found that patients with the highest severity scores had significantly lower hemoglobin and hematocrit levels, higher pCO 2 and urea levels, and longer hospital stays. The rates of noninvasive mechanical ventilation use, ICU admission, and mortality were notably higher in this group. In addition, hypoalbuminemia, anemia, lymphopenia, and elevated blood urea were linked to 30-day mortality in patients experiencing exacerbation. The receiver operating characteristic analysis showed an albumin cutoff of ≤33.3 g/L as predictive of mortality, with a sensitivity of 51.3% and specificity of 80.5%. CONCLUSION: This study is the first to the Lancet Commission’s severity classification in COPD exacerbations. Results indicate that this scoring system can effectively identify patients at high risk for poor outcomes. Future prospective studies are necessary to refine severity assessment criteria and incorporate biochemical markers for improved prognostication and management of COPD exacerbations.