RT Journal Article SR Electronic T1 Predicting In-hospital Death in Pneumonic COPD exacerbation via BAP-65, CURB-65, and Machine Learning JF ERJ Open Research JO erjor FD European Respiratory Society SP 00452-2021 DO 10.1183/23120541.00452-2021 A1 Akihiro Shiroshita A1 Yuya Kimura A1 Hiroshi Shiba A1 Chigusa Shirakawa A1 Kenya Sato A1 Shinya Matsushita A1 Keisuke Tomii A1 Yuki Kataoka YR 2021 UL http://openres.ersjournals.com/content/early/2021/12/10/23120541.00452-2021.abstract AB Introduction There is no established clinical prediction model for in-hospital death among patients with pneumonic chronic obstructive pulmonary disease (COPD) exacerbation. We aimed to externally validate BAP-65 and CURB-65 and to develop a new model based on the eXtreme Gradient Boosting (XGBoost) algorithm.Methods This multicentre cohort study included patients aged ≥40 years with pneumonic COPD exacerbation. The input data were age, sex, activities of daily living, mental status, systolic and diastolic blood pressure, respiratory rate, heart rate, peripheral blood eosinophil count, and blood urea nitrogen. The primary outcome was in-hospital death. BAP-65 and CURB-65 underwent external validation using the area under the receiver operating characteristic curve (AUROC) in the whole dataset. We used XGBoost to develop a new prediction model. We compared the AUROCs of XGBoost with that of BAP-65 and CURB-65 in the test dataset using bootstrap sampling.Results We included 1190 patients with pneumonic COPD exacerbation. The in-hospital mortality was 7% (88/1190). In the external validation of BAP-65 and CURB-65, the AUROCs (95% confidence interval [CI]) of BAP-65 and CURB-65 were 0.69 (0.66–0.72, and 0.69 (0.66–0.72), respectively. XGBoost showed an AUROC of 0.71 (0.62–0.81) in the test dataset. There was no significant difference in the AUROCs of XGBoost versus BAP-65 (absolute difference, 0.054; 95% CI, −0.057–0.16) or versus CURB-65 (absolute difference, 0.0021; 95% CI, −0.091–0.088).Conclusion BAP-65, CURB-65, and XGBoost showed low predictive performance for in-hospital death in pneumonic COPD exacerbation. Further large-scale studies including more variables are warranted.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Shiroshita has nothing to disclose.Conflict of interest: Dr. Kimura has nothing to disclose.Conflict of interest: Dr. Shiba has nothing to disclose.Conflict of interest: Dr. Shirakawa has nothing to disclose.Conflict of interest: Dr. Sato has nothing to disclose.Conflict of interest: Dr. Matsushita has nothing to disclose.Conflict of interest: Dr. Tomii has nothing to disclose.Conflict of interest: Dr. Kataoka has nothing to disclose.