Clinical course and outcomes in hospitalized patients with acute exacerbation of COPD based on the Rome severity classification

<bold>Background:</bold> This study examines the clinical course and outcomes of patients hospitalized with AECOPD based on the Rome severity classification. <bold>Methods:</bold> From 2016 to 2021, we reviewed the medical records of patients hospitalized for AECOPD at a tertiary hospital. In accordance with the Rome proposal, patients were categorized into mild, moderate, and severe groups. We compared the requirements of high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), and intubation, in-hospital mortality, and treatment failure by group. Treatment failure was defined as the need for intubation or death in hospital. <bold>Results:</bold> This study involved 435 patients: 157 mild (36.1%), 178 moderate (40.9%), and 100 severe (23%). The severity group had a significantly higher frequency of HFNC, NIV, and intubation requirements than the mild and moderate groups (HFNC: 2.5%, 5.6%, and 13%; NIV: 0.6%, 5.6%, and 38%; intubation: 1.3%, 2.2%, and 34.0%, respectively). The in-hospital mortality rates did not differ significantly among the three groups (1.9%, 2.2%, and 3.0%, respectively). In the severe group, treatment failure rates were significantly higher than mild and moderate group (2.5%, 3.9%, and 35.0%, respectively). Based on the Rome proposal, severe AECOPD was an independent risk factor for treatment failure (odds ratio, 16.9; 95% confidence interval, 6.5-56.5; P <0.000). <bold>Conclusions:</bold> According to the Rome classification of AECOPD, approximately one quarter of all hospitalized patients had severe AECOPD. Because of high risk of treatment failure, severe AECOPD requires active treatment.