Modified-CREWS scoring system for evaluating readmission risk of acute COPD exacerbation

Accurate prediction of long-term readmission risk is crucial for early intervention in patients experiencing severe acute exacerbation of chronic obstructive pulmonary disease (s-AECOPD). While the Chronic Respiratory Early Warning Score (CREWS) has demonstrated proficiency in predicting severe outcomes. This study aims to evaluate the effectiveness of CREWS in predicting readmission for s-AECOPD. This study conducted a retrospective cohort analysis of all hospitalized s-AECOPD patients from 2018 to 2019. Follow-up occurred from 2020 to 2021. Clinical parameters were collected. Patients were classified according to hospitalization frequency during the follow-up period and clinical parameters were compared between the groups. Logistic regression, ROC analysis and survival analysis were performed. A total of 301 patients were included in the cohort study, of whom 56 were classified into the non-decreased hospitalization frequency group. High serum uric acid (UA) levels and low free thyroxine (FT4) levels could be independent risk factors associated with s-AECOPD long-term readmission (OR 6.125 (1.775–21.131), p = 0.004 ; OR 2.599 (1.244–5.432), p = 0.010, respectively). The modified CREWS model demonstrated moderate predictive performance for readmission (AUC = 0.716, 95%CI 0.628–0.805, H-L = 0.287, p < 0.001). Patients with a modified-CREWS score over 8 faced an elevated risk of mortality within two years ( p = 0.008). Elevated serum UA levels and decreased FT4 levels are independent risk factors for s-AECOPD readmission. The modified-CREWS tool demonstrated acceptable discrimination for predicting both s-AECOPD readmission and mortality.