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BAP-65 Score for Acute Exacerbation of COPD

Calculators  Respiratory
This score is used to help determine the need for hospitalization and mechanical ventilation in patients aged older than 40 years who are experiencing an acute COPD exacerbation.
BUN (Blood urea nitrogen) ≥25 mg/dL(8.9 mmol/L)
No 0
Yes 1
Initial Glasgow Coma Scale <14, or stupor, disorientation, or coma as resolved by physician
No 0
Yes 1
Pulse rate ≥109 beats/min
No 0
Yes 1
Age
BAP-65 is not confirmed in patients ≤40 years old
41-64
≥65
Result:

Background

Measured Factor
need for hospitalization and mechanical ventilation
Measured Factor Disease
  • COPD exacerbation
Measured Factor Detail
This survey was developed to help helathcare providers make more accurate clinical decisions about whether a COPD patient requires hospital admission during a COPD exacerbation. Factors such as increased blood urea nitrogen (BUN ≥25 mg/dL), age (only used in patients >40 years of age), altered mental status (Initial Glasgow Coma Scale <14, or stupor, disorientation, or coma) , and increased pulse (≥109 beats/min) are used to assess patients. Based on the prescpecified criteria and laboratory results, patients are placed into five different classes of risk and need for hospitalization. If the patient has no abnormal labs or vitals, then they are placed in a lower risk category based on age. The risk category increases with increased BUN, pulse, and altered mental status. As the risk category increases, the mortality increases, thus showing the need for hospitalization. Patients who had two or more of the variables stated are also more likley to require mechanical ventilation, and using this survey can benefit both providers and patients to assess earlier whether the patient will require ventilation.
Speciality
Emergency Medicine Physician
Body System
Respiratory
Measured Factor High Impact
  • increased risk of mortality
  • need for mechanical ventilation

Result Interpretation

Ranges Ranges
  • Critical High: class 5, score 3
  • Normal: class 1-2, score 0
  • Normal Adult Male: class 1-2, score 0
  • Normal Adult Female: class 1-2, score 0
  • Normal Geriatric Male: class 1-2, score 0
  • Normal Geriatric Female: class 1-2, score 0
Result High Conditions
  • COPD exacerbation
  • risk of death
Test Limitations
This test was only performed among adults over 40 years when it was first validated, wich may make it not useful in patients less than 40 years. This test also only assess short-term mortality in order to maintain the practicality of the test. However, it may be important to assess long term mortality in some patients due to the long term effects of COPD and exacerbations. Moreover, this test does not apply to patients with acute respiratory failure, because they absolutely need to be hospitalized and mechanically ventilated. Finally, this test does not evaluate the need for noninvasive ventilation.
References: 1

Studies

Study Validation 1
This study analyzed patients who were admitted to the emergency department due to an acute COPD exacerbation or an acute respiratory failure due to COPD. The researchers used the data from the patients to assign a BAP-65 score and classification based on the specific criteria. The researchers found that an increasing BAP-65 score correlated to increased mortality, need for mechanical ventilation, and increased cost to the hospital. Based on the significant correlation (p<0.001) for both mortality and mechanical ventilation, the researchers concluded that the BAP-65 score is a useful tool to aid healthcare providers and assess patients for increased mortality risk.
References: 2
Study Validation 2
This study compared the accuracy of BAP-65 to CURB-65 in identifying patients at a higher risk for requiring mechanical ventilation during an acute COPD exacerbation. Researchers analyzed data from 34,478 patients and identified their risk based on the BAP-65 and CURB-65 scores. The results of the study showed that the BAP-65 score was more accurate in predicting the need for mechanical ventilation either early on or at any time during hospitalization than the CURB-65 score (p<0.001). The researchers concluded that the BAP-65 score is an effective tool for healthcare providers in assessing patients for risk of needing mechanical ventilation.
References: 3
Study Validation 3
This study compared the efficacy of BAP-65 to the DECAF score among 50 patients who required hospitalization for an acute exacerbation of COPD. Both scores were similar in their ability to accurately assess patients for increased mortality risk and need for mechanical ventilation. For predicting mortality, both scores had a sensitivity level of 100%; however, specificities were 34.1% and 63.4% for DECAF score and BAP-65, respectively. For predicting the need for invasive ventilation, the DECAF score had a sensitivity of 80% and specificity of 80%, whereas and the BAP-65 score had a sensitivity score of 100% and specificity of 60%. Although the study was small, it showed that both scores were accurate predictors of mortality and ventilation.
References: 4

Authors

Andrew Shorr, MD, MPH, MBA is an associate director of Pulmonary and Critical Care Medicine and the chief of the Pulmonary Clinic at MedStar Washington Hospital Center in Washington, DC. His research area includes critical care and emergency medicine
https://www.medstarhealth.org/mhri/physician-investigator/andrew-shorr/

References

  1. Tabak YP, Sun X, Johannes RS, Gupta V, Shorr AF. Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: development and validation of a simple risk score. Arch Intern Med. 2009 Sep 28;169(17):1595-602.
  2. Shorr AF, Sun X, Johannes RS, Yaitanes A, Tabak YP. Validation of a novel risk score for severity of illness in acute exacerbations of COPD. Chest. 2011 Nov;140(5):1177-1183.
  3. Shorr AF, Sun X, Johannes RS, Derby KG, Tabak YP. Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: comparing the CURB-65 and BAP-65 scores. J Crit Care. 2012 Dec;27(6):564-70.
  4. Sangwan V, Chaudhry D, Malik R. Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation Score and BAP-65 Score, Tools for Prediction of Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Comparative Pilot Study. Indian J Crit Care Med. 2017 Oct;21(10):671-677.