respiratory

BAP-65 Score for Acute Exacerbation of COPD

BUN, altered mental status, pulse > 109 and age > 65 (BAP-65) classify patients admitted with an exacerbation of COPD into five classes predicting in-hospital mortality and the need for mechanical ventilation.

Used in: COPD

Score interpretation

Class I — Lowest Risk 1

No risk factor and age ≤ 65 — in-hospital mortality 0.3% (Tabak 2009).

→ Standard exacerbation care; consider early discharge if otherwise appropriate.

Class II — Low Risk 2

No risk factor and age > 65.

→ Standard exacerbation care.

Class III — Intermediate Risk 3

One risk factor.

→ Inpatient care with close monitoring; blood gas, and NIV if there is hypercapnic acidosis.

Class IV — High Risk 4

High risk of in-hospital death and of needing mechanical ventilation (rising with each class).

→ HDU / ICU review; early NIV or ventilation decisions; discuss ceilings of care.

Class V — Highest Risk 5

All three risk factors — in-hospital mortality 13–15% (Tabak 2009); mechanical ventilation in about half (Shorr 2011).

→ HDU / ICU review; early NIV or ventilation decisions; discuss ceilings of care.

Interpretation bands for the BAP-65. Apply clinical judgement and local guidance.

References

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;169(17):1595–1602.
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;140(5):1177–1183.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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