Prognostic variables and scores identifying the end of life in COPD: a systematic review.

Laura-Jane E Smith,Patrick Stone,Jennifer K Quint,Liam Smeeth,Ifrah Ali,Elizabeth Moore

doi:10.2147/copd.s137868

Laura-Jane E Smith, Patrick Stone + Show 4 more

Open Access

https://doi.org/10.2147/copd.s137868

Copy DOI

Abstract

IntroductionCOPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, specifically including variables that contribute to risk assessment of patients for death within 12 months.MethodsWe conducted a systematic review on prognostic variables, multivariate score or models for COPD. Ovid MEDLINE, EMBASE, the Cochrane database, Cochrane CENTRAL, DARE and CINAHL were searched up to May 1, 2016.ResultsA total of 5,276 abstracts were screened, leading to 516 full-text reviews, and 10 met the inclusion criteria. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Only nine indices were identified from four studies, which had been validated for this time period. Tools developed using expert knowledge were also identified, including the Gold Standards Framework Prognostic Indicator Guidance, the RADboud Indicators of Palliative Care Needs, the Supportive and Palliative Care Indicators Tool and the Necesidades Paliativas program tool.ConclusionA number of variables contributing to the prediction of all-cause mortality in COPD were identified. However, there are very few studies that are designed to assess, or report, the prediction of mortality at or less than 12 months. The quality of evidence remains low, such that no single variable or multivariable score can currently be recommended.

Highlights

chronic obstructive pulmonary disease (COPD) is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care
Our objective was to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, including variables that contribute to risk assessment of patients for death within 12 months
We aimed to investigate known prognostic variables and scores that predict prognosis in COPD, those variables that contribute to risk assessment of patients in the community for death within 12 months

Summary

Introduction

COPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, including variables that contribute to risk assessment of patients for death within 12 months. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Systematic identification of patients approaching the “end of life” is a key recommendation of the end-of-life care strategy.[5] The unpredictable disease trajectory of COPD6 makes this difficult, compounded by the fact that there is no “gold standard” method for predicting prognosis in COPD and no clear guidance on how to identify factors that may assist prognostication in the last year of life.

Objectives

Methods

Results

Conclusion