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

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.

<p>Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based?</p>

“…17 Prognostic variables play rather a secondary role. Smith et al 5 highlighted the same conclusion in their systematic review. They did not find a single variable or a multivariate score that can be recommended for use in practice to predict mortality at or less than 1 year.…”

“…3 Currently, COPD is the fourthleading global cause of death, and in 2030 it is expected to become the third cause of mortality 4 and the seventh leading cause of disability-adjusted life years (DALYs) lost worldwide. 5 Alongside interstitial lung disease (ILD) and bronchiectasis, COPD is a Non-Malignant Respiratory Disease (NMRD), another umbrella term proposed by the National End of Life Care Intelligence Network in 2011. 6 Even though, worldwide, over 210 million people have a diagnosis of COPD, and millions of others have another form of NMRD, 7 a holistic approach to the diseases is still an idealistic concept globally.…”

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

“…Indeed, patients with COPD were less likely to die at home than patients with lung cancer 68. Prognostic variables and multivariate scores contributing to an accurate risk assessment for death within 12 months are mostly lacking 69. Identifying patients in need for palliative care thus remains a challenge 70.…”

Update: non-invasive ventilation in chronic obstructive pulmonary disease

“…Breathlessness is a cardinal symptom of COPD, which progresses with advancing disease and has a profound impact on patients' QoL. There is no widely accepted method of either predicting prognosis or defining endstage COPD (70), which may contribute to the wide variation and lower quality of end-of-life care for COPD patients compared to lung cancer patients (71,72). The American Thoracic Society recommend that palliative care should be available to all patients regardless of the stage of their disease and that relieving the dyspnoea should be a key consideration (73) .…”