Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 12

Palliative care and prognosis in COPD: a systematic review with a validation cohort

Authors Almagro P, Yun S, Sangil A, Rodríguez-Carballeira M, Marine M, Landete P, Soler-Cataluña JJ, Soriano JB, Miravitlles M

Received 26 February 2017

Accepted for publication 13 April 2017

Published 9 June 2017 Volume 2017:12 Pages 1721—1729

DOI https://doi.org/10.2147/COPD.S135657

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Pere Almagro,1 Sergi Yun,1 Ana Sangil,1 Mónica Rodríguez-Carballeira,1 Meritxell Marine,1 Pedro Landete,2 Juan José Soler-Cataluña,3 Joan B Soriano,4 Marc Miravitlles5

1Multimorbidity Patients Unit, Internal Medicine Department, Hospital Universitario Mutua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona, 2Department of Pneumology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, 3Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Valencia, 4Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, 5Department of Pneumology, Vall d’Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain

Abstract: Current recommendations to consider initiation of palliative care (PC) in COPD patients are often based on an expected poor prognosis. However, this approach is not evidence-based, and which and when COPD patients should start PC is controversial. We aimed to assess whether current suggested recommendations for initiating PC were sufficiently reliable. We identified prognostic variables proposed in the literature for initiating PC; then, we ascertained their relationship with 1-year mortality, and finally, we validated their utility in our cohort of 697 patients hospitalized for COPD exacerbation. From 24 articles of 499 screened, we selected 20 variables and retrieved 48 original articles in which we were able to calculate the relationship between each of them and 1-year mortality. The number of studies where 1-year mortality was detailed for these variables ranged from 9 for previous hospitalizations or FEV1 ≤30% to none for albumin ≤25 mg/dL. The percentage of 1-year mortality in the literature for these variables ranged from 5% to 60%. In the validation cohort study, the prevalence of these proposed variables ranged from 8% to 64%; only 10 of the 18 variables analyzed in our cohort reached statistical significance with Cox regression analysis, and none overcame an area under the curve ≥0.7. We conclude that none of the suggested criteria for initiating PC based on an expected poor vital prognosis in COPD patients in the short or medium term offers sufficient reliability, and consequently, they should be avoided as exclusive criteria for considering PC or at least critically appraised.

Keywords: COPD, palliative care, prognosis, mortality, survival, end of life


Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Alpha-1 antitrypsin Pi*SZ genotype: estimated prevalence and number of SZ subjects worldwide

Blanco I, Bueno P, Diego I, Pérez-Holanda S, Lara B, Casas-Maldonado F, Esquinas C, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:1683-1694

Published Date: 8 June 2017

Bronchiectasis in COPD patients: more than a comorbidity?

Martinez-Garcia MA, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:1401-1411

Published Date: 11 May 2017

Self-reported daily walking time in COPD: relationship with relevant clinical and functional characteristics

Ramon MA, Esquinas C, Barrecheguren M, Pleguezuelos E, Molina J, Quintano JA, Roman-Rodríguez M, Naberan K, Llor C, Roncero C, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:1173-1181

Published Date: 13 April 2017

Alpha-1 antitrypsin Pi*Z gene frequency and Pi*ZZ genotype numbers worldwide: an update

Blanco I, Bueno P, Diego I, Pérez-Holanda S, Casas-Maldonado F, Esquinas C, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:561-569

Published Date: 13 February 2017

Diagnosis of alpha-1 antitrypsin deficiency: a population-based study

Barrecheguren M, Monteagudo M, Simonet P, Llor C, Rodriguez E, Ferrer J, Esquinas C, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2016, 11:999-1004

Published Date: 10 May 2016

A cross-sectional study to assess inhalation device handling and patient satisfaction in COPD

Miravitlles M, Montero-Caballero J, Richard F, Santos S, Garcia-Rivero JL, Ortega F, Ribera X

International Journal of Chronic Obstructive Pulmonary Disease 2016, 11:407-415

Published Date: 26 February 2016

Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

Miravitlles M, Gáldiz JB, Huerta A, Villacampa A, Carcedo D, Garcia-Rio F

International Journal of Chronic Obstructive Pulmonary Disease 2016, 11:123-132

Published Date: 18 January 2016

The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD

Miravitlles M, García-Sidro P, Fernández-Nistal A, Buendía MJ, Espinosa de los Monteros MJ, Esquinas C, Molina J

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2571-2579

Published Date: 30 November 2015

Is a previous diagnosis of asthma a reliable criterion for asthma–COPD overlap syndrome in a patient with COPD?

Barrecheguren M, Román-Rodríguez M, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1745-1752

Published Date: 1 September 2015

What pulmonologists think about the asthma–COPD overlap syndrome

Miravitlles M, Alcázar B, Alvarez FJ, Bazús T, Calle M, Casanova C, Cisneros C, de-Torres JP, Entrenas LM, Esteban C, García-Sidro P, Cosio BG, Huerta A, Iriberri M, Izquierdo JL, López-Viña A, López-Campos JL, Martínez-Moragón E, Pérez de Llano L, Perpiñá M, Ros JA, Serrano J, Soler-Cataluña JJ, Torrego A, Urrutia I, Plaza V

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1321-1330

Published Date: 15 July 2015

Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease

Miravitlles M, Huerta A, Valle M, García-Sidro P, Forné C, Crespo C, López-Campos JL

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:367-377

Published Date: 16 February 2015

Caregivers’ burden in patients with COPD

Miravitlles M, Peña-Longobardo LM, Oliva-Moreno J, Hidalgo-Vega Á

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:347-356

Published Date: 12 February 2015

The concept of control of COPD in clinical practice

Soler-Cataluña JJ, Alcázar-Navarrete B, Miravitlles M

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:1397-1405

Published Date: 12 December 2014

Geographic differences in clinical characteristics and management of COPD: the EPOCA study

Marc Miravitlles, Cristina Murio, Gema Tirado-Conde, Gur Levy, Hana Muellerova, et al

International Journal of Chronic Obstructive Pulmonary Disease 2008, 3:803-814

Published Date: 5 December 2008